Credentialing and retention of visa trainees in post-graduate medical education programs in Canada.

BACKGROUND: Visa trainees are international medical graduates (IMG) who come to Canada to train in a post-graduate medical education (PGME) program under a student or employment visa and are expected to return to their country of origin after training. We examined the credentialing and retention of visa trainees who entered PGME programs between 2005 and 2011. METHODS: Using the Canadian Post-MD Education Registry's National IMG Database linked to Scott's Medical Database, we examined four outcomes: (1) passing the Medical Council of Canada Qualifying Examination Part 2 (MCCQE2), (2) obtaining a specialty designation (CCFP, FRCPC/SC), and (3) working in Canada after training and (4) in 2015. The National IMG Database is the most comprehensive source of information on IMG in Canada; data were provided by physician training and credentialing organizations. Scott's Medical Database provides data on physician locations in Canada. RESULTS: There were 233 visa trainees in the study; 39.5% passed the MCCQE2, 45.9% obtained a specialty designation, 24.0% worked in Canada after their training, and 53.6% worked in Canada in 2015. Family medicine trainees (OR = 8.33; 95% CI = 1.69-33.33) and residents (OR = 3.45; 95% CI = 1.96-6.25) were more likely than other specialist and fellow trainees, respectively, to pass the MCCQE2. Residents (OR = 7.69; 95% CI = 4.35-14.29) were more likely to obtain a specialty credential than fellows. Visa trainees eligible for a full license were more likely than those not eligible for a full license to work in Canada following training (OR = 3.41; 95% CI = 1.80-6.43) and in 2015 (OR = 3.34; 95% CI = 1.78-6.27). CONCLUSIONS: Visa training programs represent another route for IMG to qualify for and enter the physician workforce in Canada. The growth in the number of visa trainees and the high retention of these physicians warrant further consideration of the oversight and coordination of visa trainee programs in provincial and in pan-Canadian physician workforce planning.

Assessing the prospects for physician supply and demand in Canada: Wishing it was rocket science.

"It's not rocket science" is an often used phrase to describe tasks that are not very difficult. Although rocketry has proven to be an exacting science with highly predictable results, the same cannot be said for physician workforce planning in Canada. The "boom" in physician supply in the 1960s and 1970s was followed by a "bust" in the early 1990s and a further boom in the 2000s. A large generational shift in the physician population is anticipated between now and 2030; the proportion of "boomers" (1946-1964) will drop from 43% to 16% of the practising profession. Canada has not been alone in increasing physician supply. Any judgement as to whether too many or too few physicians are being trained must consider the drivers and mitigators of both supply and demand. Although there are current concerns about a shortage of practice opportunities for some specialties, the available data do not indicate a physician surplus on the horizon in Canada.

Report of the Canadian Neurological Society Manpower Survey 2012.

BACKGROUND: The Canadian Neurological Society commissioned a manpower survey in 2012 to assess Canadian neurological manpower and resources. METHODS: Surveys were sent electronically to all Canadian neurologists with available email addresses. Responses were analysed for effects of physician gender, age, geographic location (eastern or western Canada) or type of practice (academic, community). Questions focused on work patterns, neurologic conditions treated, access to or performance of procedures, and service and manpower issues. RESULTS: A total of 694 of 854 neurologists in Canada were surveyed and 219 (32%) responded. Respondents were 70% male with mean age of 50 years. Neurologists worked an average of 57 hours/week and saw a mean of 40 patients per week. There were significant differences in number of patients seen, types of practice, and areas of neurological specialization between community and academic neurologists. Fifty percent of neurologists report shortages of neurologists in their community, particularly of general adult neurologists. Wait times for neurological services exceeded international standards for consultations and also were longer than Canadian averages for other specialists. More community (18%) than academic (5%) neurologists planned to retire within the next 5 years. CONCLUSIONS: The demand for neurological services continues to outstrip resources despite the increased number of neurologists. Impending retirement of community neurologists will exacerbate manpower issues unless adequate numbers of trainees choose general neurologic practice in the community as a career.

The results of the first Canadian national physician assistant survey.

The first Canadian physician assistant (PA) survey was done in 2010 and used to establish baseline information on Canadian PAs' educational background, practices, role, responsibility, and satisfaction with their careers.

The call of the Canadian physician.

