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Monthly Archives: December 2013

International Physician Job Market Changes Hitting Home in Canada

Starting in 2013, some graduating Canadian Sub-Specialists found themselves competing for jobs in an apparent decreasing job market, particularly in Canada’s major urban centres of Vancouver, Calgary and Toronto. Consequently, some are now seeking jobs, both permanent and locum, in Canadian tertiary hospitals in smaller urban centres, the USA and overseas.

At the same time, CanAm is experiencing a significant increase in Family Physician/GP and Specialist employment applications from overseas, particularly from the UK. We assume that a major contributing factor is the predicted quadrupling of the UK GP vacancy rate in two years resulting in UK practices facing a recruitment crisis – https://live-canam-blog-site.pantheonsite.io/with-the-gp-vacancy-rate-quadrupling-in-two-years-uk-practices-are-facing-a-recruitment-crisis.

These employment shifts have resulted in increased hiring options for Canadian employers, specifically, a growing preference for Canadian trained applicants. However, there is also keen interest in overseas applicants that have wisely taken the initiative to revise their credentials to meet Canadian standards.

Those overseas applicants that revise their credentials are experiencing a significant increase in their Canadian employment options, which in turn ensures that other applicants are less likely to receive preferential selection treatment, – which in turn ensures that the physician’s career transition and their family’s relocation to their new home are better managed, less costly, more timely and much less stressful for all.

The increasing complexity associated with the verification of medical training credentials, scheduling of Canadian assessment examinations, applying and qualifying for appropriate Canadian certification status, deciphering provincial licensing policy, and navigating the Canadian immigration system – can quite literally be a daunting endeavour, and a potential recruitment deterrent.

CanAm highly recommends that any western trained physician considering a career move across any international border – should do their research and partner with a reputable, professional recruitment firm with a proven track record in international and domestic medical recruitment success.

CanAm Physician Recruiting still has the pulse of the physician recruitment market, and remains the first choice to guide physicians and their families in their quest for new careers world-wide. To get the most up to date information about the Canadian and international physician recruitment market go to – www.canamrecruiting.com.

To see new and exciting physician job opportunities across Canada, the USA, the Caribbean, New Zealand and the Middle East go to – https://www.canamrecruiting.com/JobListings.php.

CanAm Job Posting of the Month – Emergency Medicine Physicians (3) – Tertiary Trauma Centre in Teaching Hospital – $193 – $222/hour

We are seeking team-oriented and professional Emergency Medicine Physicians to be part of our dynamic and expanding Emergency Medicine department affiliated with a 600+ bed tertiary care teaching facility located in the capital city .

Full-time positions-provide coverage for all shifts in an established rotation that averages 32 hours per week. Emergency services are provided 24/7.

The position also includes the opportunity for involvement in research and academic pursuits; a clinical appointment with the University Medical School would be encouraged.

Hospital Statistics:

  • 2011-2012 Admissions 34,500
  • Average length of stay (days) 7.0
  • Births/newborn admissions 4,000
  • Emergency visits 109,000
  • Radiology procedures 116,750
  • Ultrasound procedures 27,877 30,913 30,560
  • Mammography procedures 6,900
  • MRI procedures 13,600
  • CT procedures 80,500
  • Nuclear medicine procedures 8,500

The Health Region is one of the largest and most integrated health care delivery systems in the province, and provides tertiary care services via two major hospitals serving a population of more than 450,000 residents.

Click here now to learn more about this prestigious clinical and academic career opportunity – https://www.canamrecruiting.com/ViewJob.php?JobID=817.

With the GP vacancy rate quadrupling in two years UK, practices are facing a recruitment crisis

Four years ago it would have seemed ludicrous to predict a shortage of GPs to fill partnerships and salaried posts in the UK.

Deaneries were warning GPs to expect unemployment after training, with reports of 50–80 applicants for every full-time role in some areas. Pulse even launched a ‘One Voice’ campaign calling for contractual changes and incentives to make it easier for practices to take on extra partners.

