We're Running Out Of DOCTORS And Need To Fix It | The 2023 Doctor Shortage Explained
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- čas přidán 4. 07. 2024
- For years warnings of doctor shortages in the United States and Canada have become louder and louder, but for some reason, we still haven't been able to do anything about it. As a new doctor I've already met dozens of patients who have been looking for a doctor for years without any success, so I wanted to stop and think about this phenomenon a little bit more carefully today. In today's video I'll be reviewing the current date on the North American doctor shortage as well as going over some of the proposed solutions and offering some of my own thoughts on the subject. Please feel free to agree or disagree and leave feedback about the changes that you'd make to address the current situation :)
#doctor #usa #canada
⏳ Chapters
Intro: 0:00 - 2:25
Is there really a doctor shortage: 2:26 - 2:44
Relative Specialty Shortage: 2:45- 4:07
Relative Geographic Shortage: 4:08 - 4:54
Absolute Shortages: 4:55 - 5:15
Adding More Medical Students: 5:16 - 9:01
Other Solutions (International Doctors): 9:02 - 10:01
Other Solutions (Family Medicine Schools): 10:02 - 10:43
Other Solutions (Eliminate Primary Care): 10:44 - 11:22
How do we fix this: 11:23 - 13:10
Why did I make this video: 13:11 - 14:09
Bio:
Hi everyone, its nice to meet you 🤙 My name Is Gianluca and I'm a first year family medicine resident physician in Ontario, Canada. I'm just trying to document my experiences throughout my medical training and beyond to hopefully help inspire/guide some other students... and make things more fun for myself :) I post a new video once per week.
Feel free to contact me on CZcams or Instagram if you have any questions.
📬 Follow Me On Social Media
Instagram - @NXTgenMD
(That's all... being a doctor and making CZcams videos keeps me busy enough 😅)
(Also, I always follow back 😇)
🎹 Music
All music comes from Epidemic sound.
🎥 Stock Footage
Via Pexels.com
A big drawback is that Canada is not encouraging international medical graduates to participate in the match. I'm sure IMGs will fill vacant positions for family medicine. The reason IMGs can't participate is because the match requires applicants to be PR/Citizen, whereas this is not the case in US. Canada has made it simpler for those who aren't doctors to immigrate. Immigration is going up, but doctors immigrating is very rare. They should accommodate IMGs who aren't PR/Citizens into residency programs.
Hi Pranathi, thanks for this comment :) my follow up would be to ask if getting rid of the PR requirement would help or hurt the fear that IMG doctors would take Canadian positions and then leave without notice? From casual discussions that I've had, it seems like the thought behind the PR/Citizenship requirement is such that it prevents IMG doctors from working in Canada for a short time and then using this experience as a springboard into the American system where it is perceived that doctors will make more money. Ideally any policy that replaces the PR requirement would need to ensure that we keep doctors working in Canada
I think it is not that they would go to America for more money but they go because getting match into residency is much more easier in America than Canada
That’s not even the entire problem. Even IMGs who are citizens and PR find it difficult to get residency spots in Canada. This is ridiculous.
As a pre-med, it feels like I'm fighting to get into med school. Why do they make it hard as hell to get into it, if they need more Drs
because this job is not a joke, it needs to have the best of the best to reduce as low as possible the margen of error. Errors could mean deaths.
