No job guarantees in medicine
Gone are the days when Émilie Desrosiers thought her career path was secure simply because she was accepted into medical school.
As she nears the end of her medical training as a general surgeon, she has discovered what an increasing number of young doctors have come to realize: there are no guaranteed jobs in medicine anymore.
And that unemployed doctors are a reality in the harsh landscape of Quebec’s changing medical system.
There are all kinds of heartbreaking stories out there: married doctors who will have to live in separate cities to secure employment; highly trained surgeons who could whittle away at patient waiting lists but aren’t hired because there isn’t actually time available in operating rooms; young doctors who have invested huge amounts of time and money to pursue medicine only to discover job possibilities are scarce and remote.
This new phenomenon is adding to the pressures facing the province’s medical residents. It also helps explain why there was so much resentment among them recently when Health Minister Gaétan Barrette dismissed the idea that Quebec’s medical students face too much stress or are more prone to depression and suicide.
His comments came last month after a medical resident at Hôpital Notre- Dame, Émilie Marchand, was found dead in her car after committing suicide, sending shock waves through the medical resident community.
“I screamed when I read Dr. Barrette’s comments,” said Aris Hadjinicolaou, a resident in psychiatry at the McGill University Health Centre, who knew Marchand. “He is so disconnected from reality.”
Pooja Aysola, president of the Association of Residents at McGill, said not only were Barrette’s comments dismissive, but they were wrong.
“There is an incredible amount of research showing that residents are more at risk for depression and suicide than the general population,” she said in an interview. “People contact me all the time because they are so discouraged and have mental health issues. But Dr. Barrette’s comments de- legitimize what we’re going through, and this tragic death.”
These days, by the time doctors reach the end of their residencies and are ready for employment, they have already had to navigate several major hurdles ( not including the amount of work and pressure to succeed inherent in med school itself ).
The first is getting into medical school, which is becoming increasingly competitive.
Then it is finding a match for a residency position, which has also become increasingly difficult. The Canadian Federation of Medical Students said the 2014 Canadian Resident Matching Service had a larger number of Canadian medical graduates left unmatched in the first iteration, that students were matched to lower- ranked programs on their lists in much greater numbers, and that the ratio of positions available to Canadian applicants was the least favourable ratio seen since 2000.
And, finally, the job situation also has major challenges, with increasing numbers of graduating residents reporting that jobs in specialty fields are much scarcer than they should be and that many jobs which seem to exist on paper don’t actually have the resources to back them up.
The Canadian Association of Interns and Residents ( CAIR) survey of residents in 2013 showed that 21 per cent reported they were still looking for employment after graduation, which CAIR president Christina Nowik called “a significant proportion.”
“Many specialties in Quebec have reached saturation levels,” said Joseph Dahine, president of the Fédération des médecins résidents du Québec ( FMRQ), which represent 3,695 residents. “There are definitely residents not finding jobs, which is causing a lot of stress. We have been able to rescue most, but I wonder how long we’ll be able to keep up because there are more and more cases.”
Unemployed residents who come forward are only the tip of the iceberg, he believes, since many don’t want to jeopardize their chances for employment by going public.
“It is very stressful if you studied for 10 years, but you’re not certain you can find a job and practise in Quebec,” Dahine said. “It’s not that there’s no need in specialties, it’s that resources aren’t following the needs.”
He cites as an example a young gastroenterologist who was told by a South Shore hospital that if he sub- specialized he would be hired for an expanding department. He did the training, but now there’s no job because the money’s not there.
Aysola said the already staggering stress felt by residents has now been compounded by the uncertainty of the job market.
“People are forced to do sub- specialties and continue their training to try to get jobs that may not be there,” she said. “They are jumping through hoops to land a PREM ( which secures a job in Quebec). I have had colleagues begging for positions. I really worry for the future of residents.”
The health sector is still lacking central databanks for jobs, said Dahine, and the government hasn’t always done the best job gauging where the jobs will be or planning medical school admissions accordingly. So while there should be 15per- cent more jobs than graduates for a healthy balance, that’s not always happening.
CAIR, which represents 8,000 residents across the country, says there isn’t good data on physician unemployment and has been advocating for better education to understand where the needs and jobs are, said Nowik.
Among the problems is a disconnect between infrastructure and needs, meaning that hiring may be limited by available operating room time, which is what many young surgeons are discovering.
“I cannot overstate the anxiety, financial risk and pressures faced by residents who often have 13 years of post- secondary training, who may have as much as $ 200,000 in debt from their training, who are in their mid- 30s and have sacrificed in so many ways, to find out there may not be a need for them,” Nowik said in an interview.
“It is incredibly frustrating — not just for financial reasons but because you go into medicine to help patients — to be told you can’t use the skills for which you trained.”