But fast-forward to 2013 and the profession is facing a very different jobs market. Many GPs are now complaining of a ‘dramatic’ reduction in the quality and number of candidates for vacant partnerships and of rising locum costs.

As practices struggle to cope with rising expenses, below-inflation funding awards and a huge shift in workload from hospitals into primary care, they are finding it harder to recruit GPs to share the load.

Rising vacancies

A Pulse snapshot survey of 220 practices, covering around 950 full-time positions, reveals the full extent of the problem.

The results show an average vacancy rate for all full-time-equivalent GP posts in the practice of 7.9% in January 2013 – almost double the 4.2% figure found in a similar Pulse survey in January 2012, which itself was twice the official figure of 2.1% at the start of 2011.

GP Vanacy Rate - online

There’s no doubt that, for practices looking to take on GPs, the quadrupling of the vacancy rate in just two years is causing real problems. Dr Peter Swinyard, chair of the Family Doctor Association and a GP in Swindon, says: ‘It is immensely hard to recruit. This is the experience of a lot of the doctors I have talked to. We are on our second firm of headhunters now, at significant expense, to fill our vacancy.’

Dr Anne Crampton, a GP partner in Crowthorne, Berkshire, says there were 30 applicants when her practice advertised a partner post three years ago, but only five for a similar post this year. She says: ‘I don’t know why general practice seems to be so unpopular. This difficulty in recruiting came as a complete surprise.’

‘We are on our second firm of headhunters now, at significant expense, to fill our vacancy’

Dr Peter Swinyard

Dr Malcolm Kendrick, a member of the GPC’s sessional executive committee and a salaried GP in Cheshire, says there has been an ‘absolute’ turnaround from the situation five years ago.

Recruitment is not such an issue in Scotland, Dr Kendrick adds, but rural practices in Wales are struggling to take on partners.

GPC deputy chair Dr Richard Vautrey says the problem has been a big concern at the BMA contract roadshows: ‘Wherever we have been, GPs have been telling us there is a recruitment and retention crisis. It is starting to happen now.’

The recruitment crisis comes at a particularly difficult time for practices, with CCGs taking over commissioning responsibilities and the new GP contract hiking up practice workload from April.

The difficulties practices are having in filling vacancies are also having a financial impact. In the Pulse survey, practices reported an average increase in locum costs of 9.5% over the past 12 months, on top of the further 9% increase seen in 2011.

Portfolio careers

So why are so few GPs applying for jobs? Official figures from the NHS Information Centre show there was a slight fall in the number of GP partners in 2011 – 27,218 – compared to 2001, when there were 27,938. By contrast, the number of consultants rose sharply from 27,782 in 2001 to 39,088 in 2011.

However, the total number of practising GPs has increased by an average of 2.3% annually since 2001, from 31,835 to 39,780. In other words, fewer GPs are taking the route into partnership, instead remaining salaried or locums. However, unlike in 2009, when competition for partnership vacancies was fierce, this now seems to be through choice.

Dr Crampton says: ‘Nobody wants to work full time. Initially, we wanted a nine-session partner.

‘What most GPs seem to want to do now is part-time general practice and part-time GPSI work – clinical assistants, out-of-hours work, that type of thing.’

Dr Kendrick agrees partnerships are widely seen as unattractive: ‘There is a lot of uncertainty about the contract imposition, falling income and people seeing partners working ridiculous hours.

At the other end of the scale, GPs are increasingly considering early retirement as the demands of the job pile up. Exactly half of the respondents to Pulse’s survey said they were thinking of retiring early. Many cited workload as a key reason for considering early retirement.

Dr Swinyard says: ‘We’re seeing more and more principals saying: “Sod this, I’m going early”. Some take roles working as locums for the last few years of their practice lives. It’s a shame to lose the wisdom of senior people – you cannot replace that.’