@@MD-rw6uh This is not the reason at all🙄 doctor shortage is mainly caused by lack of residency spots, the number of medical school acceptances has actually increased quite substantially over the years. The reason it’s so competitive is because there are just so many people applying; it is a factor of demand, not difficulty. It is incredibly expensive to train a med student so it takes a lot of time in order to make more spots. Needs to be new facilities, equipment, etc in order for new people to be able to be trained. It’s competitive so med schools choose the best, they don’t make it competitive purposely
@@pyrohead3166 who's talking about residency? 😅😅, Physician in general, to get into the medical school, not the residency to become a specialist with the one or tow you say are accepted. Doctors, are many (even if there are not enough in some countries) and it's matter of studying hard and to be disciplined, not even "intelligent", just disciplined. Let's roll eyes together 🙄🙄🙄,... 😁😁😂😂😂
@M D I see your point but have you considered that even the most experienced are leaving medicine possibly being overworked and burned out? . Sooner or later there's going to be even a more pressing issue of shortages than it is now. It's going to affect everyone. What do you think? I would like to hear your opinion
@@bozardo101 who´s talking about dropout rates? the first comment was done about why it´s difficult to enter to the medical school nothing else ... of course healthcare workers are most of the time burnt out and some leave the career, I am one of them, but I just take gap years every 5 years as a doctor to take a breath, that´s not a secret,.. but it doesnt mean that the entrance to the medical school should be easier to have more in quantity, in medicine quantity doesnt matter but quality... one of the reasons we burn out is the lack of professionalism form others, we are that kind of people who prefer to do things on our own instead of leaving the duty to others if they show inability to finish the task, hence, the more incapable people , more the stress added to the workers.. so yes, we are burnt out because we work with human beings not with electronic gadget and we need to be the best we can not just be there to make presence and to say "we are enough". Then if everyone who wants is just accepted without really been suitable and there is no a shortage as you say , but is full of people making mistakes , then who is going to be more affected? just tell me haa... The entrance is difficult as it should be, if there is a capable person trying to enrol in Medicine he/she will fight and dedicate their time and effort to enter till it´s done, but if they have the ability, the capacity they will do, if no, it´s better to step apart. Since the beginning it´s a continuos hard work in Medicine, so the ones who really can and are committed will do it. Not for nothing even psychologic tests are made to determine the suitability of a person for each specific job...things in life should be more scientifically guided not just because of romantic ideas from the public. Desperate movements of people without knowing , even without thinking. 🤦🏼♂God forgive them because they dont know what they are saying , amen. 😉
I wonder if part of the reason people don't go into family med/gp is having to deal with the business side. That part of medicine isn't taught. You need to be business savvy to do well. So, maybe schools could work on free teaching after people match. So that once they are out of residency, they can manage the business side.
I love this idea :) It's something that I've been trying to work out for myself lately and one way or another, I hope that I can contribute the final project in a few years time
Making the process easy for imgs will really help in curbing with the problem of doctor shortage. A lot of doctors from other countries are really interested in practising in us or canada. The only problem is they are too reluctant because of the difficulty and financial requirements that are needed to atleast apply for residency. Look at the number of engineers that immigrate every year. It's way easier for them to come and find a job compared to doctors because of the factor of certainity that they will atleast get some or the other job. I get why imgs are not taken that easily but people have to remember that there are very qualified doctors in other countries too who can come and learn the system in either us or canada and can apply. But the uncertainty of whether they would get a position or not is a big factor for people to not apply.
The physician shortage is scary. My family doctor of 30 yrs retired and I had a terrible time finding another practitioner. At the time I was rehabbing from a severe shoulder dislocation so needed a doctor. Also we are facing an acute nursing shortage the likes of I haven't seen in.my 30 yrs at the bedside. My granddaughter is 13 and wants to become a doctor. Watching your videos it scares me to think about what she's going to have to go through to get into medical school. She's a smart kid.
Hi Lisa, that’s a story that I hear and see a lot actually. A doctor that I work with has a patient roster of about 3000 patients. He’s over 70 years old now and looking to retire but is having a difficult time finding someone to see his patients so he’s been holding off on retiring.
