From the Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ont. (Ndoja, Vivekanandan, Frost, Schemitsch, Lanting); London Health Sciences Centre, London, Ont. (Ndoja, Vivekanandan, Schemitsch, Lanting); the Ontario Medical Association, Toronto, Ont. (Sibley); the Division of Orthopedic Surgery, University of Ottawa, Ottawa, Ont. (Papp); the Ottawa Hospital, Ottawa, Ont. (Papp)
From the Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ont. (Ndoja, Vivekanandan, Frost, Schemitsch, Lanting); London Health Sciences Centre, London, Ont. (Ndoja, Vivekanandan, Schemitsch, Lanting); the Ontario Medical Association, Toronto, Ont. (Sibley); the Division of Orthopedic Surgery, University of Ottawa, Ottawa, Ont. (Papp); the Ottawa Hospital, Ottawa, Ont. (Papp).
Can J Surg. 2024 Apr 26;67(2):E165-E171. doi: 10.1503/cjs.002623. Print 2024 Jan-Feb.
Underemployment is a reality for many new graduates, who accept locum or part-time work as an alternative to unemployment because of lack of opportunities. We sought to analyze orthopedic surgeons' Ontario Health Insurance Program (OHIP) billing data over a 20-year period as a proxy of practice patterns and hypothesized that billing in the first 6 years of practice would be affected by underemployment and locum.
We analyzed the annual average billing totals of orthopedic surgeons, broken down by year of graduation, year of billings, and number of surgeons billing in that year. We analyzed public census data of the Ontario population size as a proxy of orthopedic demand.
A 2019 cross-sectional analysis showed that around 15 surgeons per graduating year were billing in Ontario from the 1995 to 2016 cohorts, while 2017 and 2018 saw an increase to 30 and 36 actively billing surgeons, respectively. The number returned to more historical numbers in 2019, with 20 actively billing surgeons. For those surgeons billing in Ontario, billing trends have been roughly stable, with average billings increasing each year for the first 6 years in practice ( < 0.001). Year of graduation did not have an effect on the first 6 years of billings ( > 0.5). Billings were stable after 6 years in practice ( > 0.09).
The Ontario health care system has not expanded to support more orthopedic surgeons despite the aging and growing population; despite our growing population, the number of surgeons being trained and retained has not matched this growth. Further research needs to be done to guide optimal health human resource decision-making.
对于许多应届毕业生来说，就业不足是一个现实问题，由于缺乏机会，他们选择临时或兼职工作作为失业的替代方案。我们试图通过分析 20 年来骨科医生安大略省医疗保险计划（OHIP）的计费数据来分析他们的实践模式，我们假设在实践的前 6 年中，计费会受到就业不足和临时工作的影响。
我们分析了骨科医生的年度平均计费总额，按毕业年份、计费年份和当年计费的医生人数进行了细分。我们分析了安大略省人口规模的公共人口普查数据，以此作为骨科需求的代理指标。
2019 年的横断面分析显示，1995 年至 2016 年期间，每年约有 15 名毕业生在安大略省计费，而 2017 年和 2018 年分别增加到 30 名和 36 名活跃计费医生。2019 年这一数字又回到了更接近历史水平的 20 名活跃计费医生。对于那些在安大略省计费的医生来说，计费趋势大致稳定，在实践的前 6 年中，每年的平均计费都在增加（<0.001）。毕业年份对前 6 年的计费没有影响（>0.5）。实践 6 年后计费保持稳定（>0.09）。
尽管人口老龄化和增长，但安大略省的医疗保健系统并没有扩大以支持更多的骨科医生；尽管我们的人口不断增长，但接受培训和留住的外科医生人数并没有跟上这一增长。需要进一步研究以指导最佳的卫生人力资源决策。