Looking to the future

The Department of Health has recognised that more GPs are needed for the NHS to function, with former health secretary Andrew Lansley last year setting out a plan to boost the number of GP trainees by 20% by 2015 in England so that GP registrars would make up 50% of the specialty training places (up from 41%).

But this drive is floundering. Figures from the GP National Recruitment Office (GPNRO) last summer showed there were 2,693 GP training places accepted in England in 2012, which actually represented a net decrease of three compared with the previous year.

‘There is a significant imbalance in the workforce at junior level that has and continues to produce too many “-ologists” and too few generalists, especially GPs’

Dr Barry Lewis

This compares with a rise of almost 700 in hospital training places in England, with 4,725 places accepted, up from 4,034 in 2011. The proportion of GP trainees fell from 40% in 2011 to 36% in 2012.

A DH spokesman says: ‘The DH and Health Education England are currently working with key stakeholders to support the increase of training numbers in general practice.

‘A national GP taskforce has been established to support this work and make recommendations for increasing training posts to 3,250 each year.’

An unattractive proposition

According to the Committee of General Practice Education Directors, the struggle to recruit new GPs is down to an excess of hospital training places, rather than a dearth of GP ones. Chair Dr Barry Lewis, a GP in Rochdale, says: ‘We have expanded training steadily and have an expansion target for the next three years – there is no shortage of training places. We have empty slots in programmes, except in London and the South East.

‘There are not enough applicants because an excess of hospital specialty posts is still in the system.

‘There is a significant imbalance in the workforce at junior level that has and continues to produce too many “-ologists” and too few generalists, especially GPs.’

Research published last month showed that only 28% of medical graduates cite general practice as their first-choice career, compared with 71% who opt for secondary-care specialties.

Study leader Professor Michael Goldacre, a professor of public health at the University of Oxford, says there is ‘some cause for concern’ about this relative lack of interest in general practice from newly qualified doctors.

He says: ‘A much smaller percentage express a preference for a career in general practice than the NHS actually needs.’

The reluctance of many medical graduates to opt for general practice is not new. However, the Government is doing a poor job of encouraging people into the profession, says Dr Vautrey.

‘There is a feeling there are better opportunities for them in hospital or abroad,’ he says.

Dr Swinyard – still looking to fill his practice’s outstanding vacancy – says more must be done to encourage the next generation into the profession.

‘General practice as a whole is looking less attractive as a long-term career option,’ he says. ‘I still think this is the best job in the world, but it is becoming bloody hard to do it.’ (Reprinted from Pulse, December 24, 2013)

 

NHS England ‘almost burying head in the sand’ on GP workforce crisis, admits director

The deputy medical director for NHS England, Dr Mike Bewick, has admitted that they are ‘burying their heads in the sand’ on the GP workforce crisis.

Speaking at an NHS England ‘Call to Action’ event organised by Newham CCG and the London area team, Dr Bewick said the GP workforce problem was probably ‘the most pressing issue’ the NHS faced at the moment, but refused to link the problem to any erosion of pay.

It comes as NHS England last week rebutted calls for GPs to be given a pay rise above 1%, stating that there are ‘no compelling issues’ with recruitment in supplementary evidence to the GP pay review body, which had previously pointed out that there were problems with recruitment of salaried GPs in many parts of the country.

Answering questions from the floor at the NHS England event, Dr Bewick said there were ‘three elements’ of the GP workforce issue: ‘I think it one of the most pressing problems that we probably have and we are almost burying our heads in the sand. I think there are three elements of this… we are certainly not training enough, and I don’t think we are training enough that are going to be working full time.’

‘The second is about retention and we have got to do something to ease the burden. With the contract changes, one of the elements that we tried to pick up on was to reduce the burden and give headroom. It is a small token but I hope to keep you signposted on where we are going, into more broader outcomes rather than specific, granular outcomes, which will take away the burden.’

He also pointed to difficulties returning GPs, which is a priority of the new RCGP chair, Dr Maureen Baker.

Dr Bewick added: ‘Third, it is about bringing back people into the workforce, making it easier for people to return. We are looking at methods to do that.’