The 2007 National Physician Survey shows that 70% of physicians are on call each month. Slightly fewer female and family physicians are on call compared with male physicians and other specialists. A higher proportion of physicians under the age of 45 take on-call duty, see more patients while on call and provide more patient care than do those over 45 years. But the older doctors--both family physicians and other specialists--are on call for more hours each month than are their younger colleagues. Physicians in group or inter-professional practices are more likely to have on-call responsibilities, but they do fewer hours each month than do those in solo practice.

Ophthalmology human resource projections: are we heading for a crisis in the next 15 years?

BACKGROUND: Ophthalmology residency positions have increased in recent years. This study looks at whether the expansion is enough to avoid shortages in the future. METHODS: The Canadian Medical Association Physician Resource Evaluation Template was used to project the supply of ophthalmologists up to 2016, assuming a status quo scenario in terms of attrition and gain factors. RESULTS: The ratio of ophthalmologists to population is steadily declining but not as fast as previously projected. INTERPRETATION: With the scenario presented, the supply of ophthalmologists will be inadequate in the future. Expanding Canadian residency training programs to their maximum capacity will maintain the current national ophthalmologist-to-population ratio but will still not be enough to meet the demand for ophthalmology services because of the shift in demographics as baby boomers age.

Medical workforce policy-making in Canada, 1993-2003: reconnecting the disconnected.

The authors set out to review Canadian medical workforce policies for 1993 to 2003 and assess if data existed in the 1990s that could have reversed the policy decision to curtail the supply of physicians from Canada's medical schools just as Canada was about to experience a developing shortage. The authors reviewed existing descriptive data sources regarding Canadian physician workforce size and activity from 1986 to 2003, including the Canadian Medical Association workforce database. The review indicated that a significant loss of physicians to retirement was imminent. Physician workforce productivity had started to fall by the early 1990s. Emigration to the United States had risen above traditional levels in the early 1990s and remained higher into the late 1990s. Despite these existing findings, an integrated adjustment to physician workforce policies taken in 1993-94 only occurred after 1999. The authors recommend that policy makers and managers must monitor the numbers from existing sources. To optimize these sources, planned data tracking and linkages are essential. The period in question demonstrated major disconnects in coordinating implementation, wherein subject experts monitoring data trends were not adequately utilized by policy makers. Finally, in complex systems with regional differences, policy decisions based on normative data are insufficient.

Highlights of the 2002 Canadian Neurological Society (CNS) manpower survey.

BACKGROUND: The Canadian Neurological Society commissioned a manpower survey in 2002 to assess demographics, distribution, specialty interests, working conditions, job satisfaction and future plans of neurologists across the country. METHODS: A survey was mailed to all known Canadian neurologists (n = 694) on two separate occasions. Further encouragement by telephone contact was undertaken. The response rate was 54%. RESULTS: The mean age of neurologists who responded was 51 years, with 14% being women. Approximately 55% of neurologists were community-based. Seventy-six percent designated a sub-specialty interest. On average, neurologists worked 57 hours per week and the majority had significant "on-call" commitments. Job satisfaction was higher among academic neurologists when compared with community-based neurologists, and greater among men than women. A greater percentage of older neurologists were satisfied with their work than their younger colleagues. Significant attrition in the neurological work force is a major concern, since up to 20% of neurologists reported that they are likely to retire in the next five years and about 15% are likely to reduce their practice. CONCLUSIONS: This survey suggests that substantial concerns are facing Canadian neurology over the next five years. Major efforts to retain existing expertise and enhance residency training will be required to simply maintain the present quality of neurological care in Canada.

First practice: family physicians initially locating in rural areas.

INTRODUCTION: This paper quantifies the proportion of family physicians in rural practice and, in particular, initial rural practice. It examines differences between graduates of Canadian and international medical schools. METHODS: The Canadian Medical Association postal code master file was used to determine the distribution in rural practice of Canadian and international medical school graduates for every other year from 2000 to 2011. The master file maps practice postal codes into a census metropolitan area or census agglomeration; physicians practising outside these areas are considered rural. Initial practices were estimated based on year of undergraduate medical degree. RESULTS: Two-thirds of family physicians practising rural medicine in 2011 were graduates of Canadian medical SCHOOLS. However, between 2000 and 2011, a greater proportion of international medical graduates were practising in rural areas than graduates of Canadian medical schools. International graduates were more likely to initially locate in a rural area, but the drop-off rate was greater among them than with graduates of Canadian medical schools. The proportion of international medical graduates setting up rural practices was decreased among more recent graduation cohorts. The proportion of Canadian medical school graduates initially practising in rural areas was steady. CONCLUSION: The results of this study suggest that graduates of international and Canadian medical schools treat rural practice differently. International graduates may decide on a rural location as a means to set up practice in Canada or fulfill a return-of-service obligation, whereas graduates of Canadian medical schools may make a conscious choice to practise in rural locations. Decreasing proportions of international medical graduates in rural practice may be a result of increased opportunities for Canadian postgraduate training and full licensure.

