Not so long ago, remote locations were trying to lure Canadian doctors with signing benefits and $60,000 annual bonuses. Now it’s the doctors who are trying to claw their way into those same communities.
With senior surgeons working into retirement and hospitals loath to hire new ones, the next generation is staring at a job pool that has quickly dried up.
One of the areas most acutely affected is orthopedic surgery. Having spent about a decade learning and training for a job, an estimated 30 specialists can’t find one – and as many as 50 might face the same situation after they graduate in July. While 800 surgeons are already employed across the country, there are three full-time positions and four locums, or temporary jobs, advertised on the Canadian Orthopaedic Association job board.
“I applied everywhere,” said orthopedic surgeon Alex Rabinovich, 32, who trained in Hamilton and Dallas and has been on the job hunt for two years. “They [hospital administrators] tell me: ‘We would love to have a foot and ankle surgeon – our wait times are ridiculous. However, we don’t have the resources.’”
The glut of surgeons comes at a time when Canada is struggling with long wait times and patients are queuing for years because there are simply too few of them.
Dr. Rabinovich’s competitors aren’t the only ones stung by a tightening market. Head and neck surgeons, community medicine physicians, nephrologists, cardiac surgeons, neurosurgeons and plastic surgeons are also reporting difficulty landing permanent employment, prompting the Royal College of Physicians and Surgeons of Canada to launch a study on the topic.
“This is really high on our list of priorities,” said Danielle Frechette, the college’s director of health policy.
For surgeons such as Dr. Rabinovich, it means cobbling together a job by filling in for others in what is jokingly referred to as the burgeoning new specialty: the on-call-ogist.
Most do locums, which works the way a substitute teaching position does in schools. Typically, the roles come up when surgeons want to go on leave or holiday or have simply tired of waking up in the middle of the night to attend a call. Dr. Rabinovich also fills in as a surgical assistant in Hamilton, a job usually reserved for those with far less training.
“I feel like an express service,” said Dr. Rabinovich, who lives in Hamilton. “I should get a 1-800 number.”
Lou Halpern has been waiting almost four years to have deformities on his feet repaired. “It’s absolutely mind boggling,” said Mr. Halpern, 63, the owner of two manufacturing firms in Brampton, Ont. “The impression is that there’s a shortage of doctors. It’s a shame I would have to wait so many years when there are doctors available.”
According to Timothy Daniels, a foot and ankle surgeon at Toronto’s St. Michael’s Hospital: “The real drawback is that [the health care system] doesn’t have capitalistic incentives. Supply and demand doesn’t mean anything. It’s a frustrating thing we face constantly.”
Dr. Daniels’s patients have to wait two to four years to get their first appointment with him. They wait another two to four years for their operations. (His waits are longer than the Ontario average – one year to see a specialist, another year for surgery – because patients specifically request him.) Their feet are deformed, injured in accidents or ravaged by arthritis. Some patients struggle to walk more than three blocks. Most are desperate by the time they see him.
“I have a box of Kleenex that I walk around with,” said Dr. Daniels, a member of Ontario’s Orthopaedic Expert Panel. “… The number one complaint from patients is: ‘Why are there so few of you? Why am I waiting so long for my surgery?’ That’s all I listen to.”
Unlike hip and knee replacements – for which hospitals receive cash incentives from a $5.5-billion federal initiative to reduce wait times – surgery to repair feet and ankles is considered a fiscal drain on a hospital’s global budget, an institution’s fixed pot of cash.
