The Supply-Demand Mismatch: “What do you mean unemployed specialists?”

Reza Mirza is a second year Internal Medicine resident at McMaster University

Justin Hall is a third year Emergency Medicine Resident at the University of Toronto.

Odion Kalaci is a PGY-3 in Pediatrics at the University of British Columbia

(All authors are members of the Practice Committee of the Resident Doctors of Canada – RDoC)

In Canada, 38 percent of recently graduated specialists are unemployed or underemployed with a further 31 percent having delayed entering the job market altogether according to a Royal College report. Thus, many of us will struggle. As residents and members of Resident Doctors of Canada (RDoC), this report is alarming as it reinforces existing job-security anxieties. And yet Canadian patients face the longest wait times among high income countries. Consider: 29 percent of patients had to wait four or more hours for an emergency room visit, compared to one to four percent in Germany and France according to a Commonwealth Fund report.

Specifically, the report reveals that 16 percent of specialist physicians were unable to secure employment three months from certification. This excludes 22 percent of new physician graduates who piece together an income by combining locum and part-time positions (they wryly self-identify as “locum-ologists”); and the 31 percent who delayed entering the job market, perhaps due to hidden curriculum messaging suggesting further training and credentialing is necessary to become meaningfully employed. More concerning, employment rates plummeted within the two-year study by four to six percent between 2011 to 2012.

Our surgical resident physician colleagues face the greatest hardship: up to 34 percent report unemployment following graduation, nearly double the average among all specialists. This is compounded by an increasing number of surgeons without access to the operating theatre – “medical” ear-nose-throat physicians as an example. Our radiation oncologists share the same burden: a 2014 report by Canadian Association of Radiation Oncologists revealed that 33 previous graduates were still looking for full time staff positions. That is in spite of the fact 20 percent of Canadian graduates leave the country for work. Our surgical waitlists are indicative of this supply-demand mismatch. According to a 2017 report from the Fraser Institute, median wait-time for medically necessary surgeries is 20 weeks, double the 1993 rate.

As resident doctors, we are concerned about worsening access to care. Access inequalities for patients are greatest the further away one lives from metropolitan centres, particularly among the socially marginalized. This is not a system we want to inherit.

This is an important systems-level concern for RDoC given it affects all stakeholders. The problem is clear to all, but the solutions may not be. We actively collaborate to promote viable solutions.

At our seat with the Committee on Health Workforce’s Physician Resource Planning Advisory Committee, we champion evidence-based allocation of residency positions. We assist in the creation of a model to predict physician supply and demand. Done correctly, this may prove to be the most crucial step. RDoC has established accessible tools, including online career-counseling resources and resident profiles. The resident profiles in particular seem to resonate with trainees, as their number of unique views has doubled to 552 from 2016 to 2017 (unpublished data).

Another change likely to result in significant changes for graduates is the establishment of national licensure. Applying for licensure in different provinces and territories is a lengthy and expensive venture. Physicians who have newly transitioned into practice may be dissuaded from practicing in new areas with high levels of need. Physicians are limited in their ability to provide support and respite for their colleagues in other provinces/territories who may need urgent practice coverage.

Should our efforts resonate with you, RDoC welcomes your support.