The Reason for the Doctor Shortage

[William Ashley]

I walked by a poster for oxford seminars today that said "Only 12 out of 100" applicants for medical school are accepted. It dawned on me that this is probably the reason for the doctor shortage. I think that perhaps if more spaces were created and they filled them with people - that is accepting everyone from the highest to lowest based upon the seat existing, would go a long way in healing the domestic doctor shortage.

Aside from this creating more seats is all that is needed.

That is only 12% of people who WANT to be doctors are allowed to learn to be one...

that is the problem.

http://www.oxfordseminars.ca/MCAT/mcat_profiles.php

[Wild Bill]

I walked by a poster for oxford seminars today that said "Only 12 out of 100" applicants for medical school are accepted. It dawned on me that this is probably the reason for the doctor shortage. I think that perhaps if more spaces were created and they filled them with people - that is accepting everyone from the highest to lowest based upon the seat existing, would go a long way in healing the domestic doctor shortage.

Aside from this creating more seats is all that is needed.

That is only 12% of people who WANT to be doctors are allowed to learn to be one...

that is the problem.

http://www.oxfordseminars.ca/MCAT/mcat_profiles.php

William, to us older folks the answer is obvious. The policy of limiting medical students was a deliberate attempt to rectify a DIFFERENT problem!

At the risk of provoking a kneejerk reaction from some NDP posters to MLW, the first time I saw this happening was during Bob Rae's term as premier of Ontario. In an attempt to address the provincial deficit he decided that if we limited the number of doctors AND capped how much each doctor was allowed to bill yearly that would limit the amount of money he would have to pay out for medicare.

The earnings cap was trumpeted all over the media 'cuz it was an easy sell. I think it was about $450,000 and was presented to the public as if that was the doctor's actual net yearly income. Of course it really wasn't. The doctor had his office and his staff to pay for and that ain't cheap! To the voters however it looked like Rae was protecting us from being gouged!

Limiting the number of spots for students was kept rather quiet and basically ignored anyway, since the effects weren't immediately obvious and we all know that most media reporters are really rather thick! Every graduating doctor can get a provincial medicare billing number. No number, he doesn't get paid!

Combine the two factors together and what happened was that often doctors found themselves hitting the billing cap and yet still having more patients to see! Rather than work a lot of unpaid hours (most doctors work much more than a 40 hour week anyway) they decided to limit their number of patients.

So we ended up with doctors seeing less patients and more and more people unable to find a family doctor! But Rae had cut his medicare costs so well that no premier since of any party has changed what he did! They're ALL screwing us!

[wyly]

I walked by a poster for oxford seminars today that said "Only 12 out of 100" applicants for medical school are accepted. It dawned on me that this is probably the reason for the doctor shortage. I think that perhaps if more spaces were created and they filled them with people - that is accepting everyone from the highest to lowest based upon the seat existing, would go a long way in healing the domestic doctor shortage.

Aside from this creating more seats is all that is needed.

That is only 12% of people who WANT to be doctors are allowed to learn to be one...

that is the problem.

http://www.oxfordseminars.ca/MCAT/mcat_profiles.php

does your source say of those 88 rejected were they all qualified?

ultimately it still comes down to money...number of applicants accepted is limited by funding, there needs to be more educators to train them, expansion of facilities to train them (universities) and postions in hospitals, those all require money...

[guyser]

ultimately it still comes down to money...

Not so sure about that, since 1993 all prov govts have limited and mandated how many seats are given regardless of applicant numbers.

I know a woman who is in Bahamas getting her Med degree, and will have $200,000 in debt before she graduates.

Another is a brother of my co-worker who is getting his in Romania, but he got a scholarship after a year.

Both will return to practice here in Canada.

Edited August 24, 2011 by guyser

[wyly]

Not so sure about that, since 1993 all prov govts have limited and mandated how many seats are given regardless of applicant numbers.

they're limited by funding, you can open the floodgates to a 1000 applicants but if there are only 10 seats open in a classroom or enough educators to handle 10 students or only funds to admit 10 for a residency the other 990 will have no place to go...

I know a woman who is in Bahamas getting her Med degree, and will have $200,000 in debt before she graduates.

Another is a brother of my co-worker who is getting his in Romania, but he got a scholarship after a year.

Both will return to practice here in Canada.

and both will not be qualified to work in Canada until they pass all the same requirements that canadian graduates must pass...

[Sir Bandelot]

I have seen where these "shortages" are sometimes by design.

[wyly]

I have seen where these "shortages" are sometimes by design.

they're all by design...if funding is purposely limited to only allow the x amount of MD's when demographics demand x + y then shortages can be the only result...

[guyser]

they're limited by funding, you can open the floodgates to a 1000 applicants but if there are only 10 seats open in a classroom or enough educators to handle 10 students or only funds to admit 10 for a residency the other 990 will have no place to go...

