Highly Trained and Underemployed:
Are We Making Any Progress in Our Professional Crisis?
Access to Care
It is no secret that wait times for orthopaedic surgery in many regions are well above what orthopaedic surgeons believe to be clinically reasonable. The Fraser Institute paints a bleak picture for MSK patients. Compared to all medical specialties, orthopaedic patients wait the longest between GP referral and treatment (14.6 weeks T1, 24.5 weeks T2, 39.1 weeks overall) (Barua et al., 2019).
The CIHI Wait Times for Priority Procedures in Canada report that approximately 30% of patients who required a hip or knee replacement did not have their procedure done within the recommended wait times in 2019. This data reflects the most recent information available from the 2019 data cycle before the COVID-19 pandemic (CIHI, 2020).
The politics of education and underfunding
The system bottleneck arises largely from the lack of resources (e.g. funding to hire full time surgeons, operation room resources, recovery beds, nursing support) allotted by the government to allow orthopaedic surgeons to treat patients in a timely manner. Canada has the lowest number of orthopaedic surgeons per capita in the G7 countries, at 3.5 (Statistics Canada, 2019; Canadian Orthopaedic Association, 2019) to 4.5 (Dell et al., 2019) orthopods per 100,000 people living in Canada.
The inadequate access to MSK care for Canadians in many regions is more perplexing when we consider the number of trained orthopaedic surgeons in Canada who are ready to work and yet are unemployed or underemployed. Keeping in mind variation by region, what follows is an overview of orthopaedic employment prospects now and over the next five years across the country. How are we really doing?
COA 2020 Unemployment Snapshot
Each year, the COA gathers employment data from the 17 Canadian orthopaedic training program directors, a snapshot “what are they doing now?” update of orthopaedic graduates from the last six years. Below are the most up-to-date statistics based on graduates from 2015-2020, or “recent grads” (current at December 2020): These results are an important tool for manpower planning and advocating for patient access to care.
- 430 orthopaedic surgeons graduated over the last six years in Canada
- 127 recent grads are currently seeking full-time employment (“Looking for work”). Of those:
- 28 are underemployed (locum, research, other) and actively seeking immediate work
- 99 are currently on fellowship and will enter the job market imminently (97% are in fellowship year 1 or 2 and 3% are in fellowship year 3 or 4)
- 72 recent grads are currently working full-time outside of Canada
- 231 recent grads currently hold a full-time position in Canada
- The unemployment rate within the graduates of the past six years decreased mainly due to the decrease of residency spots and the increase of graduates working outside of Canada.
So, what now?
Underservicing and underfunding of MSK care for an increasingly aging population continues unabated, and has been a major contributor to the crisis in underemployment and unemployment of trained orthopaedic surgeons that we have seen over the last decade in Canada. Despite the slight improvement in levels of raw underemployment numbers across the country, there are still more orthopaedic surgeons entering the job market than predicted jobs, and the shortage of positions will continue to be a challenge to our new graduates for the foreseeable future. This is even more alarming when we consider that we are moving into the second decade of significant reductions in the numbers of training positions for Canadian graduates. Furthermore, the increase in graduates accepting full-time positions in the United States over the last few years is troubling.
In a report, the Royal College of Physicians and Surgeons of Canada released findings from their annual Royal College Employment Study (Royal College Employment Study, 2019) based on a survey of medical specialists newly certified in 2017 about their job prospects. The top six barriers to employment are:
- Too few available positions in Canada
- Poor access to job listings
- Desire or need to stay near family
- The need for spousal employment
- Lack of available health care resources (e.g. funding, operating room time)
- The delayed retirement of established physicians and surgeons (and their general reluctance to share resources)
Review the June 2018 COA Bulletin article to gain a better understanding of the COA’s capacity to address the unemployment crisis in various areas including government advocacy, implementation of a free job board, education through position statements, and others. One of the most impactful interventions undertaken by the COA was advocating for the reduction in residency spots, which resulted in a decrease from 81 R1 orthopaedic matches in 2011 to 53 matches in 2020 (CaRMS). This begs the question whether there will be enough trained surgeons available in the future to serve the needs of the aging population. Further limiting the number of trainees may compromise patient care in future decades.
Consistent advocacy efforts at various levels of government and in the media is critical. The COA continues to encourage innovative models of care which increase efficiency, as well as advocate for and promote the acceptance of shared practices which allow a gradual transition to retirement for senior surgeons and a gradual entry to the job force for junior surgeons.
Through the Mobilize Canada Coalition, the COA is working with other stakeholders in the orthopaedic sector on a public awareness, government relations and advocacy campaign called ‘Fast Track Care’, tackling orthopaedic wait times further exacerbated by the COVID-19 pandemic. You can get involved by accessing the tools and resources available at www.fasttrackcare.ca.
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