INSIGHTS INTO

PHYSICIAN
WORKFORCE
TRENDS
IN ONTARIO
2016 Edition
Presented by the
Ontario Medical Students Association
Education Committee
TABLE OF CONTENTS
INTRODUCTION
OMSA DIRECTOR OF REPRESENTATION (2015–2016) 4
EDUCATION COMMITTEE 5

ACKNOWLEDGMENTS 6

THE GUIDE: SUMMARY OF METHODOLOGY7

SPECIALTY PROFILES: PGY19

ANATOMICAL PATHOLOGY10
ANESTHESIOLOGY11
CARDIAC SURGERY 12
DERMATOLOGY13
DIAGNOSTIC RADIOLOGY14
EMERGENCY MEDICINE 15
FAMILY MEDICINE 16
GENERAL SURGERY 17
INTERNAL MEDICINE 18
LABORATORY MEDICINE 19
NEUROLOGY20
NEUROLOGY: PEDIATRIC21
NEUROSURGERY22
OBSTETRICS AND GYNECOLOGY23
OPHTHALMOLOGY24
ORTHOPEDIC SURGERY 25
OTOLARYNGOLOGY26
PEDIATRICS 27
 PHYSIATRY AND REHABILITATIVE MEDICINE 28
PLASTIC AND RECONSTRUCTIVE SURGERY 29
PSYCHIATRY 30
PUBLIC HEALTH31
RADIATION ONCOLOGY32
UROLOGY33
VASCULAR SURGERY 34

SPECIALTY PROFILES: MEDICINE SUBSPECIALTIES35

ALLERGY AND IMMUNOLOGY 36
CARDIOLOGY 37
CRITICAL CARE MEDICINE38
ENDOCRINOLOGY 39
GASTROENTEROLOGY 40
GENERAL INTERNAL MEDICINE 41
GERIATRIC MEDICINE 42
HEMATOLOGY 43
INFECTIOUS DISEASE44
MEDICAL ONCOLOGY 45
NEPHROLOGY 46
OCCUPATIONAL MEDICINE47
PHARMACOLOGY AND TOXICOLOGY 48
RESPIROLOGY 49
RHEUMATOLOGY50

CONCLUSION51
INTRODUCTION OMSA Director of Representation
(2015–2016)

Ontario’s healthcare system continues to suffer from a maldistribution of physicians

geographically and by specialty, despite the fact that enrollment in Ontario medical schools
has nearly doubled in the past decade. The annual physician supply is currently growing at
1.5–2% faster than population growth and forecasts estimate an 8% oversupply of physicians
compared to service utilization by 2025. This is an environment into which newly minted
medical students may be graduating if they pursue postgraduate training in a specialty. Frank
and honest discussions are required to determine long term solutions that guarantee a fair
process, while ensuring societal needs are met. Providing medical students with the tools to
make informed career planning decisions is one of many steps that can help to achieve this
goal.

Medical and surgical specialists are already noticing under/unemployment with approximately
33% of surgeons leaving the province each year after training in Ontario. Poor job prospects
can also be seen nationally, with the Royal College Employment Report stating that economic
constraints are the main factor driving this phenomena, as new physicians compete for fewer
resources. In addition to the economy, a variety of other factors — such as new models of
care and interprofessional care teams — can contribute to decreased physician demand in
certain specialties.

In response to these facts, OMSA has been advocating strongly to better understand the
complex and difficult process involved in HHR planning so that we can advocate more
effectively for medical students. The results of this work include OMSA gaining membership
onto HHR policy committees for both the Ministry of Health and Long Term Care (MOHLTC)
and the Ontario Medical Association (OMA). It is evident that there is a strong commitment by
the Postgraduate Deans, Undergraduate Deans, MOHLTC, and OMA to develop a sustainable
and evidenced-based system, and we look forward to being involved in the process.

It’s been an incredible year working closely with the newly minted Education branch of the
Ontario Medical Students Association. Tavis Apramian and Rishad Khan have consistently
advocated on behalf of medical students to provide tools necessary to become strong and
successful clinicians. Working to increase transparency and knowledge surrounding health
human resources in the province, this document is a testament to their perseverance, and
is a great step in the right direction to ensure medical students have the capacity to make
informed career decisions that meet the needs of the future populations we will serve.

Whatever career path you choose, I wish you a successful and meaningful journey.

May the match be with you,

Justin Cottrell
Director of Representation, 2015–2016
Ontario Medical Students Association

4
INTRODUCTION Education Committee
Greetings, and welcome to the first iteration of Insights into Physician Workforce Trends in
Ontario, presented to you by the Ontario Medical Students Association (OMSA) Education
Committee. As an Ontario medical student in the 21st century, you are faced with the
precariously difficult task of selecting one discipline of medicine to which you will dedicate your
career. There are many factors, both known and unforeseen, that underlie the decision-making
process of specialty selection. In light of our current economic climate, physician employment
trends are elusive and poorly understood, and as such, remain a large contributory source to
the anxiety and frustration in the career-planning for medical students.

We have created this guide in order to provide you with a snapshot of the job market for future
physicians in Ontario. Admittedly, our healthcare system is unpredictable and the layout of
health human resources is in a constant state of fluctuation. Suffice it to say that this guide
should support, rather than inform, the critical decisions that lie ahead of you in the pursuit of
your desired specialty.

We sincerely hope you find the following discussions fruitful to your career explorations. As
this is the first guide of its kind for Ontario medical students, OMSA will continue to update
future iterations, and we look forward to hearing your feedback. We wish you all the best on
your forthcoming journey.

Andrew Perrella & Claudia Frankfurter

Co-Chairs Education Committee, 2015–2016
OMSA

Thank you for trying to learn more about this important element of your medical education.
Medical students may make no more important decision than their choice of specialty. That
choice shapes so many downstream factors: where they practice, with whom they practice,
how their day to day life is structured, and, in today’s environment, their job prospects.

Creating this guide takes OMSA partway toward fulfilling the new Education Portfolio’s mandate
to mentor students through difficult transitions in the educational process. Medical students
deserve the best data available. If the stakeholders in the system want us to make wise career
decisions, then only the greatest possible transparency will enable us to be informed and
collaborative decision makers.

The guide is built on the truly heroic efforts of Andrew Perrella (OMSA Education Committee)
and Claudia Frankfurter (VP External, University of Toronto). Without Andrew and Claudia’s
dogged efforts to bring this guide to life, we would all be much less informed. The guide
is also a product of collaborative efforts from program directors, specialty associations, the
undergraduate deans, the OMA, and HealthForce Ontario. We wish to thank all of these
stakeholders for their willingness to provide data, fill out surveys, and work with students on a
project of this magnitude. We also hope each of these partners will see in this guide the utility of
contributing to its development in future years. The data we have is imperfect. The process of
making the decisions is imperfect. But the more collaborative effort we put into transparency,
the more we as medical students can make socially accountable career decisions.

Tavis Apramian Rishad Khan

Director of Education, 2015–2016 Director of Education, 2016–2017
Ontario Medical Students Association Ontario Medical Students Association

5
ACKNOWLEDGMENTS
Special shout-out to the CFMS Match Book, which provides a comprehensive overview of the
CaRMS process and statistics. As this Guide does not concern itself in-depth with CaRMS
information nor competition for residency programs, the Match Book provides supplemental
information that may be of interest to readers.

