Environmental Scan - Government of Nova Scotia

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Physician Resource PlanningAn Environmental ScanThe pattern of growth atDalhousie Faculty of Medicineparallels the national medicaleducation system in terms ofgeneralist/non-generalistdistribution.One of the keys to changing thedistribution is altering the widelatitude afforded residents topursue subspecialization afterPGME year 3 once core trainingis completed in general surgery,general paediatrics, and internalmedicine.Non-generalist postgraduatetraining positions haveincreased by 64% compared toa 50% increase in generalistpositions since 2000. The Royal College Physicians Surgeons of Canada and College Family Physicians of Canadaview workforce supply compared to population need as a government responsibility. Governments and theirprimary delivery agents, health authorities, and faculties of medicine, will need to take responsibility formanaging the supply of physicians to meet the need of populations.Figure 5 National Growth (Number and %) in Postgraduate Positions (2000/01-2009/10) - Generalist & Non-Generalist DisciplinesPhysician Age - Nationally, the average age for family practitioners and specialists is 49.1 and 50.3 yearsrespectively. Nova Scotia is comparable at an average age of 49.6 years for family practitioners and 49.9years for specialists.Physician Gender – Nationally 35% of practising physicians and 28% of FTEs are female. In Nova Scotia thepercentages are slightly higher at 37% and 31%, respectively. In 2009/2010, women represented 53% offirst year medical postgraduate trainees, 45% of surgical, 46% of laboratory medicine, and 63% of familymedicine trainees. Both the national and Nova Scotia ratio will continue to change towards a 47% men,53% women ratio based upon current UGME and PGME trends. Data shows that women work from 10% to20% less over their career span than men. Notably before and after family-raising years, women will worksimilarly or equivalently to men. The physician resource plan model and resulting forecasts in this FinalReport adjust for the changing gender mix.Physician Practice Location and Medical School of Graduation – The location of the medical school ofgraduation is the single biggest factor in determining where physicians decide to practice. OnlyNewfoundland, Quebec (McGill), Manitoba, and Saskatchewan had less than 50% of practicing physiciansas graduates of their medical school. Nova Scotia retains 58% of Dalhousie Faculty of Medicine graduatesand Dalhousie Faculty of Medicine graduates comprise 47% of all practicing physicians in the province.16 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
Physician Resource PlanningAn Environmental ScanFigure 6 Percentage of Canadian-trained physicians practising in the jurisdiction where they graduated from Medical School, 2009(Source: CIHI)Given 58% of DalhousieFaculty of Medicinegraduates practice in theprovince, there is strongmotivation to better alignthe postgraduate residencyprograms with the needs ofthe population and also toeducate undergraduatesaccordingly.International Medical Graduates (IMGs) –Individuals who receive basic medical degrees from medicalschools that are not accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS)or the equivalent committee in the United States, the Liaison Committee on Medical Education (LCME), areconsidered to be IMGs. IMGs are typically Canadian citizens or permanent residents. Approximately thirtypercent (30%) of IMGs are Canadians Studying Abroad (CSA). These individuals are typically born in Canadaand take their undergraduate medical education outside Canada. Their main motivation (78%) for studyingabroad is their inability to obtain a place in the highly competitive Canadian medical school system. In2011, approximately 3,250 CSAs were studying medicine abroad with approximately 650 graduating eachyear and adding an additional 25% to the number of students looking for postgraduate training positions inCanada. Significant time is required to evaluate their UGME experience. In 2010, approximately 100residents of Nova Scotia were CSAs, with approximately 25 applying annually through Canadian ResidentMatching Service (CaRMS) to obtain a Canadian postgraduate training position.Approximately 45% of IMGs enter medical practice after completing postgraduate training in Canada and55% enter practice by meeting requirements for licensure without Canadian postgraduate training.Licensure requirements are administered at a provincial level but certain requirements are common to allprovinces such as successful completion of the Canada Evaluating Exam (MCCEE) and the Medical Councilof Canada Qualifying Exam Part 1 (MCCQE1).IMGs are an integral component of physician workforce planning. Since 2000 IMGs have filled one in threevacancies and new positions per year across Canada. Since 2005, 320 per year have entered practice aftercompletion of Canadian postgraduate residency training and 400 per year have entered practice directly bymeeting licensure requirements. In Nova Scotia, an average 45 IMGs have entered practice annually since2000 and have filled approximately 40% of vacancies and new positions.IMGs also present two key challenges to physician workforce planning. Firstly, while robust data is availablenationally on the 45% IMGs in Canadian postgraduate training, information on the 55% entering practicedirectly resides at a provincial level and is therefore less accessible and standardized. Secondly, IMGs arevery likely to move jurisdictions once initially licensed. Nationally only 65% are continuously active fiveyears later in their initial practice jurisdiction and in Nova Scotia the number drops to 36%. Physicianworkforce planning must recognize and address these challenges.Net Interprovincial Migration (NIPM) – Between 2008 and 2009, Ontario and British Columbia had a netincrease and the remaining provinces a net decrease in physicians as a result of NIPM. Only about 1% of17 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
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INCIDENCEPhysician Resource Plannin
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Environmental Scan - Government of Nova Scotia

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