Not as I understand it.

It is limited as in the Prov Gov tells X Uni they have 9 spots etc.

Yes the funding matches, but the #'s are limited to what the Gov says.

[William Ashley]

The earnings cap was trumpeted all over the media 'cuz it was an easy sell. I think it was about $450,000 and was presented to the public as if that was the doctor's actual net yearly income. Of course it really wasn't. The doctor had his office and his staff to pay for and that ain't cheap! To the voters however it looked like Rae was protecting us from being gouged!

I don't know, I can't wait till I get paid $30 to fill out a piece of paper.

I checked and that 450,000 as net income doesn't seem unbeleivable for some doctors.

http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/MedStudentCentre/Medicine/income.pdf

For Thoriatric and Cardiovascular Surgeons their "average" income was $440,082

My post isn't about doctors wages, but supply and demand does say, the fewer they are the higher they can charge due to simple supply and demand.

I really think the problem is medical schools only admiting the top 12%.. these are people who completed undergraduate studies. IMO a failed wanna be doctor is worth it if you look at graduation rates of those 12%.

It seems like the problem would be gone if the threshold was raised to top 25%

This is a post I found online.. note the very high graduation rate.

Can't speak for Mac, but over 4 years of med school here at UBC, my class has had 1 person leave because of health reasons, and a few others (4-5) have taken a year off/had to repeat a year for personal or academic reasons. We've had one person leave the program for academic reasons. So, overall, out of the initial 120 of us, 118 (or thereabouts) will graduate either on time, or a year later.

If you get into med school, it will be your decision to leave it as well.

Ian

UBC, Med 4

This 1 in 60 or so can be compared to - say the UK's undergraduate drop out rate of 1 in 7.

Clearly there seems to be a little wiggle room for more failures for the ability to

have more doctors.

Edited August 24, 2011 by William Ashley

[wyly]

Not as I understand it.

It is limited as in the Prov Gov tells X Uni they have 9 spots etc.

Yes the funding matches, but the #'s are limited to what the Gov says.

chicken and egg scenario...my MD friend who is also an medical instructor tells me they only have room for x amount of students to admit more they need funding, instructors don't work for free and there aren't enough of them now to handle more students... old uni's need need funding for expansion to accommodate more students, what was ok when we were a country of 20 million now longer works at 34...mrs wyly(uni financial manager) informs me that funding is restricted, unless there are private donations coming in there is no more...then also hospitals need more for wages if they're taking on more interns, as it is now they're already stretched in many departments...

it comes down to is priorities what do value more, multi billion dollar super planes flying over desolate arctic regions or medical services...

to get more medical services governments need to shift funding from other projects to medical education, and then even more money to pay those MD's when they begin practice...

[guyser]

I checked and that 450,000 as net income doesn't seem unbeleivable for some doctors.

For Thoriatric and Cardiovascular Surgeons their "average" income was $440,082

after wages, insurance, office lease costs....?

I really think the problem is medical schools only admiting the top 12%.. these are people who completed undergraduate studies. IMO a failed wanna be doctor is worth it if you look at graduation rates of those 12%.

It seems like the problem would be gone if the threshold was raised to top 25%

The govt mandates how many. If there are 12 spots, there are 12 spots regardless if 200,000 apply or 14.

[Wild Bill]

I checked and that 450,000 as net income doesn't seem unbeleivable for some doctors.

http://www.cma.ca/multimedia/staticContent/HTML/N0/l2/MedStudentCentre/Medicine/income.pdf

For Thoriatric and Cardiovascular Surgeons their "average" income was $440,082

Not quite, William. I was talking about family doctors. They have to pay for the roof over their head, their staff and their supplies and utilities.

Specialty doctors such as YOU cited generally work out of a hospital. They have either no staff or just share one clerical assistant. Their overhead is FAR lower than a family doctor!

But they all have the same cap!

I kind of expected you to make that sort of mistake. There's no shame in it. Most people would and did! We are programmed to believe that certain professions are just money-making machines. We see only their net income. We don't see the sacrifices to become educated and qualified in such professions, the overheads, the extra hours. Basically, it's just an extension of "the grass is always greener".

Or more simply "I'm the only one who works hard and doesn't get paid enough!"

It's just human nature.

[wyly]

specialty MD's expenses vary, my friend works out of 4 different hospitals and a few clinics he'll require staff in each as well as attending numerous medical conferences in canada around the globe that need to be paid for...another friend I has a staff of 4-8, it varies...yet another shares one admin person with another MD and that's it...some net 150k, others net a half mill or more...one size doesn't fit all...

[PIK]

William, to us older folks the answer is obvious. The policy of limiting medical students was a deliberate attempt to rectify a DIFFERENT problem!

