Saskatchewan—like my first province of practice, New Brunswick—is under-doctored. Moving to Nova Scotia I discovered a province that had the highest per capita rate of physicians in the country (this despite one of the lower-pay schedules in the country but that is an entirely different discussion!). For the first time I encountered signs outside clinics advertising that they were accepting walk-ins and new patients!
So what was the difference between New Brunswick and Nova Scotia? I believe it was, of course, the presences of a long-standing, highly successful medical school that resulted in the dramatic difference in the number of doctors in both provinces. This explains my passion to establish Dalhousie Medicine New Brunswick in the five years before I came to Saskatchewan. It also explains my belief that a vibrant college of medicine distributed throughout the province is key to having sufficient physicians and a high quality healthcare system for the people of Saskatchewan.
However, the world of physician employment is changing rapidly. Medical students’ seats in Canada nearly doubled between 1995 and 2008 and residency positions increased correspondingly. As a result, nationally we are now seeing physicians in some specialties and sub-specialties having difficulty finding employment. The reasons for this are multiple and complex. Certainly manpower planning for healthcare has been a challenge with a long history of boom and bust cycles in nursing and more recently in medicine.
Various agencies and jurisdictions have taken action in recent years in an attempt to resolve this issue. Some provinces, such as Nova Scotia, have implemented a structured physician resource plan that manages both the recruitment of replacement and new physicians, as well as the mix of residency positions across the specialties.
FMEC PG (Future of Medical Education in Canada – Postgraduate) has as its first recommendation: “Ensure the right mix, distribution and number of physicians to meet societal needs.” The Physician Resource Planning Task Force has been established by the deputy ministers of health in collaboration with the deans of medicine. That group has a mandate as follows:
- A pan-Canadian physician resource planning tool to better understand the complexities of physician supply;
- A process for addressing physician imbalances across identified specialties; and
- Accurate information to support decision-making by those considering and currently pursuing medical education, both in Canada and abroad.
The Royal College of Physicians and Surgeons has shown leadership in this regard having produced a study in 2013 entitled “What is really behind Canada’s Unemployed Specialists” and at that time they reported that 16 per cent of new specialists and sub-specialist positions couldn’t find work and 31 per cent were pursuing additional training to become more employable.
In 2014, the Royal College organized a national summit on physician employment. I attended a follow up meeting in the first week of November. While overall the numbers showed a possible slight improvement, there continues to be a substantial number of new physicians that are having challenges finding employment. What is also of further note is that the number of specialties involved seems to be growing quite considerably. Whereas the original data seemed to focus on three or four specialties there are now more than 12 that are reported to have graduates experiencing difficulty finding employment.
This year’s meeting was very educational and a great opportunity to learn the diverse views on this challenging problem. Some were very frustrated at the lack of hospital resources, which was the real limit, rather than patient needs. Some resident groups feel their specialty is training too many. There is generational conflict as some young specialists feel senior colleagues are taking advantage of this situation. In one study, 35 per cent of residents don’t know enough about employment prospects and 25 per cent are not confident about finding a job. Surprisingly, there were some at this year’s meeting that challenged the idea that all physicians should be gainfully employed. This was not the consensus of the meeting and was certainly not my opinion.
SaskDocs organized a recent panel discussion before medical students and residents that consisted of myself, Dustin Duncan, Minister of Health; Greg Ottenbreit, Minister Responsible for Rural and Remote Health; Dan Florizone, CEO Saskatoon Health Region; Dr. Mark Brown, President Saskatchewan Medical Association and Dr. Dennis Kendel, CEO SaskDocs. The panel listened to the concerns of the students and residents, and chief among those was the plans for the province on its physician manpower plan.
I do know that CaRMS and the issue of physician employment are among the greatest concerns facing our students and our residents. I think that one of the key things we can do as a medical school is ensure we have excellent career counselling as our students progress through medical school and residency. I also believe that as a province we need do our best to inform our students of the predicted future manpower needs in Saskatchewan so they can make informed choices.
I think this challenge of physician employment across the country has many aspects. One beneficial to Saskatchewan is that over the next 10 years we have a superb opportunity to recruit excellent doctors and, in particular, excellent academic physicians who would make major contributions to the College of Medicine. In addition, we have already seen an improvement in the retention of U of S medicine graduates in Saskatchewan. I think we need to do our best to see these national challenges around physician employment as an opportunity for us here in Saskatchewan.
I sit on the Board of CaRMS and am very interested on feedback that can assist CaRMS in helping us “ensure the right mix, distribution and number of physicians to meet societal needs.” As always, I look forward to discussion and debate on these and other issues impacting our college and my door is always open.
In my opinion CaRMS is a matching service only and should not be involved in policy decisions regarding “the right mix, distribution and number of physicians to meet societal needs”.
I have also felt that if physicians were more equitably compensated the right mix would likely be easier to obtain since physicians would follow their passions and not the money!