TORONTO - The findings are startling, given years of complaints about doctor shortages and long wait times for surgeries. But a new report suggests that nearly one in six recently minted medical specialists cannot find work in their field.
And one in five of the new specialists reported taking a series of short term fill-in posts — locums, in the lingo of medicine — to stay working.
Physicians who reported having trouble finding work included urologists, critical care specialists, gastroenterologists, ophthamologists, orthopedic surgeons and general surgeons, though doctors from other sub-specialties were also unemployed.
Steven Lewis, a health policy consultant based in Saskatchewan, suggested the report is proof reactive moves made over the last 15 years or so solved one problem by creating another. And he said the situation the report captures will only get worse, because medical schools will continue to graduate specialists at current levels for the next few years at least.
"I think we overshot the mark," said Lewis, who was not involved in this study.
"I think that there is no question that ... almost doubling medical school enrolments since the late 1990s combined with easier paths to licensure for international medical grads was the wrong thing to do. We didn't think it through as a country."
The study was conducted for and released by the Royal College of Physicians and Surgeons. The principal investigator was Danielle Frechette, executive director for health systems innovation for the college.
Frechette said the organization, which sets standards for physician education in the country, had been hearing anecdotes about rising numbers of unemployed doctors, so decided to assess the situation.
The ensuing report, released Thursday, is based on a survey of over 4,000 newly graduated doctors and interviews with about 50 people knowledgeable about the situation — deans of medical schools, hospital CEOs and the like.
The report paints a grim picture but does not recommend ways to fix it; that was not the mandate. The Royal College of Physicians and Surgeons is convening a national summit in February to explore ideas for developing a co-ordinated approach to planning health system workforce needs, Frechette said.
She noted a fix will not be easy.
"We're hoping that our research shows that this is not a simple issue. And that we shouldn't have any knee-jerk reactions, otherwise we will perpetuate this boom-bust cycle that we've been in. It's like Groundhog Day," she said, referring to the popular Bill Murray movie.
Frechette suggested, however, that a national health systems workforce planning body would be an important start. Australia, Britain and the U.S. all have such an entity.
The report pointed to a number of factors that have contributed to the oversupply of specialists. Poor stock market returns in recent years have meant that some older doctors — most of whom must finance their own pension plans — have delayed retirement.
And there has been a realignment or rationalization of tasks in health care, with nurses and physician assistants taking on responsibilities that were once left to doctors, freeing them up to do some tasks that used to fall to specialists.
That effect, which Lewis called sensible, will only accelerate as less invasive treatments are brought on line. For instance, angioplasty — opening blocked cardiac arteries with balloons and stents — has replaced many open heart surgeries to bypass blocked arteries.
Lewis suggested the cycle of training specialists — which typically takes about nine years — is out of sync with the cycle of assessing future medical system requirements.
"Forecasting health human resource needs more than three or four or five years out is a fool's game, because medical science changes, health needs can change, technology can change and so on."
But Frechette said there are some low hanging fruit — problems that should be relatively easy to address. For instance, her study noted there are jobs going for the asking. And yet while it seems inconceivable in the era of Craigslist and LinkedIn, doctors are having a hard time finding these "help wanted" ads.
"Our research did discover that there are a lot of people who can't find jobs, including orthopedic surgeons who would gladly go to where the jobs are, but they don't know where they are," she said.
Lewis said there are some other adjustments the system should consider. One is shortening the period of time it takes to train a specialist, which would allow planners to adjust the course more quickly if it appeared that a glut of doctors was forming.
"If your whole life is going to be doing hip and knee replacements, I think one can question whether it should take nine years of training," he said.
Another suggestion involves sharing the wealth. He said it isn't uncommon to hear of small communities where patients have to wait to see a specialist — but the three specialists in town aren't keen to let a fourth hang a shingle.
"I think the one thing that's clear is there won't be a spontaneous solution that employs all of these new doctors effectively. Somebody has to make room for them," Lewis said.
"And there have to be some policy and practice changes that will make sure that the vast majority of the new entrants find a useful home in the system without driving up system costs unreasonably."