We must also thank in deepest gratitude the residency Program Directors who took the time
to answer our questionnaire and provide us all with key insight into their respective fields of
practice — we hope that we are able to synthesize their responses into our Guide — as well
as the individuals from HealthForceOntario who provided key edits, and the FMEQ Residency
Guide for the inspiration for this project.

CLAUDIA ANDREW
FRANKFURTER PERRELLA

RISHAD
TAVIS
KHAN
APRAMIAN

6
THE GUIDE:
SUMMARY OF METHODOLOGY
In the writing of this Guide, OMSA amassed data from information available from the CaRMS
website, survey of the Program Directors and residents, and several key documents (see
below).

DOCUMENTS SUMMARY
2014 National Physician The 2014 National Physician Survey presents the quantitative data collected for
Survey physicians of Canada — separated based on specialty (family physicians or
“other” specialists), gender (male or female) and various age groupings — on a
series of questions ranging from: online media presence, use of email and mobile
apps, use of electronic medical records, on-call services provided, telemedicine
practices, and management of chronic illness. For the purposes of our Guide,
the results of the data only provided an indication of which physician groups find
themselves at the early stage of their training, and which are nearing retirement
(based on age-group data for the sub-specialties). Overall, the 2014 National
Physician Survey provided largely general demographic data in conjunction
with other sources (e.g., “CMA Specialty Profiles”).

Link: [Link]

CMA Practice Opportunities The CMA Practice Opportunities and Specialty Profiles (January 2014) is a slide
and Specialty Profiles (Jan deck outlining general projected physician supplies across the country, with
2014) specific highlights of Ontario, Alberta, and Saskatchewan, and concludes with
links to various provincially-based resources. Much of the data provided here is
too vague to be interpreted concretely. However, the slides entitled “Opportunities
for Physicians — Top 10 Disciplines and Bottom 10 Disciplines” do provide some
indication of which specialties may face growth or decline, loosely analyzed with
a comparison between the percent of graduates from a given specialty and the
percent of specialty positions available. Given the ambiguity in the data and
lack of external citations, this information was principally used to support trends
found in other data sources, and was not interpreted in isolation.

CMA Projections to 2030 The CMA Projections to 2030, written in 2013, is a short-texted based document
that discusses specific trends related to nationwide physician retirement,
emigration, IMGs, and returns from abroad. Two graphs provide an indication
of the projected number of physicians (separated into general practitioners and
other specialties) per 1000 population until the year 2030. Overall, as the data
analysis in this document comprises a national, rather than provincial scope,
in addition to speaking only in very broad generalizations of specialist services
compared to family practice, the CMA Projections to 2030 provided little useful
information regarding a practical approach to Ontario’s physician job market.

7
Report: “What’s Really The report “What’s Really Behind Canada’s Unemployed Specialists?” is a
Behind Canada’s comprehensive document which publicizes the results of a national scan of
Unemployed Specialists?” the current growing trend of specialists and sub-specialists unable to find work
after graduation. The research outlines three principle correlative factors — the
state of the economy, the organization of the healthcare system, and personal/
context-specific factors of new graduates — as the drivers of underemployment,
with an in-depth analysis of each. This report has caught the eyes of many recent
or soon-to-be graduates of our healthcare system, and of interest to our Guide,
speaks particularly of select specialties that are suffering the effects of the three
aforementioned factors (e.g., resource-intensive surgical specialties). However,
on the whole, this report depicts information that is too broad (e.g., Canadian
economic drivers, macro-level system organization) without providing concrete
figures/data of projections to be of use to province-specific predictions. Overall,
its use was to support similar findings across other documents, but otherwise
limited.

CMA Specialty Profiles The CMA Specialty Profiles are a set of short slide decks for 38 specialties, which
provide: a succinct outline for the medical practice and training for each specialty,
demographic information (including age, gender distribution, and practice
organization), hours worked, remuneration, and job satisfaction. A portion of the
data provided here comes from the 2014 National Physician Survey. A review
of each of these decks provided the majority of the background information
for each specialty, and assisted in outlining the important determinants and
factors that may influence job prospects (e.g., practice organization) when used
in conjunction with other supporting documents. The CMA Specialty Profiles
provide a general overview of the current practice of physician specialists — the
majority of which are current as of 2014/2015 — but provide no indication of
whether these trends are projected to change in the coming years.

Link: [Link]

Ontario’s Approach to The short presentation entitled “Ontario’s Approach to Evidence Based Human
Evidence Based Health Health Resources Planning” — given in May 2015 by the Assistant Deputy
Human Resources Planning Minister of the MOHLTC — outlines the three current models used by Ontario’s
provincial government in their efforts to forecast physician job markets. Notably,
slide 11 provides a summary for the three models (ADIN, UM, and NBM), with
an acknowledgement of the limitations of current models, and these models will
continually be revised in coming years.

FMEQ Guide Several years ago, the FMEQ — Fédération médicale étudiante du Québec —
published their inaugural guide to physician job prospects for the province of
Quebec. Serving both as an inspiration and model for our work, we owe a great
deference to their efforts. Although our approaches to data interpretation and
provincial landscapes differ, OMSA plans to continue to work with the FMEQ
in coming years to refine and re-model our respective approaches in order to
expand the scope of our services in assisting Canadian medical students in
making optimized career choices.

Link: [Link]

Note: LHIN-specific numbers and data from specific models (e.g., Needs Based Model) were
not used as these models are currently being updated, and would be unreliable at this time.

8
SPECIALTY PROFILES:
PGY1
The following graphs depict data only of CMGs and the first-iteration of the CaRMS PGY-
1 and Medicine Subspecialty Matches. The projections encompass roughly the next 10
years, with the firm acknowledgement that the individual trends of each discipline should
be reviewed annually.

Due to the combined lack of Ontario-specific data, program size, and predictable
trends, the following R-1 programs were omitted from the Guide: General Pathology,
Hematological Pathology, Medical Biochemistry, Medical Genetics, Medical Microbiology,
Neuropathology, and Nuclear Medicine.

Finally, in regards to programs for which a conclusion of “Indeterminable” was reached,

this simply means there was insufficient evidence to make an accurate prediction. We
encourage medical students to speak with colleagues, faculty, and physicians regarding
any further questions they may have for these, and other, specialties!

NAVIGATING THE GUIDEBOOK

Please note the following:

• Within the program graphs, PGY1 CMG positions are residency positions allocated
for Canadian Medical Graduates (CMG) entering Post-graduate Year 1 (PGY1) of a
particular residency program. The upper graph represents the number of residency
positions available and filled in Ontario, while the lower graph represents the number
of residency positions available and filled in all of Canada.

• Job prospect ratings were ranked on a scale spanning (1) Difficult/Very difficult, (2)
Potentially difficult, (3) Indeterminable, (4) Good, and (5) Very good/Excellent. This
assessment was based on several factors (outlined in the Summary of Methodology
above).

