CUA 2018: Canadian Urology Workforce Study — The Graduating Cohort of 2014–2016

Halifax, Nova Scotia (UroToday.com) For many years, and across many surgical specialties, there has been the perception among medical students, residents, and in fact the general public that it is difficult for newly trained surgeons to find employment in Canada. This has led some to conclude that residency programs are training too many surgical residents. Urology is not immune to these perceptions.

In a podium presentation at the Canadian Urologic Association Annual Meeting, Omar Nazif, MD, presents the results of a survey of recent Canadian Urology residency graduates performed through the auspices of the Canadian Urological Association Health Policy Committee (CAU HPC).

Seeking a quantitative assessment of this issue, the Canadian Urological Association Health Policy Committee (CAU HPC) formulated an anonymous, self–report, and multifaceted 88–question survey to study the graduating cohort of 2014–16 in the following areas: demographics, competency, fellowship training, employment, job resources, work week, income, and job satisfaction. Questions were open-ended, binary, and five-point Likert scale. A web–based survey was created and piloted through the HPC. Descriptive statistics were used to analyze the data.

The authors do not report a response rate in the abstract; however, data presented show a response rate near 50%. The demographics of the respondents are in keeping with what we may expect - 98% of grads are between the ages of 30–39. Respondents represented almost every province in Canada, with additional representation from 18% currently in the U.S.

In keeping with the anecdotal experience in Canada, 85% of respondents are planning to, actively doing, or have completed a fellowship. The majority of these were 2-year fellowships. A full 93% believe the likelihood of finding a job is better with fellowship training. These patterns differ significantly from urology residents in the U.S., the majority of whom forgo fellowship training for employment in private practice directly out of residency.

Of those surveyed, the majority (57%) are gainfully employed as a staff urologist. However, a significant proportion of these urologists (29%) are in the limited capacity of locum–tenens. Thus, full-time permanent positions are held by only 40% of respondents. Interestingly, a permanent staff position with hospital privileges was offered to 28% in residency. 

For those with a permanent job, 63% report a gross income between $300–500K per year. Most urologists performing locum jobs were unsatisfied with their current level of income. 

While issues with obtaining permanent employment are only one contributing factor, it is very notable that only 70% of respondents report satisfaction as a urologist and only 40% would encourage a medical student to apply to urology. Perhaps due to these reasons, 86% support contraction of residency positions across Canada. Only 56% of respondents suggested that they would apply for urology at the end of medical school knowing what they know now.

The authors conclude that, despite more challenging job prospects, the majority of Canadian–trained urology graduates are satisfied in their role as a urologist. The surveyed recent graduates support a contraction of residency positions. However, it must be noted that these are survey data and the perception of oversupply is not necessarily well-founded. In fact, urology is expected to be one of the medical specialties with the greatest increase in need according to the American Urological Association, owing in part to the aging of the population1. Thus, it is likely that a government-mandated restriction in resources to support the hiring of new urologists, including for operating room time, accompanied by the delay the retirement of many senior urologists is contributing to a lack of resources to support new graduates rather than a true overabundance of urology graduates.

Presented by: Omar A. Nazif, MD, Urologist, Department of Urologic Sciences, Surrey Memorial Hospital, Surrey, Canada, University of British Columbia, Surrey, BC, Canada, Health Policy Committee, Canadian Urological Association, Montreal, QC, Canada

Co-Authors: Hassan Razvi2,3, Curtis Nickel2,4, Keith Rourke2,11, Christopher French2,10, Frank Papanikolaou2,7, John Kell2,6, Lorne Aaron2,5, Robert Siemens2,4, Dianne Heritz2,8, William Tinmouth1,2, Peter Anderson2,9
Author Information: 
1. Department of Urologic Sciences, University of British Columbia, Surrey, BC, Canada
2. Health Policy Committee, Canadian Urological Association, Montreal, QC, Canada
3. Urology, University of Western Ontario, London, ON, Canada
4. Urology, Queen's University, Kingston, ON, Canada; 5Urology, McGill University, Montreal, QC, Canada
6. Urology, University of Toronto, East York, ON, Canada
7. Urology, University of Toronto, Mississauga, ON, Canada; 8Urology, McMaster University, St. Catharines, ON, Canada; 9Urology, Dalhousie University, Halifax, NS, Canada; 10Urology, Memorial University, St. John's, NL, Canada; 11Urology, University of Alberta, Edmonton, AB, Canada

References: 
1. American Urological Association. Number of Urologists Projected to Decrease Dramatically Through 2025, Despite Increase in Demand. American Urological Association Media Center: 3, May, 2013. Press.

Written By: Christopher J.D. Wallis, Urology Resident, University of Toronto @WallisCJD on Twitter at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia
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