Best of luck to your granddaughter, I’m sure she’s a smart kid :) stay well
School for 10-15 years and tuition rates on the rise probably deter most of the population from ever trying to go to medical school here in the United States
I would agree with you Joy. While I'm sure there are solutions to limit tuition cost inflation, I have yet to work out the 10-15 year education problem
I definitely do believe a physician shortage is a real problem. Working at a pediatric clinic in a suburban community, I regularly hear from parents that A) They cannot find a reliable a family doc to transition their child to OR 2) Difficulty getting a pediatrician to see their child. I think we need to start looking into ways to incentivize moving to or working in rural communities. I am unsure if there are pre-existing programs but having loan forgiveness or startup clinic incentives for people who work in rural areas for ex. 10 years, could potentially encourage them to stay there. Even offering rural clinic-academic centre collaborations (ex. Requiring big hosp. docs to work one day/week in rural communities or spend a full season there with financial support from the govt would be great). After working a medical assistant and I have realized how much I enjoy the clinic setting and working longterm with patient, pushing me to choose family med/pediatrics. I would love to hear your thoughts!
In India too we have doctors shortage but here government is opening more med colleges so that more graduates comes out f these med colleges and join the workforce ..I am too a doctor working in a medical college as assistant professor in department of psychiatry.not even a single seat goes vacant in new med colleges ..I think this can be done in your country too
Thank you for your comment Rohit - its always useful for me to learn about the medical education systems from other countries. Exploring more medical colleges is definitely something that I too would support
I feel like a huge reason why people don't match into family is because of pay. If the government paid students 300 K instead of the usual 200 K I think there would be a huge influx of people matching.
We’ll be able to test your hypothesis in the coming months now that family doctors in BC (and hopefully the rest of Canada) will be getting a very nice raise :)
Very good video. Hopefully I can be considered for the upcoming match and help with the crisis
Best of luck Gavin 🤞💪
I agree with quite a few points in your video, but I do think there are some nuances here that need to be considered - 1) training folks in rural/Indigenous and from rural/Indigenous communities needs to be considered in designing med programs/picking applicants - 2) I don’t know, as someone who worked in Moose factory, if I would give that community as a token example of physician shortages. There are many docs who have dedicated their lives to serving that community and there are many reasons they may not be in community anymore. And that community is a great example of an in-community nursing program. 3) Nursing is generally not referred to as allied health. Nursing is facing a massive shortage in Ontario- and if I have learned one thing in my decade as a nurse and now in med school- a lot of physicians undervalue/fail to recognize how wonderful nurses are. Nurses are grossly underpaid. I do think nurse practitioners and midwives are a huge solution for many communities- especially those who have a history of loosing trust in medicine, in providing primary care. Nursing and midwifery are family based careers- many people settle down in one place with these jobs. Makes for consistency. I do think overall we should move away from an us versus them solution in primary care-as many ppl care and are invested in making things better for these communities- regardless of profession. Follow @nursewithsign416 on insta to learn more about the Ontario nursing shortage - even some docs were working nursing shifts this past summer to cover! Thanks for starting the convo and allowing discussion!
Indeed - across the literature, the single most recurrent factor influencing family physician recruitment and retention to rural areas is *whether a person comes from a rural background*. Exposures to rural medicine during medical education border on negligible in their effects. Creating schools that are built with strong connection to rural areas and have an identity in that, such as NOSM, are not very common, but seem to be effective at capturing the right target applicants. Their training programs are focused on rural medicine, they emphasize recruiting rural applicants.. It's not the one and only answer, but I think these kinds of initiatives are a big part of the way forward.
Thanks for your feedback and experience Crystal :) I hope all has been well as of late
@@lumdisumdi Thanks for the expansion Davide. I received your email and will definitely give the paper a read sometime in the next week :) Looking forward to continuing the discussion
There isn't a physician shortage there is a physician ill distribution on the world scale there is a very long process of exams and licensing to like literally every country has its own long exam process to allow foreign doctors to practice medicine in the Country, solution is the WHO make an international licensing exam approved worldwide so that doctors can travel easily and work in places of need.
Thanks for your comment Amr :) One potential issue with that are many policy and legal issues that exist between countries. As someone who wrote both the American and Canadian licensing exams, I can attest to the fact that there are some pretty major differences between even relatively similar countries that may be hard to capture on a single standardized exam
I think that's the goal. I've read about this. It's extremely wise considering the world's migration issues right now.