Difficult/Very difficult Potentially difficult

Indeterminable Good

Very good/Excellent

9
 ANATOMICAL PATHOLOGY

Positions Offered in Ontario Program Director Comments

10
0/4 reported
8

6
Job Prospects
4 (Program Directors)
2

0 Not reported
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Students filled inanOntario
who Accepted Ontario School
No. Positions
PGY1 in Ontarioin Ontario
CMG positions

OMSA Summary
The number of anatomical pathologists
in Ontario has been on the rise since
2005, finding their work predominantly
in academic health science centres or
community hospitals.
Positions Offered in Canada
50 Consistently, there have remained
unfilled residency positions in Ontario,
40 and there is a strong opportunity to find
employment in this field.
30

20
Job Prospects
10

0
2010 2011 2012 2013 2014 2015 2016 Good
PGY1
No. CMG positions
Positions filled in Canada
Filled in Canada
No.
PGY1Total
CMG Positions in Canada
positions in Canada

10
 ANESTHESIOLOGY
Program Director Comments
Positions Offered in Ontario 1/6 reported

50 Although attaining a residency position

in anesthesiology has become more
competitive over the years, job prospects
40 are very good to excellent for this field.
This trend is expected to continue for
30 the coming decade as graduates do not
often need to pursue further training to
secure permanent positions.
20

10
Job Prospects
0 (Program Directors)
2010 2011 2012 2013 2014 2015 2016
PGY1
No. CMG positions
Students filled inan
who Accepted Ontario
Ontario School
No. Positions
PGY1 in Ontario
CMG positions in Ontario Very good/Excellent

OMSA Summary
Positions Offered in Canada Employment has been on the rise in
Ontario for anesthesiologists since
120 2009, with most physicians finding work
in academic health science centres or
100 community hospitals. The role of the
anesthesiologist is lending itself to a
80 greater number of surgical procedures,
allowing for greater opportunities
60 for employment. Matching remains
relatively competitive, although Ontario
40 positions have been left unfilled in the
past two cycles. Overall, job prospects
20 for this field are strong.

0
2010 2011 2012 2013 2014 2015 2016
Job Prospects
PGY1
No. CMG positions
Positions Filled in filled
Canada in Canada
No.
PGY1Total
CMG Positions in Canada
positions in Canada

Very good/Excellent

11
 CARDIAC SURGERY

Positions Offered in Ontario Program Director Comments

6
0/4 reported
5

4 Job Prospects
3 (Program Directors)
2

1 Not reported

0
2010 2011 2012 2013 2014 2015 2016

No. Students
PGY1 who Accepted
CMG positions filled inanOntario
Ontario School
No. Positions
PGY1 in Ontarioin Ontario
CMG positions
OMSA Summary
Due to the resource-intensive nature
of this field and limited OR time, job
prospects for cardiac surgeons may be
at risk. Although there have historically
been vacancies in residency positions
Positions Offered in Canada in Ontario, the last two cycles have
seen them entirely filled. Half of cardiac
14
surgeons will operate in hospitals.
12 However, those facilities with reduced
funding may slow their training of
10 these physicians, and in general, these
8 positions have reached saturation.

6
Job Prospects
4

0 Difficult/Very difficult
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Positions filled in Canada
Filled in Canada
No.
PGY1Total
CMG Positions in Canada
positions in Canada

12
 DERMATOLOGY
Program Director Comments
Positions Offered in Ontario 1/3 reported

10 Although attaining a residency position

9 in dermatology has become more com-
8 petitive over the years, job prospects are
7
very good to excellent for this field, and
this is not expected to change. In partic-
6
ular, office-based ambulatory disciplines
5 in Ontario have enormous potential for
4 employment. Normally, only a minority of
3 graduates will pursue additional training
2
in order to secure employment.
1
0
2010 2011 2012 2013 2014 2015 2016
Job Prospects
(Program Directors)
PGY1
No. CMG positions
Students filled inanOntario
who Accepted Ontario School
No. Positions
PGY1 in Ontarioin Ontario
CMG positions
Very good/Excellent

OMSA Summary
Since 2010, evidenced by the fact that
Positions Offered in Canada Ontario residency positions have almost
35 consistently been filled, dermatology
continues to be a competitive residency
30 to enter, made more so by the decline in
Ontario positions this past cycle. These
25 physicians find themselves working
predominantly in private offices or
20
clinics. The work-life balance afforded
15 by this specialty is attractive, and is
overall a field of work that is in-demand.
10 Consistently, there have remained
unfilled residency positions in Ontario,
5 and there is a strong opportunity to find
employment in this field.
0
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Positions Filled in filled
Canada in Canada
Job Prospects
No.
PGY1Total
CMG Positions in Canada
positions in Canada

Very good/Excellent

13
 DIAGNOSTIC RADIOLOGY
Program Director Comments
1/5 reported
Positions Offered in Ontario
Job prospects have been described
30
as good, with no anticipated change
in the coming decade. Competition for
25
residency positions seems to be less
20 competitive than in previous years.
Many graduates will pursue fellowships,
15 although not for reasons of improving
employment prospects, but rather to
10 narrow their focus within a particular
aspect of diagnostic radiology.
5

0
2010 2011 2012 2013 2014 2015 2016
Job Prospects
PGY1 CMG positions filled inanOntario
(Program Directors)
No. Students who Accepted Ontario School
PGY1
No. CMG positions
Positions in Ontarioin Ontario
Good

OMSA Summary
Positions Offered in Canada Data have suggested that, currently,
there are moderate excess of diagnostic
100 radiologists in the field. However, as a
notable proportion of these physicians
80 are over the age of 65, this excess will
likely give way to younger graduates
entering the field. This field is one that
60 involves significant group practice in
community hospitals or academic health
40 science centres, as radiologists are often
involved in many diagnostic and surgical
20 procedures of patient care. Although
the few residency positions that are
available in Ontario will occasionally be
0
2010 2011 2012 2013 2014 2015 2016 filled, diagnostic radiology possesses
good job prospects.
PGY1
No. CMG positions
Positions Filled in filled
Canada in Canada
No.
PGY1Total
CMG Positions in Canada
positions in Canada
Job Prospects

Good

14
 EMERGENCY MEDICINE

Positions Offered in Ontario Program Director Comments

40
2/5 reported

30 Although competition for this residency

has increased as of late, there nonethe-
less exist strong employment possibili-
20 ties for emergency medicine physicians
in the coming decade. It is estimated
that approximately half of graduates
10 pursue additional training (e.g., a Mas-
ter’s degree or Fellowship) within their
residency training in order to assist in
0 securing permanent positions.
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Students filled inan
who Accepted Ontario
Ontario School
No. Positions
PGY1 in Ontarioin Ontario
CMG positions
Job Prospects
(Program Directors)

Very good/Excellent

Positions Offered in Canada

80 OMSA Summary
70 The number of emergency physicians in
60 Ontario has been steadily growing since
2001. Likewise, emergency medicine
50 residency positions have consistently
40 been filled, or near to, in the past 6 years
— furthering the case for this being a
30
competitive residency position. Overall,
20 there is a great need for specialist-
trained ER physicians in Ontario.
10
0
2010 2011 2012 2013 2014 2015 2016
Job Prospects
PGY1
No. CMG positions
Positions filled in Canada
Filled in Canada
No.
PGY1Total
CMG Positions in Canada
positions in Canada

Very good/Excellent

15
 FAMILY MEDICINE
Program Director Comments

Positions Offered in Ontario 1/6 reported

500 Family medicine residency positions

have become more competitive in recent
years, but job prospects for graduates
400
remain strong and this is not likely to
change in the foreseeable future. Few
300 graduates find themselves having to
pursue additional training in order to
200 secure permanent positions.