He also reiterated that NHS England intends to ensure that the right people become GPs, a point previously stated by NHS England’s head of primary care Dr David Geddes in an interview with Pulse.

Dr Bewick said: ‘Workforce planning… in this country, it really isn’t something that we are good at. I think that we are not actually choosing well at the basis of entry to medical school. We are not looking at people who want to serve their community as well as do medicine, and I think that we need to go back to the beginning of choosing of doctors because most of the reasons for why people are going into this has nothing to do with their local practices. We have got to get something out there which shows what a really wonderful job this is.’

‘We have got to go out to the schools, and it might mean that we have to do more workplace programmes with younger people to show that this is where you want to work for the rest of your life, because it is exciting, interesting and innovative.’

Speaking to Pulse about the issue of GP pay, Dr Bewick said: ‘The workforce issue is one about retention and recruitment. The issue about whether that is related to pay directly is probably very slim because we know people come into medicine for lots of other reasons other than just earning money. The issue that I think we have got to address is that many doctors are worried about the system at the moment and they are looking to leave it. We have got to make their workplace a better place to work in so that they don’t feel under so much pressure, and what we have been trying to do with the contract is to give them the headroom to do that.’

‘That was part of what I was trying to do today, to give them some confidence that NHS England is on their side to try and make change.’

Asked whether recommending a pay rise may have given GPs some confidence, Dr Bewick said NHS England would ‘rather’ GPs improved their model.

He said: ‘I’d rather we gave them resources to improve the service, which might actually decrease the amount of work on them. It would be very difficult in this situation, where you’ve got other parts of the workforce losing their jobs, and other parts of the workforce on virtually negative [pay development]. Particularly as GPs are not the worst-paid part of the system, I don’t think that would go down well with people in the health service who are on a more moderate pay either.’

NHS England has launched its ‘Call to Action’ to explain to professionals and the public why they think that primary care has to change its ways of working, and help CCGs shave £30bn off the cost of running the NHS. The call has been supported inresearch papers by the King’s Fund and Nuffield Trust, as well as the RCGP, which have said GPs must join together in federations for general practice to remain affordable and sustainable in the long term.

In Hansard … Rural emergency services in Saskatchewan and Manitoba

Saskatchewan

Last Thursday, on the last day of the fall session of the Saskatchewan legislature, the government was asked about reduced emergency services at a number of small rural hospitals, and Premier Brad Wall alluded to the two Collaborative Emergency Centres the government has opened, adopting the Nova Scotia model. “I think rural Saskatchewan and those communities are encouraged by this development. It speaks to the innovation we’re going to bring to ensure that rural Saskatchewan gets the health care that it deserves,” he said.

Manitoba

Rural hospital emergency services were again an issue in the Manitoba legislature last Thursday, also the last day of the fall sitting. Progressive Conservative MLA Wayne Ewasko said there are 20 ERs closed across the province with rural ambulances missing their targets almost half the time, a situation he said is bound to get worse with the suspension of the STARS air ambulance helicopter service while an external review into a number of mishaps is underway. Health Minister Erin Selby said the government is working with STARS “to see when we can best restore service.”

(Health Edition, December 13, 2013)

HealthForceOntario strategy falling short, AG says

Ontario has not met its goal of having the right number, mix and distribution of health-care professionals to meet its needs, Auditor General Bonnie Lysyk said in her 2013 annual report released this week.

This is despite $3.5 billion being spent on the government’s HealthForceOntario Strategy over the last six years.

The lion’s share of these expenditures have been on physician and nursing initiatives. Of the almost $740 million spent on the strategy in 2012-13, $505 million went to physician programs and $151 million was for nursing programs.

This is not to say that Ontario has not made progress in adding more doctors and nurses to the workforce. Ms. Lysyk noted that between 2005 and 2012 Ontario added 18 per cent more physicians and 10 per cent more nurses.

