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Physician Trends

Physician Trends . 10 th Annual CASPR Conference 13 May 2014 Charlottetown, PEI, Canada Steve Slade, Director of CAPER Canadian Post-M.D. Education Registry. Why look at physician trends?. Canada has ramped up physician supply, but we still have access challenges

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Physician Trends

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  1. Physician Trends 10th Annual CASPR Conference 13 May 2014 Charlottetown, PEI, Canada Steve Slade, Director of CAPER Canadian Post-M.D. Education Registry

  2. Why look at physician trends? • Canada has ramped up physician supply, but we still have access challenges • There is considerable variation in access to physician care across geographic settings • The #1 recommendation of the FMEC PG Project was to “ensure the right number, mix and distribution of physicians to meet societal needs” • In 2013 Deputy Ministers established the Physician Resource Planning Task Force to act on FMEC PG recommendation #1

  3. Why look at physician trends? 25,000 Medical Students and Residents 75,000 licensed physicians

  4. What is CAPER? • Comprehensive data and statistics on post-MD training and physician practice location • All PGME programs and trainees since 1988 • Trainee demographics (age, sex, and legal status) • Trainee medical education (residency program, specialty & subspecialty training, fellowship training) • Practice location after training • A 28-year partnership • 17 Canadian faculties of medicine • Professional medical organizations • F/P/T governments Reports Custom data www.caper.ca

  5. Disclosure • Steve Slade is Director of CAPER, the source of most of the data • Errors, omissions, misinterpretations are those of the author and not CAPER

  6. … context … … context … … context … … context …

  7. Practising Doctors per 1000 Population, 2000 and 2011 (or nearest year) Canada: 2.4 physicians / 1,000 population. Ranked 29/40 among OECD nations. OECD, 2013

  8. Physicians Rate per 100,000 Population, 2011 CIHI, 2013

  9. Access to Family PhysiciansHealth Indicators 2013

  10. Access to Other SpecialistsHealth Indicators 2013

  11. Nevertheless… • In spite of these metrics, new physicians are expressing employment difficulties.

  12. Un-or-Underemployment among Graduate Physicians 16% 31% 22% Royal College Employment Study, 2013

  13. Residents’ Job Prospects and Future Training Residents in surgical specialties were the least likely to feel confident (16.4%). CAIR National Resident Survey, 2013

  14. Undergraduate and Postgraduate Medical Education Physician supply trends

  15. 85% increase in number of first year medical students since 1997/98 First Year Enrolment in Canadian Faculties of Medicine, 1968/69 - 2012/13 Source: AFMC, 2013.

  16. PGY 1 Trainees by Place of MD Graduation, Canada, 1995/96 – 2013/14 CAPER, 2013

  17. Medical Students and ResidentsPer 100 Fully-Licensed Physicians CIHI, AFMC, CAPER, 2013

  18. PGY 1 Trainees by Jurisdiction, Canada, 1995/96 and 2013/14 CAPER, 2013

  19. PGY1 Trainees by Specialty, Canada, 2004/05 - 2013/14 Note: Canadian citizens and permanent residents only. Excludes visa trainees.. Source: Canadian Post-M.D. Education Registry (CAPER), 2014.

  20. Total Number of PGY1 Trainees, Canada, 2004/05 - 2013/14 • 25,758 trainees in total • Family Medicine and Internal Medicine account for 56% • The top 10 specialties account for 87% Note: Canadian citizens and permanent residents only. Excludes visa trainees.. Source: Canadian Post-M.D. Education Registry (CAPER), 2014.

  21. Percent Growth in Total Number of PGY1 Trainees, Canada, 2004/05 - 2013/14 10 ---> 34 28 ---> 72 10 ---> 24 20 ---> 44 13 ---> 27 22 ---> 43 749 ---> 1354 19 ---> 34 Overall, 61% increase in total number of PGY1 trainees 16 ---> 27 18 ---> 29 Note: Canadian citizens and permanent residents only. Excludes visa trainees.. Specialties with at least 100 PGY1 trainees between 2004/05 and 2013/14. Source: Canadian Post-M.D. Education Registry (CAPER), 2014.

  22. Average Years of PGME Training: 1996-2013 (Including leaves of absence/training gaps) CAPER, 2013

  23. Percentage in Subspecialty Training: 1996 - 2013 CAPER, 2013

  24. Percentage in Fellowship Training: 1996 - 2013 CAPER, 2013

  25. Broad Specialty Composition of Study Exit Cohorts

  26. Exiting Trainees by Jurisdiction, Canada, 2013 CAPER, 2013

  27. Practice Location Two Years After Training, Canada, 1995-2011 Exit Cohorts 2-year practice location of 1995 exit cohort: 1,451 (87%) in Canada 148 (9%) in USA 73 (4%) not located/other 2-year practice location of 2011 exit cohort: 2,272 (92%) in Canada 17 (1%) in USA 187 (7%) not located/other

  28. Practice Location Five Years After Training, Canada, 1995-2011 Exit Cohorts 5-year practice location of 1995 exit cohort: 1,440 (86%) in Canada 156 (9%) in USA 76 (5%) not located/other 5-year practice location of 2008 exit cohort: 1,947(94%) in Canada 30 (1%) in USA 103 (5%) not located/other

  29. 2-year Practice Location of Family Medicine Trainees, by Exit Cohort

  30. 2-year Practice Location of Medical Trainees, by Exit Cohort

  31. 2-year Practice Location of Surgical Trainees, by Exit Cohort

  32. Percent of physicians practising outside Canada 2 years after training, by broad specialty and exit cohort group

  33. Two Year Practice Location of Trainees Who Exited Between 2009-2011, by Jurisdiction, Canada CAPER, 2013

  34. Two Year Practice Location of Trainees Who Exited Between 2009-2011, by Jurisdiction, Canada CAPER, 2013

  35. Summary • Canada has ramped up physician supply, but we still have challenges related to accessing physicians • On the surface, it is difficult to reconcile our access challenges with reports of physician unemployment • Ten (10) primary specialties account for 90% of PGY1 trainees, but subspecialty and fellowship training is on the rise

  36. Summary (continued) • Canada retains the vast majority of it’s trainees, and particularly so among more recent exit cohorts • Surgical trainees are more likely to leave Canada, compared to family medicine and medical trainees • There is cross-jurisdiction variability with respect to physician retention • FMEC PG Recommendation #1: “Ensure the Right Mix, Distribution, and Number of Physicians to Meet Societal Needs”

  37. Thank You!

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