The Medical Job-Lottery

At one time in the not-too dimly-distant history of Canada's confrontation between balancing the health needs of Canadians and providing suitable academic-professional educations for the cadre of medical professionals that would look to the needs of people requiring medical attention, it was decided that the country was producing too many doctors. Medical schools, on order from the provinces, reduced the numbers of health professionals they were teaching.

Unsurprisingly, a shortage of doctors developed. And tens of thousands of people were unable to find a medical practitioner in general medicine willing and able to extend their practise any further, to absorb additional patients. The patient-load on established family doctors became so dire that thousands upon thousands of people were left without a general practitioner to look after their basic medical needs. Which placed an additional burden on hospital emergency rooms.

The situation became so serious that fast-tracking the upgrades seen to be required to allow foreign-trained medical professionals emigrating to Canada was thought as a possibility to solve part of the problems. And university medical schools began to extend enrolment, to produce more doctors. But many new doctors were disinterested in general practise; they wanted to specialize. Seeing themselves putting in fewer hours, and hauling in larger salaries.

And nor was there any interest in locating to rural communities, or more isolated areas where there was such an appeal from the communities badly in need of local health professionals that they were prepared to subsidize a new doctor to an extent unimaginable, buying them houses, cars, paying off their university tuition loans. The situation has since become less dire; more people are successfully being absorbed into new medical practices.

And suddenly, new problems have erupted. The Canadian Medical Association has responded to new surveys showing that one in six newly graduated medical specialists in Canada are unable to find employment. These are not the generalists, those entering the medical profession content to work as family doctors. These are those more ambitious professionals who aimed a bit higher, wanting to make their life work as medical specialists.

Such as cardiologists, anesthesiologists, gynecologists, dermatologists, surgeons, internists, geriatric physicians and oncologists. And, it seems now, so many are graduating with their spanking-new degrees and raring to go to work, that they cannot all be accommodated. According to a Royal College of Physicians and Surgeons of Canada employment survey for 2013, 16% of new specialists and sub-specialists were reporting an inability to secure employment.

These newly-graduated doctors are competing for fewer resources, according to the College. Hospitals are reducing the number of their beds, as well as operating-room time. Older doctors have been postponing retirement, in reaction to a relatively weak stock market, where their retirement funds have been placed to grow as the prospect of non-earning years become more immediate. And there is the charge that medical schools are responsible, failing to produce the right mix and physician numbers.

Even while Canada's population is steadily aging, in 2012 its medical schools graduated a mere 17 specialists in geriatric medicine. This, in comparison to 142 pediatricians and sub-specialists focusing strictly on the medical treatment of children's needs. The specialities of critical care, gastroenterology, neurosurgery, ophthalmology, radiation oncology and urology present as the tightest squeezes for new graduates.

And though it might once have been thought to be counter-intuitive, general practitioners aren't working the long hours they once did, nor spending time with home visits; working in group practices has proven beneficial in this regard. But for specialists, emergency situations are common, and they can call out the specialists at any time, many of whom work very long hours. And those specialists too are aging. Of their numbers only 34% report "satisfied" or "very satisfied" with their profession.

On the other hand, they are exceedingly well paid; most averaging gross incomes of around $350,000. Before overhead, granted, but still a significant remuneration in light of their professional expertise. Neurosurgeons averaged $430,000, and eye surgeons can have gross earnings up to $700,000; just about triple what family doctors earn. In 2011/12 the 39,000 family medicine doctors in Canada earned on average $246,266.

And presumably, they do earn it. Society is dependent upon their professional skills.