A new report from the Royal College of Physicians and Surgeons of Canada tells us one in six newly minted specialists can't find work.
Beyond that catchy headline, the report and reaction to the report goes a long way toward explaining why Canada's health system seems so morose and mired in mediocrity.
The research presents some fairly straightforward reasons why the seemingly unthinkable – gasp, unemployed and underemployed doctors – has happened.
1) The economy: Older doctors aren't retiring and hospitals aren't expanding surgical services because money is tight.
2) The way the health system is organized (or not) contributes to underemployment: Human-resource planning is poor.
3) Personal factors: Physicians make personal choices – like where they want to live – that don't always align with job openings.
The RCPSC study details the problems over 60 pages, but offers no solutions. This is not a criticism of the authors; proposing solutions was not their mandate. This approach is all-too-common in Canadian health care: We do a lot more whinging than fixing, a lot more finger-pointing than introspection.
But back to the problems: They are, of course, presented from a particular point of view, that of physicians and surgeons. God forbid that anyone suggest that they have helped create the problem for which they offer no solution. This is hinted at only in the most delicate manner, so let's state the facts a little more bluntly. Physicians are pretty adept at turf protection. The unspoken solution is that we need to get these docs jobs, and quickly.
The plain fact is that there have never been more doctors in this country – in gross numbers or per capita.
There are 75,142 licensed physicians in Canada, and fully half of them are specialists, according to data released this month by the Canadian Institute for Health Information. That is 9,072 more doctors than there were in 2008 – a whopping 14-per-cent increase over five years.
These large increases are going to continue because we are now churning out 2,647 medical graduates a year – a number that has doubled in the past 15 years.
The increases in medical enrolment and physician numbers were based on dire predictions of shortages. The result is a glut – and a fairly predictable one.
The only thing that has risen faster than physician supply is physician pay. We pay doctors handsomely in Canada – in some cases double what they would earn in Europe.
The justification is that we risk having our docs scooped up by the big hospitals in the United States. Again, the facts don't support the rhetoric. At most, a couple of hundred Canadian docs go south each year, and usually as many come back home. Last year, there was a net gain of 77 physicians – hardly a brain drain.
There are many reasons workers – including doctors – choose to live and work in particular communities.
When it comes to physicians, Canada has much more of a distribution problem than a supply problem. The RCPSC makes it clear that many newly graduating docs don't want to practise in rural areas, where the jobs are.
Fixing that problem requires a good health human-resources strategy. But many groups of health professionals (not just doctors) have consistently undermined this process. The reality is that the market for physicians and other health workers is largely (for better or worse) state-controlled. When the planning is inadequate, you get outcomes like this : A boom-and-bust cycle of employment.
In Canada, whenever a problem arises – such as wait times for surgery – our solution is invariably to throw more bodies at the problem. When something isn't working, we just spend more money to do more of it. Is that logical?
We have, for far too long, neglected making basic engineering and administrative changes to make health-care delivery more efficient.
Take just one example: Improvements in angioplasty and stenting mean there is less demand for bypass surgery, hence less need for cardiac surgeons.
Is this not a good thing? Why is health care the only industry where improvements in technology don't bring down costs?
Our overarching goal should be to provide all Canadians with accessible, affordable, quality health care in a timely manner.
It shouldn't be to ensure that every medical graduate has their dream job.
Editor's note: The number of Canadian physicians increased 14 per cent between 2008 and 2012 – that includes a 24 per cent increase in female doctors and 10 per cent increase in male doctors. Incorrect information appeared in an earlier version of this article.
André Picard