Australia piloted a medical school program to address the need for rural and primary care doctors. This program has been adopted and implemented in various ways by other countries, including South Africa (where I am a doctor).
There are different facets to it:
1. Increase recruitment of medical students from rural areas - people who come from rural areas are much more likely to return to a rural area than what somebody from a big city is to go live in a rural area.
2. Train medical students in the rural or primary care setting (or at the very least, significantly increase their exposure). In South Africa (and Australia if I am not mistaken), you are a general practitioner at the end of university (6 year degree) and your 2 years of internship. By increasing the teaching time in a primary care or rural setting, it increases rural doctor retention.
So bottom line:
- Choose the people who are more likely to enjoy living in the under geographic shortage regions, to become doctors.
- Increase exposure to the rural and family medicine specialities in order to show students how diverse and amazing these specialities are, therefore increasing chances that medical students will choose these specialities.
Increasing compensation for these under staffed specialities wouldn't hurt either....
Our nation's population has grown, but our health care system, at least in Alberta, is stuck in the 80s. Not enough hospitals, not enough doctors, or rather, not enough skilled caring/compassionate/empathetic/intuitive and eager beaver doctors. I've seen three neurologists, a rheumatologist, a two gynecologists and my family doctor in the last two years. the only doctors that were decent and did their job were the gynecologists! the others are useless. I've been metaphorically screaming, begging, and pleading to get my family doctor or specialist to HEAR what I say--they don't and I keep getting worse. It appears they're more than willing to let me and others get to total disability state before they think about doing anything.
Train doctors that each and every patient needs to have their problems heard and not have the doctor just nod off.
Your opinion on encouraging students to get into under served specialties is right. Perhaps letting the province run family medicine clinics vs them running it would help
Your opinion on foreign trained nations, uhm, I'm not a fan because every foreign born/ trained doctor i have seen was beyond horrible. I found a family doc, but he's foreign born in the Middle East and his cultural bias against the west and Western women is very obvious. He medically gaslights me. His vommunication skills are pathetic. He thinks he's God. Other doctors, all from the Middle East are like him too. I'm trying to find a new doctor, but few to none are setting up shop--they're leaving instead.
Thanks for your comment Jeanette - its hard for me to comment on individual patient experiences with providers that aren't myself but unfortunately, finding a physician that's a good fit for you is incredibly difficult when shortages are so pronounced (as we're seeing right now). I've had similar discussions with family members and was recently asked "whether I'd rather have a bad doctor or no doctor at all?" I don't think that I have the answer here but I do like to think that everyone is trying their best - or in the very least, they should be. Best of luck and thanks again :)
Your presentation on this topic the pros cons was excellent. I live in Las Vegas. We do have a mass shortage in alot of areas. Part of the problems from Doctors I know well as I was a nurse for 20 yrs. Is the insurance companies! Most reimburse so low its shameful. Were so short I've personally watched multiple doctors burn out at young ages retire in there 40s to pursue other careers. Some pcp docs are forced to see 50 patients a day!. Here I think insurance companies need to be accountable. Not sure WHT I'm not getting all your videos. Drives me nuts
First of all, thank you very much for your professional insight.
Wouldn't it help if medical universities tried to accept medical students from rural areas? Upon graduation, they may feel more comfortable going back to a small town.
Also, the provincial governments should set up a tuition grant for going into family medicine and a higher grant for family medicine in a rural area.
A certain amount of years would have to be committed.
I agree with you about the IMGs idea, but I think it's a sort of exploitation for them if they will have only family medicine as a specialty to choose from, I think if all the infield positions will be given to the qualified IMG it will be okay. Otherwise, it's all about motivation, in the rural areas, physicians didn't like their extra work activities cause the zone is underserved, life there is boring it's not all about money but also the lifestyle. Canada and the US are looking for quality medicine not only quantity and by quality, you will have a great care .