The landscape of ophthalmologists in Canada: present and future.

OBJECTIVE: To describe the current national and regional population distribution of ophthalmologists in Canada and provide national predictions up to 2030. DESIGN: Cross-sectional, study. PARTICIPANTS: Ophthalmologists listed in the Canadian Medical Association (CMA) database and Canadian population. METHODS: The CMA database was used to determine the number and location of currently licensed ophthalmologists in Canada. Using Statistics Canada population data, we determined the ratio of ophthalmologists to 100,000 population. Projections were also made for the supply of ophthalmologists up to 2030 using the CMA Physician Resource Evaluation Template and assuming a status quo scenario in terms of attrition and gain factors. RESULTS: In Canada, there are currently 3.35 ophthalmologists per 100,000 population. There is, however, significant regional disparity; provincial ratios vary from 5.40 (Nova Scotia) to 1.96 (Saskatchewan) and 0.89 in the territories. If 3 ophthalmologists per 100,000 is the ideal ratio, then 4 provinces and the territories were below this ratio, and of the 104 regions with an ophthalmologist, 22 were below the ratio. The national projection to 2030 is a slight increase to 3.38; however, the full-time equivalent ratio is expected to decrease from 3.29 in 2012 to 3.06 in 2030. For the population ≥ 65 years old, with a projected growth 4 times greater than that of ophthalmologists, the ratio of ophthalmologists to population ≥ 65 years old is projected to decline by 34%. CONCLUSIONS: Although national estimates appear stable, there is significant regional variation. The projected marked growth of the population ≥ 65 years old may compromise our future ability to provide care at the current standard.

Recruitment trumps retention: results of the 2008/09 CMA Rural Practice Survey.

INTRODUCTION: In 2008, the Canadian Medical Association (CMA) conducted a survey of rural practitioners. The survey covered incentives to choose rural medicine, current satisfaction, plans for future migration and strategies for retention. METHODS: The CMA Canadian Collaborative Centre for Physician Resources, in collaboration with the Society of Rural Physicians of Canada, surveyed 1960 rural practitioners and received 642 responses (33% response rate). Because of similarities with earlier surveys, longitudinal analyses were possible. RESULTS: More than 70% of physicians older than 45 years received no incentives for setting up rural practice, compared with 41% of younger physicians. Younger physicians attached greater importance to financial incentives than older physicians, but personal incentives, such as accommodations in the community, were also important. The opportunity to practise one's full skill set was considered important (84%) as was liking the lifestyle (82%). One in 7 (14%) respondents planned to move from their communities within the next 2 years. They reported they might stay if they had a more reasonable workload, professional backup and locums. CONCLUSION: Although increasingly common, cash incentives are not the main reason physicians choose rural practice. Practice and lifestyle factors are even more important. Communities need to focus as much on retention issues to protect their investment in the long term.

Analysis of international migration patterns affecting physician supply in Canada.

This paper analyzes the migration patterns of both Canadian medical school graduates and international medical graduates (IMGs), and the impact of these patterns on physician supply in Canada. Immigration patterns of IMGs have changed over time, with fewer physicians from the United Kingdom and more from South Africa. A large portion of IMGs who leave Canada (43%) return "home." Recently, the average duration of practice in Canada for these doctors has been three years, a finding that suggests many came for educational purposes or to acquire skills. The heterogeneity and complexity of international migration are highlighted in this paper.

Intergenerational differences in workloads among primary care physicians: a ten-year, population-based study.

Analyses of population-based services and surveys in Canada from the early 1990s and early 2000s indicate that younger and middle-aged family physicians carried smaller workloads in 2003 than their same-age peers did ten years earlier and that older family physicians carried larger workloads in 2003 than their same-age peers did ten years earlier. Yet family physicians in all age groups worked similar numbers of hours in 2003. Intergenerational effects are similar for male and female physicians, although feminization of the workforce will affect supply, as a result of the falling service volumes delivered by women.