But she expressed concern that a significant number of new doctors are leaving the province, and many rural hospitals are permanently reliant on locum services to keep services going even though this is meant as only a temporary measure.

“It costs the province $780,000 on average to train a medical specialist, including up to five years of postgraduate residency training. But about a third of Ontario-funded graduates with surgical special¬ties—neurosurgeons and cardiac, orthopaedic, paediatric and general surgeons—don’t stay and practise here,” Ms. Lysyk said in a news release.

The report also included a follow-up of value-for-money audits on alternative funding arrangements for physicians. These were the subject of a highly critical report by the previous Auditor General in 2011.

That report found that family physicians were making millions of dollars in capitation fees without always making good on promised services such as after-hours care. It also revealed that the health ministry did not have a handle on the alternate funding it was providing to specialists.

Two years later, Ms. Lysyk said the ministry has made some progress in implementing recommendations in the 2011 report but it remains a work in progress “such as monitoring the frequency and nature of physician services provided to patients, tracking the average amount paid to a family physician participating in an alternate funding arrangement, reviewing the impact of enrolment size on patient access to care, and reviewing the impact of existing financial incen¬tives on hard-to-care-for patients.”

For specialists, Ms. Lysyk said incorporating performance measures into contracts will depend on future negotiations with the Ontario Medical Association.

The Auditor General’s report also surfaced a lack of coordination within the hospital rehabilitation system, an inconsistency in land ambulance services across the province, and a general failure of the province’s Health Schools Strategy. Many students are spurning healthier food choices in schools and heading for fast-food joints instead. The report can be found at www.auditor.on.ca/en/reports_2013_en.htm. HE

Medical mistake registry coming in Nova Scotia – Health authorities will have to report mistakes within 12 hours

The Nova Scotia government is moving closer to a province-wide system of reporting medical mistakes.

Currently, each health authority collects its own information in its own way, making it difficult to get a clear picture of the magnitude of the problem.

Beginning Dec. 22, all nine of the province’s health authorities will be required to report medical mistakes to the Department of Health and Wellness within 12 hours.

Previously, each health authority had its own definitions of what are called adverse events.

Health Minister Leo Glavine said this new process will allow his department to identify trends and problem areas.

“I think it helps to bring greater safety and stronger health delivery as we collect that kind of information,” he said.

Personal injury lawyer Ray Wagner often represents victims of medical errors. He said this new system is needed.

“In our experience, in dealing with medical cases, is that frequently we see the same error made often in the same hospital,” he said.

Wagner said the system must also allow patients to report suspected medical errors and he said it must be transparent.

Glavine said this is just the first step in moving toward a standard system of reporting and reviewing medical errors.

He hasn’t decided yet whether the information will be made public, but he said there’s little reason not allow the public to see the information.

Mastectomy mix-up

Nova Scotia’s previous Health Minister Dave Wilson promised a new registry of medical errors earlier this year, hoping it would provide a way for health care professionals to learn from their colleagues’ mistakes.

Capital Health confessed in August it made mistakes in two separate instances, both involving cancer patients.

A woman in her 60s had a breast removed when the process was unnecessary and the other patient, who needed surgery, was not scheduled for the procedure until after the mistake was caught.

In a second separate case, tissue samples were switched before the pathology analysis. One patient had an unnecessary diagnostic biopsy and the other patient never got the followup they needed.

Capital Health said there were over 19,000 reports of adverse events in the last fiscal year, but it says only three per cent of cases resulted in harm to a patient. That works out to almost 600 people.

 

http://www.cbc.ca/news/canada/nova-scotia/medical-mistake-registry-coming-in-nova-scotia-1.2456240?cmp=rss

Saskatchewan ED docs get new contract

The emergency department at Regina’s Pasqua Hospital is staying open around the clock. The health region had announced that the ED would be closed as of last Thursday during the overnight hours due to a persistent and serious shortage of resuscitation-capable physicians. However, a last-minute deal was reached in which physicians agreed to work extra shifts until locums are found to fill in.

