CUA 2018: Canadian Urology Workforce and Interprovincial Economics

Halifax, Nova Scotia (UroToday.com) In this talk, Omar Nazif, MD highlights the current states of the Canadian Urology workforce and subsequently addresses interprovincial economics. He was asked to give the talk as he has been working with CUA Health Policy committee on these issues. 

The first part was specifically an evaluation of the graduating residents between 2014-2016 to assess their challenges regarding finding employment. The basis for the evaluation was the following:

1. Concern that Canadian Urology residency may be training too many residents
2. In the 2000’s, # of residency spots ballooned from 15 to mid-30’s
3. Despite this doubling of residents graduated, there doesn’t appear to be more jobs
    - 37 urologists gave up their licenses during 2013-2015
    - # of practicing urologists has remained steady ~680-690 in this time frame
4. Urology is a resource-intensive specialty – lack of hospital resources is perceived as a barrier to employment
5. CIHI demonstrates a decrease in health care funding ~0.1% per year

To address this, they completed 88 question multi-faceted survey of all graduates from 2014-2016 – open-ended, binary / Likert scale questions. The response rate was moderate: 50 of 100 eligible residents responded. There were responders from all 3 years and from all 12 major urology programs. Below, I will highlight some of the key findings that he reviewed:

1. Frustration and concern is palpable regarding the shortage of jobs
2. The majority believe there is overtraining of residents
3. Competency – most residents feel they are competently trained in general urology, endourology, and laparoscopy (>85%). Pediatrics was lagging as expected.
4. 85% were planning on doing a fellowship (primarily oncology or robotics/MIS)
    - Primarily in the US or Canada
    - The main reason was to compete for a better job (83%); less commonly for interest (63%) or feeling uncomfortable with skills (12%)
5. Employment
    - 28% were offered staff positions before graduating from residency
    - 57% were employed as staff urologist (though 30% of those were locums)
    - The majority wanted to stay in Canada and most did (88%)
    - He commented on how much they wanted to work vs. how much they were working – most were satisfied with how much they were working (88% 5+ days/week)
    - He reviewed salary of those employed and most earn between 300-500K/year
6. Choosing employment
    - Location is one of the major factors
    - Resources available is another major factor
7. The majority felt that Canadian residency programs should graduate fewer residents – most felt the total number should reduce by 1-5 (48%) or 5+ (38%)

To address this, they are working on creating a CUA job finding board (and to make the hiring process more transparent). They are also exploring alternative work models (part-time, non-surgical practice, mentorship models).

In the second part, he shifted gears and examined the differences in income and remuneration amongst provinces. Urologists in all the provinces work fee for service – but each province sets the fees for procedures separately. 

  • As specialties are competing for funds (it’s a zero-sum game), when going into arbitration over prices / fee schedule, its important to have strong data regarding interprovincial disparities.
To do this, they evaluated the interprovincial disparities by looking at the top 20 urology fee items (encompassing ~84% of all billings) across all the provinces. They solicited input from all the provincial section heads or HPC members – bill as the average urologist in your province would bill these procedures. 

  • This model does not include private insurance, uninsured, etc. Nor does it include taxes, salary paid to support staff, etc. It is purely gross income.
  • The top 20 fee codes were as follows:

UroToday CUA 2018 Canadian Urology Workforce and Interprovincial Economics 1

  • Notable interprovincial disparities were identified
  • Nova Scotia consistently had some of the lowest oncology fees and disproportionately high stone fees (URS+lithotripsy paid more than a radical prostatectomy +LND and lap partial nephrectomy!)
  • Ontario – Radical cystectomy and diversion fees were 2nd lowest in the country (after NS), and was almost the same as a radical prostatectomy
  • Annual gross income
UroToday CUA 2018 Canadian Urology Workforce and Interprovincial Economics 2

  • The 3 most populous provinces  make the least money
  • This assumes a similar practice across the country

Despite the limitations of the analysis, it highlights the discrepancies between provinces and can be used to arbitrate with the provincial government.

Presented by: Omar Nazif, MD, Urologist, Surrey Memorial Hospital — Surrey, Canada, University of British Columbia, Vancouver, BC

Written By: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto   Twitter: @tchandra_uromd at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia
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