Thanks for your comment Wizzo - IMGs getting more access to family med is not meant to be exploitive but rather as a consequence of relative need. Most specialty positions are readily filled by Canadian students in the first round. Because medical school in Canada is government subsidized, it is in their best interest from a financial perspective that these students get priority to positions in many cases
As a med student we already soo much in stress even in first years most of the student I see drop out or choose another major because we have no time to take care ourselves like mentally and physically instead we put a lot of time on studying.
I am 66 and mostly retired myself an living in Ireland. I am trying to do something in getting solutions and then lobbying politicians to solve the problem. Obviously interesting as it shows the problem in US and Canady is impacting and increasing problem in Ireland as many Irish Doctors are choosing to go to work in Canada and US. Interesting to see why doctors are moving from family medicine to other areas . The incentive idea is very good and at least is a starting block to a complex problem.
Kindly make a video for entry into surgical programmes for IMG students and for how much percentage Canada is offering to img student in every field like general surgery /Neurosurgery/plastic surgery/thoracic surgery etc thank u
In the Midwest (US) where I live nurse practitioners are taking all the family medicine positions, way cheaper for the hospitals and they graduate hundreds of thousands each year (they are 2 year part time online programs so they can continue to stay in their community and work a bit and raise their families)
Hi Cathy thanks for the reporting - fortunately for myself and the other fam doc residents in my area, this isn't a problem. I'll do some more research into what many have called "mid-level creep" and might do a follow up in the future.
Yes definitely mid level creep and I am aware of all the arguments why it’s not exactly the ideal solution but honestly with our US Med school tuitions at $300,000 ave it’s sort of like well I can be family practice for $200,000 salary or I can go 2 more years for that specialty (endo in my case) to make $400,000 salary (I am a diabetes educator with many years experience) this is what my dilemma is
I m pretty sure majority prefer to be seen by a family doctor than a nurse practitioner. Nurse practitioners cant replace family doctors. They are just complementary
@@mah11sa yeah you’re wrong I’ve been in healthcare for the past 25 years in Mn, is, nd, sd and here in the middle of no where it’s all NPs for family medicine
I think the solution is to increase the number of seats in medical universities(schools) ...in this way more Canadian trained doctors will be ready...IT will be a win win situation for students and hospitals....
Money, if you pumped the FM salaries by 20% you will see 20% increase in applicants, increase it by 50% you get 200% increase in applicants to FM.
It's definitely possible that happens. I don't know if we could afford to do that with Canada's current funding models but I don't doubt the financial incentive strategy 🤙
100% this is it. its no mystery that the trend of competitive specialties mirrors the trend of highest salaries lol
And me, a Doctor lying down on my confortable sofa, without a job, taking a break from my hectic doctor life , watching a video about the need of more doctors 😅,,... let´s take a good breath 🌴🍹
Hi :) you leave a lot of context out of that comment but I’d love to know more! Are you an IMG who is currently in the process of doing the Canadian transfer exams and reapplying for residency? Or are you a Canadian trained physician that for some reason cannot find work? I do not know of any Canadian trained physicians who cannot find a job somewhere in the country right now. Please expand as I’d like to know more and maybe make a follow up video in the future
@@nxtgenmd 😅hehe no, I am not a Canadian doctor or an IMG trying to enter the canadian system... Yes, I am an IMG who has worked around 10 years in my home country and overseas almost always in the ED , so it´s quite stressful from time to time and I need to take months to rest so that I dont become crazy, more.... but I love medicine. maybe masochism. 🙊😅😅
In the US, 50k+ students apply annually and there are only 22k spots........so we turn away 30k people away every year.....
Similar story here unfortunately. The numbers in the states are larger but it seems that we're in the same boat
I think significant tax cuts / increased compensation for areas deemed to have the biggest shortages is the easiest thing the government can do. Not sure if they care that much though or understand the value of FM docs vs PA’s etc. I worry what’s going to happen to the medical system once all the baby boomers retire and our tax payer base shrinks a ton. Where will we get the revenue to pay the healthcare system, partial private care could alleviate this but it would be unfortunate to lose universal healthcare in Canada.