100
Job Prospects
0 (Program Directors)
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Students filled inan
who Accepted Ontario
Ontario School
PGY1 CMG positions in Ontario
Very good/Excellent
No. Positions in Ontario

OMSA Summary
With our province’s continued focus on
Positions Offered in Canada improving access to primary care, fam-
ily medicine physicians continue to be
1600 in demand. This is reflected in the in-
creasing number of residency positions
offered each year in Ontario and the rest
1200 of the country. Approximately half of
graduates work in private offices or clin-
ics with a strong group practice model.
800 The adaptability within the specialization
(e.g., “+1” programs) allow physicians
to become more adaptable to changing
400 healthcare needs, but also result in fam-
ily medicine residencies becoming an
increasingly attractive selection for med-
0 ical students.
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Positions Filled in filled
Canadain Canada
No.
PGY1Total
CMG Positions in Canada
positions in Canada Job Prospects

Very good/Excellent

16
 GENERAL SURGERY
Program Director Comments
3/6 reported

Positions Offered in Ontario As it stands, it is potentially difficult

for new general surgeons to find
40 employment. Over half of graduates
undergo additional fellowship training
to become more competitive, although it
30 has been observed that top-performing
residents secure positions easier, and
if they pursue fellowship training, do so
20 by choice. However, employment trends
are shifting in a positive direction and
there does not seem to be any change in
10
the competition of obtaining a residency
position.
0
2010 2011 2012 2013 2014 2015 2016

No. Students
PGY1 who Accepted
CMG positions filled in an Ontario School
Ontario
Job Prospects
No. Positions
PGY1 in Ontario
CMG positions in Ontario
(Program Directors)

Potentially difficult

OMSA Summary
Positions Offered in Canada
General surgery is largely a solo practice,
120 with half of physicians working out of
community hospitals or academic health
100 science centres. A notable number of
physicians entering the field are young
80
compared to other specialties. However,
given its resource-intensive nature, there
60
is a risk of senior surgeons monopolizing
40 resources and OR time in their favour,
thus interfering with the feasibility of new
20 graduates to train and collaborate. There
has been a slight decline in the number
0 of residency position offered in Ontario
2010 2011 2012 2013 2014 2015 2016 over the past 4 years and the positions
available consistently reach capacity.
No.
PGY1Positions Filled infilled
CMG positions Canada
in Canada
No.
PGY1Total
CMG Positions ininCanada
positions Canada
Job Prospects

Potentially difficult

17
 INTERNAL MEDICINE
Program Director Comments
Positions Offered in Ontario 3/6 reported
160
The field of internal medicine seems to
be becoming slightly more competitive
120 in terms of obtaining a residency posi-
tion, although given the size of the pro-
gram, this may not create significant
80 change. Employment trends remain
good, and are not expected to change.
The majority of graduates will pursue ad-
40 ditional fellowship training (see “Special-
ty Profiles: Medicine Subspecialties”) in
order to secure employment, or to align
0 with personal career interests.
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Students filled in an
who Accepted Ontario
Ontario School
Job Prospects
PGY1
No. CMG positions
Positions in Ontario
in Ontario
(Program Directors)

Good

Positions Offered in Canada

500 OMSA Summary
Internal medicine, from which branches
400
many career trajectories, is of increasing
popularity among graduates. This is
300 reflected in the increasing number of
positions available to applicants over
200 the years. Internists find themselves split
between working in academic health
science centres, community hospitals,
100 and private offices/clinics. Overall, the
job prospects are good, but competition
0 is increasing.
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Positions Filled infilled
Canadain Canada
Job Prospects
No.
PGY1Total
CMG Positions in in
positions Canada
Canada

Good

18
 LABORATORY MEDICINE
Program Director Comments
Positions Offered in Ontario 1/1 reported
14
Current job prospects for laboratory
12 medicine are good, and this trend is
expected to remain as such in the
10 coming years. Some graduates may
choose to pursue further training in
8
order to secure employment. Laboratory
6 medicine residency is not expected to
become more competitive in the coming
4 years; however, the data display a
severe decline in the number of available
2 positions.
0
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Students filled inan
who Accepted Ontario
Ontario School
Job Prospects
PGY1
No. CMG positions
Positions in Ontario
in Ontario
(Program Directors)

Good

Positions Offered in Canada

14 OMSA Summary
12 There remains a paucity of reliable data
to predict the future of this specialty.
10 Interestingly, this is one of the rare
circumstances in which there has
8
been a sharp decline in the number of
6 positions offered in years past. Since
this pattern has emerged, residency
4 spots have become filled and will pose
some difficulty for graduates interested
2 in this field.
0
2010 2011 2012 2013 2014 2015 2016

PGY1 CMG positions

Job Prospects
No. Positions Filled infilled in Canada
Canada
PGY1
No. CMG
Total positions
Positions in in Canada
Canada

Indeterminable

19
 NEUROLOGY
Program Director Comments
Positions Offered in Ontario 2/5 reported

16 Good employment with an expected

14 increase in the coming decades is
the outlook for neurology. A moderate
12 proportion of graduates will pursue
additional fellowship training in order to
10 improve job prospects. However, as of
8 late, it has become more competitive to
obtain a residency position in this field.
6

4
Job Prospects
2
(Program Directors)
0
2010 2011 2012 2013 2014 2015 2016

No. Students
PGY1 who Accepted
CMG positions filled in an Ontario School
Ontario
Good
No. Positions
PGY1 in Ontario
CMG positions in Ontario

OMSA Summary
Positions Offered in Canada Neurologists often find themselves
working out of academic health science
50 centres, and to a lesser degree, private
offices/clinics. Advancements in the field
40 could propagate employment, although
additional training may be likely. This
field seems to have become a popular
30 choice for graduates, as evidenced by
the fact that all of Ontario’s neurology
residency positions were filled in the last
20 three cycles.

10
Job Prospects
0
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Positions Filled infilled in Canada
Canada Good
No.
PGY1Total
CMG Positions in in
positions Canada
Canada

20
 NEUROLOGY: PEDIATRIC
Program Director Comments
2/3 reported
Positions Offered in Ontario
The field of pediatric neurology is facing
5 potentially difficult employment futures,
one which is likely to become worse.
4
There has been no noticeable change in
difficulty obtaining a residency position
for this field. However, a considerable
3 proportion of graduates pursue
additional training in order to become
more employable. Currently, there is a
2
need for pediatric neurologists pursuing
work in the community-setting, as there
1 are notably few academic positions.

0
2010 2011 2012 2013 2014 2015 2016 Job Prospects
PGY1
No. CMG positions
Students filled in Ontario
who Accepted an Ontario School (Program Directors)
No.
PGY1Positions in Ontario
CMG positions in Ontario

Potentially difficult

Positions Offered in Canada

OMSA Summary
12
Similar to the field of neurology, ad-
10 vancements in the field could propa-
gate employment but require additional
8 training. However, given the paucity of
jobs in academic centres, obtaining em-
6 ployment in this field may be difficult.
Across the country, residency positions
4 for pediatric neurology have been on the
decline, which may mirror the declining
availability of employment in academic
2
health science centres.

