Thursday, May 31, 2012

Do We Owe Residents a Job?

While attending the Resident's Research Day, a resident approached me and asked if he could meet with me.  "I am happy to meet with you, " I replied, "But if you are looking for job, I do not anticipate hiring anybody in the near future."  He still wanted to meet with me so we did a week later and I told him the same thing.  He already had a 0.5 position at a suburban hospital and was looking for something more.  I told him we could offer him locums on a weekly basis and that some people looked for people to do call on weekends.  He left a little disappointed and felt I little guilty that I couldn't help him out more.  Should I?

I went into my residency fairly confident that I would get a good job when I finished.  Things had changed by the time I finished and although I send my resume to just about every place I could conceivably work in, I got few nibbles.  I did end up getting quite a good job in a nice community for which I am grateful (and sometimes wish I never left).  When I did my fellowship orals, 4 other people did theirs at the same time as me.  I was the only one of the group of 5 who had a job after my residency.  Things got worse during the 1990s to the point that we actually tried to talk medical students out of anaesthesia as a specialty because there would be no jobs for them.  Suddenly things shifted, people died, people retired, people cut down, operating rooms opened and in the late 90s the residents who had gone into anaesthesia despite our warnings not to, had their pick of good jobs.  This persisted into this century until fairly recently.  Because of the perceived shortage, there was a doubling of residency positions.

The impression I get is that while in the larger centres, jobs are hard to come by; many of the larger "rural" hospitals are still hard to staff.  Every time somebody asks me for a job, I always ask them if they have considered any of the other hospitals outside of our city and our evil sister city.  They usually have some excuse.  These hospitals it is true, tend to smaller which means more call and the communities lack the amenities of the city.  These are hospitals however that were once places that specialists considered working in.  I remember in the early 1990s when a larger rural hospital posted a job, resulting in a feeding frenzy among the final year residents as to who would get it.  Rural hospitals do not really seem to looking for our residents either.  They seem to have gotten into the pattern of recruiting from overseas (mostly South Africa).  Our University Department recently had to assess the training of a SA anaesthesiologist going to work at a rural hospital 5 hours away.  Our chairman asked why this hospital had not tried to recruit any of the finishing residents, some of whom didn't have full-time jobs yet (assuming any of them would consider working there)?

The main problem is that operating room numbers have not kept pace with the population growth.  Our metropolitan area had 800,000 people when I moved here in 1992 and now has 1 million people.  Logically this should mean 25% more operating rooms.  There are in fact more or less the same number as in 1992.  Meanwhile we seem to do more "urgent" cases after hours.  We recently built a modest size hospital in suburbs; it has 4 operating rooms.  These will be staffed by GP-anaesthesiologists; there has as far as I know been no effort to have it staffed by specialists.  Our evil sister city, recently to great fanfare opened a brand-new hospital.  This new hospital will result in no net increase in operating rooms; rooms at other hospitals are being closed in order to allow it to use its brand-new ORs.

The problem of physician over-supply is not limited to anaesthesia.  Even in the 1990s certain specialties like neurosurgery, ENT and cardiac surgery turned out residents, knowing there would not be jobs for them in Canada.  Most of them went to the US which was able to absorb them quite well until recently.  A rational person would ask why we are training specialists for non-existent jobs or for jobs in other countries and there is of course only one rational answer.  For service of course.  We can't expect a cardiac surgeon to actually look after his patients can we?  Radiation oncology is now massively over-subscribed, a graduating resident wrote a lament recently wondering why this could not have been anticipated 5 years ago when he was applying for a residency.

A city our size could easily absorb to a point all the graduating residents.  We might all have to take a couple of extra weeks of holidays a year.  In time we might actually enjoy it and wonder why we didn't think of this earlier.

The question is:  "Do we owe our residents a job?"

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