With emergency physicians in demand across the country, recruitment has been a challenge for the province but the following day the government and Saskatchewan Medical Association announced a new three-year contract with emergency physicians which will see them getting a pay hike of around 13 per cent in the first year and additional increases in the subsequent two years.

They will earn between $320,000 and $400,000 a year which Premier Brad Wall says is comparable to what is paid in Alberta, British Columbia and Ontario.

The agreement also expedites the hand-off of ED patients to specialists so that emergency physicians have more time for trauma care. Previously they were responsible for patients they had seen until a specialist took over or they had been admitted to a hospital bed.

But this is not the end of the emergency service issue in Saskatchewan. Saskatoon, which has three hospitals to Regina’s two, received some criticism from Provincial Auditor Judy Ferguson in a report this week. She said the hospitals are falling short of national wait-time standards in emergency care, and is in fact not measuring wait times accurately. She said authorities need to start the clock from when patients arrive at the ED not when they see a doctor. The government has promised to eliminate all ED waits by 2017.

The auditor’s report can be found at http://auditor.sk.ca/publications/public-reports/item?id=128. (Health Edition, December 6, 2013).

Emergency Department issues flare up across Canada

Emergency department issues were a hot topic in three provinces this past week, coming on the heels of a warning in a recent position paper from the Canadian Association of Emergency Physicians (CAEP) that ED overcrowding is worsening and constitutes a “public health crisis.”

In Newfoundland and Labrador Tuesday, the St. John’s Telegram reported that hospitals in the city are falling short of their wait-time targets for 75 per cent of Level 3 ED patients. The situation is even worse (23 per cent) for Level 4 patients.

Questioned about this in the legislature Wednesday, Health Minister Susan Sullivan said the government has already made progress with its ED wait-time strategy. In fact, in response to a related question last Thursday, she said the government has acted on seven of the 11 needed action steps cited in the CAEP position paper.

Ms. Sullivan said that despite a 16 per cent increase in traffic, the time to initial physician assessment has decreased by 17 per cent and the total length of stay is down 11 per cent. She also said the number of patients who leave without being seen by a physician has decreased by 35 per cent.

In the Manitoba legislature Tuesday, Progressive Conservative Health Critic Cameron Friesen cited data from a freedom of information request that show 10 per cent of people who go to Winnipeg EDs leave before seeing a doctor. He said 28,000 “simply got up and walked out,” 5,000 more than the year before.

Over the past number of months, the Opposition in Manitoba has also criticized the government for patient off-load times at EDs and rotating ED closures at some rural hospitals.

Emergency department issues, while prevalent in many parts of the country, are a particular concern in Regina right now. As of this Thursday, one of the two EDs in the city is closed during the evening and overnight hours.

From 7:30 p.m. to 8:00 a.m., the Pasqua Hospital ED is closed, and a paramedic team is assessing patients who turn up at the ED and referring those who truly need emergency care to the General Hospital, about 10 minutes away. Others are being sent to a primary care centre across the street from the Pasqua which has agreed to stay open until midnight.

The problem is a shortage of resuscitation-capable physicians. The Regina Qu’Appelle health region needs 30 of these doctors to staff the two city EDs, but has only 20 despite aggressive recruiting efforts.

It is estimated that the General could end up seeing around 30 additional patients a night, and this has raised questions about how it will be able to cope. Tracy Zambory, the president of the nurses’ union, says the southern part of the province cannot function with only one ED in Regina.

“You can’t do it,” she told the Regina Leader-Post this week. “Patient safety is going to be put at risk and we can’t have that.”

Health Minister Dustin Duncan has blamed the situation on a global shortage of highly-trained emergency physicians, although the NDP Opposition says the government has been ignoring the looming issue for years.

In the legislature Wednesday, Mr. Duncan suggested that the situation may improve when a new contract is signed with physicians. He said the government hopes this will put the province in a competitive place with other provinces across Western Canada and “help fill some of the gaps in terms of coverage.” HE