0
2010 2011 2012 2013 2014 2015 2016
Job Prospects
PGY1
No. CMG positions
Positions Filled infilled
Canadain Canada

No.
PGY1Total
CMG Positions in in
positions Canada
Canada

Potentially difficult

21
 NEUROSURGERY

Positions Offered in Ontario Program Director Comments

10 0/3 reported

8
Job Prospects
6 (Program Directors)

4
Not reported
2

0
2010 2011 2012 2013 2014 2015 2016 OMSA Summary
PGY1
No. CMG positions
Students filled in Ontario
who Accepted an Ontario School
The field of neurosurgery has seen little
No.
PGY1Positions in Ontario
CMG positions in Ontario growth since 2005, with most jobs being
confined to academic health science
centres. Given its nature as a resource-
intensive specialty, growth in the field
is greatly limited as hospital budgets
Positions Offered in Canada limit OR time and training of new
graduates. With long residency training
25 and uncertain practice opportunities,
it will likely be quite difficult to secure
20 employment in the field of neurosurgery.
Residency positions in neurosurgery
have been declining across the country,
15 but have remained unfilled in Ontario
until this past cycle. Thus, there appears
to be a greater barrier to entry into the
10 workforce than into a residency position.

5
Job Prospects
0
2010 2011 2012 2013 2014 2015 2016
PGY1
No. CMG positions
Positions Filled infilled in Canada
Canada Difficult/Very difficult
No.
PGY1Total
CMG Positions in in
positions Canada
Canada

22
 OBSTETRICS AND GYNECOLOGY
Program Director Comments
Positions Offered in Ontario 1/5 reported
35
Current job prospects for obstetrics/
30 gynecology are good, with an expected
growth in employment opportunities
25 in the coming decade. It seems to
have become competitive obtaining
20 a residency position in this field, as
evidenced by the declining availabilities
15 of residency positions over the past
couple of years. Finally, some graduates
10 may choose to pursue additional training
to secure employment, but this is not
5 necessary.
0
2010 2011 2012 2013 2014 2015 2016

PGY1 CMG positions filled in Ontario

Job Prospects
No. Students who Accepted an Ontario School
(Program Directors)
No.
PGY1Positions in Ontario
CMG positions in Ontario

Good

Positions Offered in Canada

120
OMSA Summary
100
This field has seen moderate growth
in jobs since 2005, with almost half
80 of obstetrics/gynecology specialists
finding work in private offices/clinics,
60 and to a lesser degree, academic health
science centres. Moving forward, the job
40 market for these physicians may remain
as it currently stands, with the possibility
20 for a modest growth.

0
2010 2011 2012 2013 2014 2015 2016 Job Prospects
PGY1
No. CMG positions
Positions Filled infilled in Canada
Canada
No.
PGY1Total
CMG Positions inin
positions Canada
Canada
Good

23
 OPHTHALMOLOGY
Program Director Comments
Positions Offered in Ontario 1/5 reported

Despite an unfavourable job market

14 for ophthalmologists during the past
decade, employment growth is expected
12
in the next decade with a greater
10 provincial emphasis on vision care.
Historically, this has been a competitive
8 residency position to pursue, and there
is no expected change in this regard.
6 Of note is that a considerable proportion
of graduates pursue further training
4 or fellowships to assist in securing
2 permanent positions.

0
2010 2011 2012 2013 2014 2015 2016
Job Prospects
PGY1
No. CMG positions
Students filled in Ontario
who Accepted an Ontario School (Program Directors)
PGY1
No. CMG positions
Positions in Ontario
in Ontario

Good

Positions Offered in Canada

OMSA Summary
45
40 The majority of ophthalmology specialists
find work in private office/clinic settings.
35 However, given the resource-intensive
30 nature of this field, physicians have
historically had difficulty obtaining jobs.
25 The coming years look more optimistic
20 and the job market for ophthalmologists
is favourable. Unfortunately, the pattern
15 of residency positions speaks for itself,
10 with unrelenting competition to enter this
specialty.
5
0
2010 2011 2012 2013 2014 2015 2016 Job Prospects
PGY1
No. CMG positions
Positions Filled infilled in Canada
Canada
No.
PGY1Total
CMG Positions
positionsininCanada
Canada
Good

24
 ORTHOPEDIC SURGERY
Program Director Comments
1/6 reported

Positions Offered in Ontario Currently, wait times for orthopedic

surgeries are exceptionally high in
35
Ontario, especially in the past two
years. Lack of operational time for new
30
graduates results in inadequate training
25
and poor job prospects, even though
many patients require orthopedic
20 speciality care. As a result, the vast
majority of graduates seek further
15 training.

10
Job Prospects
5
(Program Directors)
0
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Students filled in Ontario
who Accepted an Ontario School Difficult/Very difficult
PGY1
No. CMG positions
Positions in Ontario
in Ontario

OMSA Summary
Orthopedic surgery falls under
Positions Offered in Canada the category of resource-intensive
90 specialties, in that new graduates require
OR time in order to secure employment.
80 Notably, there are a significant number
70 of new graduates into this specialty,
which further limits available operating
60 time — perhaps the declining number
50
of available residency positions reflects
this trend. Employment locations for
40 these physicians are split roughly evenly
between academic health science
30
centres, community hospitals, and
20 private clinics. However, as it currently
stands, securing employment in the field
10
is posing a challenge.
0
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Positions Filled infilled in Canada
Canada Job Prospects
No.
PGY1Total
CMG Positions in in
positions Canada
Canada

Difficult/Very difficult

25
 OTOLARYNGOLOGY
Program Director Comments
1/4 reported

Positions Offered in Ontario The outlook for otolaryngology appears

mixed: securing employment in the field
14 has becoming increasingly difficult,
with approximately half of graduates
12 furthering their training through
fellowships to become more employable,
10 with competition for residency positions
becoming more competitive. Of note,
8
however, is that these employment
trends are not expected to change in the
6
foreseeable future.
4

2 Job Prospects
0
(Program Directors)
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Students filled in Ontario
who Accepted an Ontario School
Difficult/Very difficult
No.
PGY1Positions in Ontario
CMG positions in Ontario

OMSA Summary
Positions Offered in Canada
Otolaryngology specialists predomi-
35
nantly find themselves operating in pri-
vate offices/clinics, with a smaller minori-
30
ty working in academic health science
25 centres. As a surgical field, it may suffer
from being resource-intensive, and op-
20 erating times may be less accessible to
new graduates. It is currently difficult to
15 secure a permanent position in this field,
and fellowship training is often required.
10 Similar to ophthalmology, the fact that
residency positions continue to be near-
5 ly entirely filled itself poses a barrier to
entry.
0
2010 2011 2012 2013 2014 2015 2016
PGY1
No. CMG positions
Positions Filled infilled in Canada
Canada Job Prospects
No.
PGY1Total
CMG Positions
positionsininCanada
Canada

Difficult/Very difficult

26
 PEDIATRICS
Program Director Comments
3/6 reported

Positions Offered in Ontario Job prospects for pediatrics are good,

with more employment opportunities
60 expected for the future. This is especially
the case for generalist pediatricians
50 who should not have difficulty
finding employment as their skills are
transferable, although relocation may
40
be necessary. Only a small proportion of
graduates find it necessary to undergo
30 additional training in order to become
more employable. Of note is that entering
20 a pediatrics residency has become more
competitive over the years.
10

0 Job Prospects
2010 2011 2012 2013 2014 2015 2016
(Program Directors)
PGY1
No. CMG positions
Students filled in Ontario
who Accepted an Ontario School
No.
PGY1Positions in Ontario
CMG positions in Ontario
Good

Positions Offered in Canada

OMSA Summary
160
Pediatricians find themselves working
140
either in private offices/clinics, or
120 academic health science centres. There
exist a variety of subspecialty training
100 opportunities for graduates; however,
it appears that remaining a generalist
80
allows one to become more employable.
60 Historically, until this past cycle,
residency positions have remained
40 open in pediatrics, presenting good
opportunities for interested graduates to
20 pursue this field.
0
2010 2011 2012 2013 2014 2015 2016
PGY1
No. CMG positions
Positions Filled infilled in Canada
Canada
Job Prospects
No.
PGY1Total
CMG Positions
positionsininCanada
Canada

Good

27
 PHYSIATRY AND
REHABILITATIVE MEDICINE
Program Director Comments
2/5 reported

Positions Offered in Ontario Job prospects for this field are quite
good, and this is not expected to change
10 in the coming years. The specialty of
physiatry and rehabilitative medicine
is expected to maintain these good job
8
prospects as the work does not require
hospital resources to operate. Very
6 few graduates find a need to pursue
additional training in order to become
employable, and there exists a demand
4 for physiatrists as current patient wait-
times in the field can be several months
2 in length.

