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Spectre of unemployment dogging new orthopedic surgeons, COA says

Responding to an "unemployment crisis" facing newly trained orthopedic surgeons, the Canadian Orthopaedic Association (COA) has called for "immediate" steps to curb residency training levels.

"[We] recognize that Canada's high rate of unemployment among orthopedic graduates poses a serious threat to the profession and its ability to serve society," the COA, a CMA affiliate, says in a recently released position statement. "Continued high unemployment among graduating orthopedic surgeons is an unacceptable state of affairs."

Dr. Ed Harvey, the COA president, says the association expects that there will be no positions available for about 50 of the orthopedic surgeons who complete residency training next year.

He said the current situation includes numerous incongruities. For instance, as new surgeons cope with an extremely tight job market, some foot and ankle surgeons in Montreal have six-year wait lists.

"We know the work is there," said Harvey, the chief of orthopedic trauma at McGill University. However, the government resources required to make that work possible are in short supply, and this means many new graduates are being left out in the cold.

"More physicians are competing for fewer resources," Harvey explained. In a recent presentation to colleagues, he said there are currently 107 unemployed Canadian-trained orthopedic surgeons, and next year that number is expected to rise to 158.

The COA statement, which calls on members to "educate themselves further about this issue and take steps to help manage the situation," offers four recommendations:

  • Reallocate resources to make more hospital positions available: "Patients face an access-to-care problem that will continue to worsen as demand increases. Meanwhile, well-trained and newly qualified Canadian orthopedic surgeons cannot find full-time employment to provide the needed services.... A well-articulated plan that considers resources, surgeon numbers and new models of care [is required] to improve access."
  • Senior surgeons should consider job-sharing as they approach retirement: Although the COA says it will not "impose a specific retirement age,... senior surgeons who opt out of surgical practice could be instrumental in reducing wait times by setting up screening, triage and non-operative care clinics."
  • Make hiring practices transparent: "Serial fellowships and locum positions do not meet the criteria for full-time orthopedic practice. Hiring should be a real-time transparent process so that all qualified graduates have an equal opportunity to apply for new orthopedic positions."
  • Reduce the number of trainees: Canada had a shortage of around 400 orthopedic surgeons in 2006, and as a result the number of residency slots jumped from 35 in 2002 to 82 in 2011. In 2013, the number fell to 70. "Canada is clearly training too many orthopedic surgeons for the current hospital resource environment, and... critical evaluation suggests a substantial reduction in residency numbers is urgently required."

The paper concludes: "Currently, Canada has a surplus of orthopedic graduates who cannot find funded hospital positions, and new graduates are forced to languish in serial fellowship training or in chronic locum experiences or seek work abroad." It says practising surgeons can help by educating themselves about the problem and by considering adding a new surgeon to group practices.

Orthopedic surgeons are far from alone in facing employment pressures. In an article prepared for the 2014 edition of New in Practice, a CMA publication for final-year residents, Dr. Paul Johnston described the difficulties he faced after graduating from Queen's University and then completing his residency in urology at Indiana University.

"It was demoralizing to find out that after all those years of training nobody really has room for you," he said. "It was a bit of a shock - in the US I was getting an offer of a job a week, if not daily,... but there was complete radio silence from Canada."

Johnston, who has since started to practise in St. John's, said some of his colleagues are living with their parents and are only able to operate one-third of a regular urology practice. "They gave their 20s to get trained and now they have nothing," he said.

Harvey said the search for solutions will continue. "We know the [human resource] situation is cyclical," he concluded. "I started to practise in 1996, and the situation was horrible then too. But that's not to say it's right."

Several national bodies will be seeking solutions in the new year. The topic will continue to be featured on the agenda of the CMA's Specialist Forum, which represents more than 40 specialty groups. In February, the CMA will be one of several national groups represented when the Royal College of Physicians and Surgeons of Canada hosts a summit on the unemployment issue. The summit follows a recent Royal College survey, which determined that 16% of the country's new specialists and subspecialists cannot find work.

Finally, a task force formed by Health Canada and the Association of Faculties of Medicine of Canada will also meet in February to tackle health human resource issues.

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