At the risk of provoking a kneejerk reaction from some NDP posters to MLW, the first time I saw this happening was during Bob Rae's term as premier of Ontario. In an attempt to address the provincial deficit he decided that if we limited the number of doctors AND capped how much each doctor was allowed to bill yearly that would limit the amount of money he would have to pay out for medicare.

The earnings cap was trumpeted all over the media 'cuz it was an easy sell. I think it was about $450,000 and was presented to the public as if that was the doctor's actual net yearly income. Of course it really wasn't. The doctor had his office and his staff to pay for and that ain't cheap! To the voters however it looked like Rae was protecting us from being gouged!

Limiting the number of spots for students was kept rather quiet and basically ignored anyway, since the effects weren't immediately obvious and we all know that most media reporters are really rather thick! Every graduating doctor can get a provincial medicare billing number. No number, he doesn't get paid!

Combine the two factors together and what happened was that often doctors found themselves hitting the billing cap and yet still having more patients to see! Rather than work a lot of unpaid hours (most doctors work much more than a 40 hour week anyway) they decided to limit their number of patients.

So we ended up with doctors seeing less patients and more and more people unable to find a family doctor! But Rae had cut his medicare costs so well that no premier since of any party has changed what he did! They're ALL screwing us!

We have some new doctors in my town and they cut off at 400 patients, replacing doctors that had 1400. Now I have a new doctor for the last 3 years ,she has been pregnant twice and only works mornings. I thought they took a oath, how do they justify what they are doing by saying no to people in need.

[guyser]

Not quite, William. I was talking about family doctors. They have to pay for the roof over their head, their staff and their supplies and utilities.

Specialty doctors such as YOU cited generally work out of a hospital. They have either no staff or just share one clerical assistant. Their overhead is FAR lower than a family doctor!

But they all have the same cap!

Surprise surprise, the cap was scrapped in 2006 ! Takes us old fellers a bit to get news I guess !

Specialists were not part of cap prior IIRC.

[guyser]

We have some new doctors in my town and they cut off at 400 patients, replacing doctors that had 1400. Now I have a new doctor for the last 3 years ,she has been pregnant twice and only works mornings. I thought they took a oath, how do they justify what they are doing by saying no to people in need.

The oath is still viable, they are not breaking it unless every Doc on the beach in Miami in January is guilty too.

Female docs work about 17 hours less than males, and older males work a ton more than younger males.

Find an old dude as your Doc

[William Ashley]

after wages, insurance, office lease costs....?

Those were "NET" figures not gross. So yes.

Edited August 24, 2011 by William Ashley

[wyly]

We have some new doctors in my town and they cut off at 400 patients, replacing doctors that had 1400. Now I have a new doctor for the last 3 years ,she has been pregnant twice and only works mornings. I thought they took a oath, how do they justify what they are doing by saying no to people in need.

having a life comes to mind maybe having 1400 isn't practical and requires too many hrs....

women MDs is one reason for our shortage, the majority of uni students are now women and I assume that applies med students as well, women due to family restrictions tend not spend as many years in the profession as men...

[William Ashley]

Not quite, William. I was talking about family doctors. They have to pay for the roof over their head, their staff and their supplies and utilities.

Specialty doctors such as YOU cited generally work out of a hospital. They have either no staff or just share one clerical assistant. Their overhead is FAR lower than a family doctor!

But they all have the same cap!

I kind of expected you to make that sort of mistake. There's no shame in it. Most people would and did! We are programmed to believe that certain professions are just money-making machines. We see only their net income. We don't see the sacrifices to become educated and qualified in such professions, the overheads, the extra hours. Basically, it's just an extension of "the grass is always greener".

Or more simply "I'm the only one who works hard and doesn't get paid enough!"

It's just human nature.

http://www.ctv.ca/CTVNews/TorontoHome/20061004/ont_doctors_061004/

Give me an example of an actual doctor who is "in the crunch" over needed office salaries, and rent.

The link given states

Figures for top physician earners show 224 family doctors in Ontario earned an average of $627,000 last year, while 374 diagnostic radiologists averaged $652,000.

224 family doctors (not sure how many are in Ontario as a whole), earned an average of $627,000

$170/h is a high wage rate.

1 doctor = 17 minimum wage workers.

They would need to fill out 6 forms to earn that within an hour, then you wonder why doctors hand writing is classically seen as so bad. That is 1 form every 10 minutes. Or a page every 5 minutes. Those 10 lines of ink or only $1 or so per word is actually probably what leads to 7% of doctors committing suicide. (That figure is a little off apparently it is only 4 or 5 per 10,000 so say 1 in 2000, which works out to 0.05% or something. My bad or 0.025% depending on the figures - percentages like that are probably only relevant in chemistry and medicine.)

This post is about "doctor shortage" not wage rates though.