0
2010 2011 2012 2013 2014 2015 2016 Job Prospects
PGY1
No. CMG positions
Students filled in an
who Accepted Ontario
Ontario School
(Program Directors)
PGY1
No. CMG positions
Positions in Ontario
in Ontario
Very good/Excellent

OMSA Summary
Positions Offered in Canada
The field of physiatry and rehabilitative
30 medicine has undergone steady growth
in employment since 1995, with most
25 deciding to practice in private offices/
clinics. This is made possible as these
physicians are not often dependent on
20
specialized hospital-based resources
that restricts some other specialties,
15 notably surgical specialties. There
is no expected change in the rising
10 employment trends. Of note, however,
is that obtaining a residency position
5 in this field is becoming increasingly
competitive, as evidenced by the last
0
three Ontario cycles.
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Positions Filled in filled
Canadain Canada
Job Prospects
No. Total
PGY1 CMG Positions in in
positions Canada
Canada

Very good/Excellent

28
 PLASTIC AND
RECONSTRUCTIVE SURGERY
Program Director Comments

Positions Offered in Ontario 1/4 reported

12 This field continues to remain competitive

for residency positions and is expected
10 to grow in coming years. As it stands,
employment prospects for plastic
and reconstructive surgery is good,
8
but this too may see a decline in the
coming decades. The vast majority of
6 graduates from this field pursue further
training or fellowships in order to secure
4 employment opportunities.

2
Job Prospects
0
2010 2011 2012 2013 2014 2015 2016 (Program Directors)
PGY1
No. CMG positions
Students filled in Ontario
who Accepted an Ontario School
PGY1
No. CMG positions
Positions in Ontario
in Ontario Good

OMSA Summary
Positions Offered in Canada
These specialists operate predominantly
30 in a solo practice, working out of either
academic health science centres or
25 private offices/clinics, for the most part.
There has been minimal employment
20
growth in the field since 2001, and given
that plastic and reconstructive surgery
is a resource-intensive field, specialists
15
may face difficulty finding employment.
Currently, a pattern is emerging in which
10 this specialty continues to have all of its
residency positions filled.
5

0
2010 2011 2012 2013 2014 2015 2016
Job Prospects
PGY1
No. CMG positions
Positions Filled infilled in Canada
Canada
No.
PGY1Total
CMG Positions inin
positions Canada
Canada
Indeterminable

29
 PSYCHIATRY
Program Director Comments
Positions Offered in Ontario 4/6 reported

70 Psychiatry is a field with strong job

prospects for graduates, the vast
60 majority of whom do not need to
pursue further training to become
50
more employable. Furthermore, these
40
employment trends are not expected to
change in the coming years. However,
30 as job prospects have strengthened,
psychiatry residency positions have
20 become more competitive.

10

0 Job Prospects
2010 2011 2012 2013 2014 2015 2016 (Program Directors)
No.
PGY1Students who Accepted
CMG positions an Ontario School
filled in Ontario
No.
PGY1Positions in Ontario
CMG positions in Ontario
Very good/Excellent

OMSA Summary
Positions Offered in Canada
Psychiatry could be considered an “old”
200 profession, with a significant proportion
of practicing specialists approaching
age of retirement. This will open up
160
opportunities for new graduates, the
majority of whom will find work either
120 in private offices/clinics, or academic
health science centres. The increasing
number of residency positions offered in
80
psychiatry both in Ontario and nationally
has been coupled with an increasing
40 graduate interest in the field. Overall,
this field has been identified as one for
which there is a demand.
0
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Positions Filled infilled in Canada
Canada Job Prospects
No.
PGY1Total
CMG Positions
positionsininCanada
Canada

Very good/Excellent

30
 PUBLIC HEALTH
Program Director Comments
2/5 reported
Positions Offered in Ontario
The future of the Ontario job market for
12 public health and preventative medicine
specialists is difficult to generalize. What
10 is known is that a moderate proportion
of graduates will pursue further training
8 or fellowships in order to assist in finding
employment. Currently, job prospects
6 are neither growing nor diminishing,
although entry into this program has been
4 noted as becoming more competitive.
Judging from the data, there have
2 remained a number of unfilled positions
since 2012; however, this trend appears
0 to be reversing.
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Students filled in Ontario
who Accepted an Ontario School
PGY1 CMG positions in Ontario
Job Prospects
No. Positions in Ontario
(Program Directors)

Indeterminable

Positions Offered in Canada

30
OMSA Summary
25 There has been no appreciable change
in employment in this field for two
20 decades currently, with most specialists
finding work at administrative offices,
15 and to a lesser degree, elsewhere in
various areas of healthcare. Given
10 the emergence of interprofessional
practices, public health physician jobs
5 may be at risk as an interprofessional
approach to care reduces reliance on
0 specialist services (i.e., public health).
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Positions Filled infilled in Canada
Canada
No.
PGY1Total
CMG Positions inin
positions Canada
Canada
Job Prospects

Indeterminable

31
 RADIATION ONCOLOGY
Program Director Comments
3/5 reported

Positions Offered in Ontario The apparent consensus is that currently,

jobs in radiation oncology are difficult
14
to obtain. However, this is very likely
12 to change in the coming decade, with
improved employment across Ontario. It
10 has been observed that the vast majority
of graduates pursue fellowship training
8 not for the intent of becoming more
employable, but rather to keep current
6 with newer treatment technologies and
to have the ability to offer specialized
4
services. Obtaining a residency position
2 in this field is not expected to become
more competitive than currently.
0
2010 2011 2012 2013 2014 2015 2016

PGY1
No. CMG positions
Students filled in Ontario
who Accepted an Ontario School Job Prospects
No.
PGY1Positions in Ontario
CMG positions in Ontario (Program Directors)

Good

Positions Offered in Canada

30
OMSA Summary
There has been a large growth in the
25 employment trends in this field since
2001, with a little under half of radiation
20 oncologists finding work in academic
centres. As it stands, there appears to
15 be an excess of radiation oncologists
per patient population they serve,
10 but this is likely to swing in a positive
direction in coming years. One concern
5 to be aware of: radiation oncology is a
resource-intensive speciality, and thus
0 may factor into an institution’s ability to
2010 2011 2012 2013 2014 2015 2016 train new graduates.
No.
PGY1Positions Filled infilled
CMG positions Canada
in Canada
No.
PGY1Total
CMG Positions ininCanada
positions Canada
Job Prospects