Although Australia seems to have a public and private system and I think it works decently well for them from what I’ve heard
The question the way I see it is how do we get the unmatched doctors to get mandated to match to family medicine and after so many years in FM they will be given there chose of the specialty they wished to match and not lose this unmatched Doctor to the other available avenue that they can branch out too. Just a idea, thanks
@@marcello7993 I agree, I don't believe you can really force anyone to do anything especially highly educated people who value their career freedom. I think monetary incentives is generally the way to go. Any specialty will drop off the competitive ranks if money and jobs are harder to come by than others (look what happened to rad onc in the states). If FM docs were making as much as Toronto surgeons just by practicing out in north bay people would go.
They already have ROS contracts for IMG's in most provinces (Ontario being the strictest) and from what I've seen it pushes a lot of the top candidates to the states for training.
@@marcello7993 Good idea Marcello :) as a current family medicine resident, I wouldn't want to switch down the road and I feel like this would cause a lot of doctors to leave family medicine which might worsen the problem. But its a good thought exercise to think about, especially if we were to for example, give all newly graduated medical students a general license and then allow them to sub specialize after completing generalist training
6 million Canadians without a family doctor?! Am I reading that right?? WHAAAAAT I need that article if you have it pls n thx
Sure thing Gameel :) I'll link it here: www.ctvnews.ca/canada/6m-canadians-don-t-have-a-family-doctor-a-third-of-them-have-been-looking-for-over-a-year-report-1.6059581
It's a 2022 article from CTV and truthfully, I'm not sure if the way that they've reached their figures are the best. However, even if we conservatively round downwards, the number is in excess of hundreds of thousands
In Surrey British Columbia..family medicine doctors shortage
BC's family medicine shortage is on an entirely different level than what we see here in Ontario. Definitely some changes that need to be made out that way in support of running family medicine practices
most docs and nurses are leaving the hospital industrial complex due to being worked to death and violating "do no harm"...
Let's see if this shortage is for real...there is an ideal amount of doctors needed versus what we can function on! Is the shortage based upon what's ideal or what's functional? They are hiring NP'S to take on workloads supervised by an MD to help out.
It takes 9 years after high school to be a GP in Canada and USA perhaps this is to be looke into , in E its 6-7 years
Form a bridge program where PAs can only become PCPs. With a curriculum formed by current PCPs. Not every PA wants to be a doctor but it’ll give those that still want that opportunity to become one.
Verry good video
Thank you :)
I really like u so much.
I think what would be great is have the Public Service Student Loan Forgiveness program be available to primary care and emergency medicine physicians. They are serving the public… sooo why not?
Whatever is done, it is coming a bit too late. I used to wonder why it was so complicated to get into nursing, well too many people applying and not enough space, i remember a time where even a 3.8GPA would not get you a spot in nursing school at Ottawa U. Now they are offering all kinds of bursaries and guess what, people are not interested after seeing that working in the medical fields also puts you at risk of being a Guinee pig for whatever new jab is manufactured and that big *farma is able to push it pas our politicians. Secondly, the ones being admitted are either changing majors, dropping out or choosing to not go anywhere near bedside nursing where they are most needed for example, LTC. You could not pay me enough to go to Long Term Care, I'd rather go work at Costco and take a pay cut stocking bread so long as it comes with benefits. Hiring internationally is not a solution. Been there, done that. eventually they would seek a quality of life and either quit or worst case scenario, you have a Dr who is not interested in the job at all, putting the patient at risk of all kinds of problems. I am all for increasing space in med school particularly for nurses, yes I am biased lol.
Why don’t areas that need PCPs offer $$$?
I avoid modern healthcare.. people seem to only die when they go to hospitals,