Edited August 24, 2011 by William Ashley

[guyser]

Those were "NET" figures not gross. So yes.

Please show me a link as the cap used to b around the $450g mark, and OHIP aint paying 'net'

[dre]

The doctor shortage is engineered. Its not an accident. Various diferent medical associations control certification and they make sure that enough scarcity exists to keep wages for their members high. They protect their members from competition from foreigners (more than 1/2 of the Indian doctors in Canada drive cab because they cant afford to get certified), and they even protect their members from competition from other members with all kinds of artificial regional boundaries. These associations are likely to fight pretty much any efforts to saturate the market with Doctors which is what we need to do to increase availability and reduce prices.

There is no shortage. There are many thousands of competent doctors around the world that would gladly come to Canada and work for 100 G's.

We need to crush these associations, and make them completely advisory in nature. They basically ammount to allowing a labor union to control certification across a whole industry. Theyre too powerfull and theres a blatant conflict of interest there. And we need to change rules at the federal level as well that stop procedures done outside Canada from being covered.

OK. I am a doctor myself from South Africa. When I came to Canada I had to work through a painstaking 3 year process to validate my medical license here. I was sent to a small city north of Regina for two rotations after I had finished the never ending exams, but finally I was awarded with my license.

Thus, it is possible, however the process is so painstaking that you may see medical doctors from Poland, Mexico and even the USA working in real state and even as taxi drivers.

I came to Canada as a pediatrician. Now I run a catering service. Business it is not bad at all now, but it took me more than 5 years of frustrations to realize that I needed to do something else.

Canada is a tough place for foreign doctors. I do not know if all places are the same, but here is almost impossible.

Those stories are typical. And much of this stuff is just beareucratic and does nothing to ensure the quality of those applicants.

Even doctors that DO successfully run a beareucratic gauntlet that can take up to 5 years, they still often wind up taking other jobs because the medical associating have set up residency requirements (you have to train at a hosptical for 2 years before you can practice as a professional), and Canadian and American doctors are moved to the front of that queue.

Wanna see a doctor fast? Call a cab!

Edited August 24, 2011 by dre

[William Ashley]

Please show me a link as the cap used to b around the $450g mark, and OHIP aint paying 'net'

See page one and look at the links I posted.

I should restate this is about "doctor shortage" not wage rates of doctors.

Edited August 24, 2011 by William Ashley

[wyly]

The doctor shortage is engineered. Its not an accident. Various diferent medical associations control certification and they make sure that enough scarcity exists to keep wages for their members high. They protect their members from competition from foreigners (more than 1/2 of the Indian doctors in Canada drive cab because they cant afford to get certified), and they even protect their members from competition from other members with all kinds of artificial regional boundaries. These associations are likely to fight pretty much any efforts to saturate the market with Doctors which is what we need to do to increase availability and reduce prices.

There is no shortage. There are many thousands of competent doctors around the world that would gladly come to Canada and work for 100 G's.

We need to crush these associations, and make them completely advisory in nature. They basically ammount to allowing a labor union to control certification across a whole industry. Theyre too powerfull and theres a blatant conflict of interest there. And we need to change rules at the federal level as well that stop procedures done outside Canada from being covered.

your way off the mark here dre...space and funding limits the amount of students accepted not MD profession...once admitted only failing the exams can prevent a someone from becoming a MD not a mythical quota, wages for services are fixed, determined by the number of cases seen, procedures done, lectures given etc. it's not based on supply and demand...foreign MDs must go through the same procedure as canadian students there only x amount of spaces they will not get preference over Canadian students even if they are qualified, a small percentage of spots are allocated for foreign MDs who pay far higher costs than canadian students, this helps fund our system...and regards to those cab driving MDs, it's more than likely they are not qualified...any MD who wishes to work in Canada must pass Canadian medical examination, not India's, Bulgaria's or Republic of Congo...

[wyly]

Even doctors that DO successfully run a beareucratic gauntlet that can take up to 5 years, they still often wind up taking other jobs because the medical associating have set up residency requirements (you have to train at a hosptical for 2 years before you can practice as a professional),

residency is part of training procedure it can not be eliminated...foreign MD's need to go through it as...I don't about you but when I have surgery I like to believe my MD knows what he's doing if a MD has skipped part of the training I'm ok with you seeing him but not me...foreign MDs MUST go through the same qualification procedure as canadian MDs

Canadian and American doctors are moved to the front of that queue.

what? you would deny canadians MDs the right to work??? that's just weird...and it wouldn't make a difference anyways there only a limited amount of spaces for residencies banning canadians from the opportunity will not improve the MD shortage... Edited August 24, 2011 by wyly

[guyser]

See page one and look at the links I posted.

I should restate this is about "doctor shortage" not wage rates of doctors.

I did , and right at the bottom it states....

Based on gross payments

The question still stands.