Good

32
 UROLOGY
Program Director Comments
2/5 reported
Positions Offered in Ontario
Current employment trends for urolo-
16 gy are good, and this does not appear
to be changing in the coming years.
14
Whether or not competition for residency
12 positions will be increasing is indeter-
minable. However, approximately half of
10 graduates will pursue additional training
in the field to assist in securing employ-
8
ment.
6

4
Job Prospects
2
(Program Directors)
0
2010 2011 2012 2013 2014 2015 2016

No.
PGY1Students who Accepted
CMG positions an Ontario School
filled in Ontario Good
No.
PGY1Positions in Ontario
CMG positions in Ontario

OMSA Summary
Positions Offered in Canada Since 2005, there has been some growth
in the job market in urology, working
35 mostly in group practice. Urologists in
Ontario primarily work in academic and
30 community hospitals, as well as private
offices/clinic. Unlike other surgical
25
specialties, it appears that urology
does not suffer from the resource-
20
intensiveness that appears to hinder
job prospects in other surgical fields.
15
Judging from the data, urology does
10 appear to be a relatively competitive
specialty, with occasional residency
5 positions going unfilled.

0
2010 2011 2012 2013 2014 2015 2016 Job Prospects
PGY1
No. CMG positions
Positions Filled infilled in Canada
Canada
No.
PGY1Total
CMG Positions ininCanada
positions Canada
Good

33
 VASCULAR SURGERY
Program Director Comments
2/4 reported
Positions Offered in Ontario
Currently, employment prospects for
8 vascular surgery are good; however, this
may be changing in the coming years.
What is known is that the vast minority
6 of graduates find it necessary to pursue
a fellowship to secure employment.
Although the data suggests that vascular
4 surgery is a competitive residency
program to enter, it remains difficult to
ascertain whether this competition will
decline, plateau, or increase further.
2

0
Job Prospects
2010 2011 2012 2013 2014 2015 2016 (Program Directors)
PGY1
No. CMG positions
Students filled in Ontario
who Accepted an Ontario School
No.
PGY1Positions in Ontario
CMG positions in Ontario
Indeterminable

Positions Offered in Canada OMSA Summary

12 Since spawning in 2012, vascular surgery
is a young specialty. It is premature to
10 ascertain the job market for this field. As
with other surgical specialties, limited
8 access to facilities and resources may
hinder opportunities to train graduates
6 and allow these specialists to practice.
Residency spots have never gone
4 unfilled; however, given its relatively
recent addition as a residency program,
2
it is difficult to make accurate future job
market predictions.
0
2010 2011 2012 2013 2014 2015 2016

PGY1 CMG positions

Job Prospects
No. Positions Filled infilled in Canada
Canada
No.
PGY1Total
CMG Positions inin
positions Canada
Canada

Indeterminable

34
SPECIALTY PROFILES:

MEDICINE
SUBSPECIALTIES
Note: CaRMS does not published province-specific match data for Medicine Subspecialties.
As a result, the graphs for Ontario and Canada were combined.

35
ALLERGY AND IMMUNOLOGY
Positions Offered in Ontario and
Canada
16
14
12
10
8
6
4
2
0
2010 2011 2012 2013 2014 2015

#PGY4
of students who accepted
CMG positions filled inan Ontario school
Ontario
#PGY4
of positions filled in Canada
CMG positions filled in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

1/3 reported The field of clinical immunology and
allergy has seen steady growth since
Currently, employment prospects for 2001, with around half of physicians
allergy and immunology are good, and practicing in private offices/clinics.
this is not expected to change in the According to the data, residency
coming decade. Very few residents in positions have consistently remained
this sub-specialty pursue additional unfilled across the country ­­— a gap
training to secure employment. However, which appears to be diminishing in recent
it should be noted that as allergy and cycles given the increasing popularity
immunology is becoming increasingly of the specialty. Nevertheless, the
popular as a specialty preference, given employment prospects for specialists in
their small size, competition for entry is this field are poised to remain relatively
vulnerable to a rapid change if there is a strong in the coming decade.
sudden influx of trainees.

Job Prospects Job Prospects

(Program Directors)

Good Good

36
CARDIOLOGY
Positions Offered in Ontario and
Canada
70
60
50
40
30
20
10
0
2010 2011 2012 2013 2014 2015

#PGY4 CMG positions

of students filled inan
who accepted Ontario
Ontario school
#PGY4
of positions filled in Canada
CMG positions filled in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

0/5 reported It is largely difficult to predict the job
market for this field, given the lack of
reliable data. This specialty saw both
Job Prospects sharp increases in popularity in 2007
and 2011, with a little under half of cardi-
(Program Directors) ologists finding work in academic health
science centres in group-based prac-
tices. Residency positions consistently
approximate saturation, suggesting that
Not reported competition for cardiology in Ontario is
high. Although not as resource-intensive
as cardio-surgical specialties, it is like-
ly that additional training would be re-
quired to secure jobs in these academic
institutions.

Job Prospects

Good

37
CRITICAL CARE MEDICINE
Positions Offered in Ontario and
Canada
60

50

40

30

20

10

0
2010 2011 2012 2013 2014 2015

#PGY4 CMG positions

of students filled inan
who accepted Ontario
Ontario school
#PGY4
of positions filled in Canada
CMG positions filled in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

4/5 reported Critical care medicine finds itself in a
peculiar position. As both a resource-
The field of critical care medicine is un- intensive practice and one which is
dergoing an uncertain change in the job valued by hospitals, the future for this
market moving forward. The vast major- specialty in our province remains largely
ity of ICU physicians (i.e., intensivists) indeterminable. At the outset, it would
are able to work in their desired spe- appear that the cost of sustaining this
cialty of critical care medicine; however, practice is trumping the necessity of
landing a job in both academic centres intensivist specialists. The number
and community centres may become of available residency positions has
more difficult due to saturation of closed remained relatively static for several
units, and progressing slow closures of years, although interest in the field may
still “open” units in many hospitals. Al- be increasing. More data and trends are
though very few critical care physicians required to make accurate predictions
require additional training to become regarding critical care medicine.
more employable, competition for this
subspecialty may be becoming more
competitive. Job Prospects

Job Prospects
Potentially difficult
(Program Directors)

Indeterminable

38
ENDOCRINOLOGY
Positions Offered in Ontario and
Canada
35
30
25
20
15
10
5
0
2010 2011 2012 2013 2014 2015

#PGY4 CMG positions

of students filled in an
who accepted Ontario
Ontario school
#PGY4
of positions filled in Canada
CMG positions filled in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

1/4 reported This field has enjoyed steady growth
for almost 20 years, with just under
The job market for endocrinologists half of specialists finding work in
is looking potentially difficult, and academic health science centres. The
this is not expected to change in data suggests that one-third will work
the coming decade. Interestingly, in group-based practices, and another
very few specialists find themselves one-third in solo practices. Interest
pursuing additional training to become in this sub-specialty has remained
employable, so further investigation relatively static — aside from a peculiar
is needed in order to ascertain the sudden drop in interest in 2012 — and
future job market. Residency positions it appears that more positions have
in endocrinology are also noted to be opened up in the past three years.
becoming more competitive. Unfortunately, endocrinology too finds
itself as a specialty for which concrete
data is lacking. Of solace is that future
Job Prospects job prospects are unlikely to be different
from current employment trends for this
(Program Directors) field.

Potentially difficult Job Prospects

Indeterminable

39
GASTROENTEROLOGY
Positions Offered in Ontario and
Canada
50
45
40
35
30
25
20
15
10
5
0
2010 2011 2012 2013 2014 2015

#PGY4 CMG positions

of students filled in an
who accepted Ontario
Ontario school
#PGY4
of positions filled in Canada
CMG positions filled in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

1/5 reported This field has experienced a large growth
since 2005, with specialists roughly
Similar to endocrinology, gastroenterol- divided in their practices between work in
ogists are finding themselves facing a academic health science centres, private
potentially difficult job market which will offices/clinics, and community hospitals.
persist in the coming decade. However, Unfortunately, gastroenterology also
it was noted that the vast majority of spe- finds itself in the realm of “resource-
cialists will in fact find themselves pursu- intensive medicine,” resulting in notable
ing additional training in order to secure employment challenges. The plateaued
employment. Entry into a gastroenterolo- trend of residency positions in Ontario
gy sub-specialty seems to be less com- strongly suggests high competition for
petitive now than historically. this field and subsequent saturation,
with all Canadian residency positions
being filled in recent cycles. Overall,
Job Prospects the job market for gastroenterologists in
the coming decade is shaping up to be
(Program Directors) difficult.

Job Prospects
Potentially difficult

Potentially difficult

40
GENERAL INTERNAL MEDICINE
Positions Offered in Ontario and
Canada
100
90
80
70
60
50
40
30
20
10
0
2010 2011 2012 2013 2014 2015

#PGY4 CMG positions

of students filled in an
who accepted Ontario
Ontario school
#PGY4
of positions filled in Canada
CMG positions filled in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

0/5 reported Unconfirmed upcoming changes to the
handling of general internal medicine
(GIM) as a “subspecialty” under Internal
Job Prospects Medicine, coupled with a paucity of
data, result in a black-box future for this
(Program Directors) practice. Internists are roughly divided in
their practice to work in either academic
health science centres, private offices/
clinics, or community hospitals — all
Not reported of which are predominately group
practices. Given that the majority of
Canadian residency positions for GIM
have approached saturation, it is safe to
assume that spots rarely remain unfilled
in Ontario. As GIM is often treated as
a prolongation of internal medicine
training, the two likely share similar
employment prospects.

Job Prospects

Good

41
GERIATRIC MEDICINE
Positions Offered in Ontario and
Canada
35

30

25

20

15

10

0
2010 2011 2012 2013 2014 2015

#PGY4 CMG positions

of students filled in an
who accepted Ontario
Ontario school
#PGY4
of positions filled in filled
CMG positions Canada in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

2/4 reported Geriatric medicine is facing excellent job
prospects, and a very difficult workload
The job prospects for physicians pursu- given the aging population, both currently
ing geriatric medicine will be very good and in the coming decade. The field has
to excellent for the coming decade. Very seen a steady growth since 1997, with
few specialists require additional train- the majority of geriatricians working
ing, and competition for entry into this in academic health science centres.
sub-specialty appears stable. It is largely an interprofessional group
practice. Available residency positions
have remained relatively stable, and
Job Prospects spots remain unfilled each year. Overall,
employment for anything related to older
(Program Directors) adult health is already on the rise.

Very good/Excellent Job Prospects

Very good/Excellent

42
HEMATOLOGY
Positions Offered in Ontario and
Canada
45
40
35
30
25
20
15
10
5
0
2010 2011 2012 2013 2014 2015

#PGY4
of students who accepted
CMG positions filled in an Ontario school
Ontario
#PGY4
of positions filled in filled
CMG positions Canada in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

1/5 reported Hematology is a field which has experi-
enced a steady growth since 2001, with
Current job prospects for the field of just under half of specialists working in
hematology are good, with an expected academic health science centres. Un-
growth in employment in the coming like other lab-based residencies, hema-
decade. Very few specialists require tologists often find themselves working
additional training in order to become in a group practice. It is difficult to tell
more employable. However, it has been from the data if the competition for this
noted that entry itself into this sub- residency will stabilize, with the last few
specialty is facing greater competition. years seeing both rises and falls in pop-
ularity. Overall, it appears to be an area
of expected growth if work in academic
Job Prospects institutions is valued by the applicant.

(Program Directors)
Job Prospects
Good

Good

43
INFECTIOUS DISEASE
Positions Offered in Ontario and
Canada
7
6
5
4
3
2
1
0
2010 2011 2012 2013 2014 2015

#PGY4
of students
Positions
CMG who
filled accepted
positions filled inan
in Ontario Ontario school
Ontario
#PGY4
of positions
Positions
CMG filled
filled in Canada
positions
in Canada
filled in Canada
#PGY4
of total
Positions
CMGpositions
in Canada in Canada
positions in Canada

Program Director Comments OMSA Summary

2/3 reported Microbiology and infectious disease has
experienced steady growth in the past
The field of infectious disease medicine 20 years, with half of specialists finding
is looking up, with strong opportunities work in group practices in academic
for employment with the potential for health science centres. On the one
continued growth in the coming decade. hand, advances in the field of bacterial-
There are discrepancies regarding resistance may promote growth into
whether competition for this field is also this field. However, funding for these
increasing. However, a consensus was residency positions has been declining
reached in that a sizeable minority of since 2012. As it stands, there are very
specialists will seek additional training few residency positions nationwide for
opportunities to promote employment. this sub-specialty, resulting in a likely
relocation for interested applicants.
Given the persistent reduction in
Job Prospects residency positions, the job market
remains questionable.
(Program Directors)

Job Prospects
Good

Indeterminable

44
MEDICAL ONCOLOGY
Positions Offered in Ontario and
Canada
45
40
35
30
25
20
15
10
5
0
2010 2011 2012 2013 2014 2015

#PGY4 CMG positions

of students filled in an
who accepted Ontario
Ontario school
#PGY4
of positions filled in Canada
CMG positions filled in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

0/4 reported The field of medical oncology has
experienced steady growth since 1995,
with just under half of specialists working
Job Prospects in group practices within academic
health science centres. Unfortunately,
(Program Directors) due to the paucity of data, it is difficult
to predict the future outlook for this
profession. According to the data,
the availability of residency positions
Not reported has remained relatively constant after
experiencing a slight growth about 5
years ago. More data is required in order
to ascertain the future job market.

Job Prospects

Indeterminable

45
NEPHROLOGY
Positions Offered in Ontario and
Canada
50
45
40
35
30
25
20
15
10
5
0
2010 2011 2012 2013 2014 2015

#PGY4 CMG positions

of students filled in an
who accepted Ontario
Ontario school
#PGY4
of positions filled in Canada
CMG positions filled in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

2/5 reported Currently, nephrologists are finding
it very difficult to secure employment
The field of nephrology is facing a poten- in Ontario. Although not a resource
tially difficult future of employment that intensive specialty, the field may have
is not expected to change in the com- reached saturation after having enjoyed
ing decade. Entry into this sub-specialty a steady growth since 1997. Half of
has also become more competitive, and all nephrologists have found work
approximately half of new graduates in academic health science centres
will pursue further education/training in in group-based practices (similar to
order to improve their employment pros- many other sub-specialties of internal
pects. medicine). This saturation point is
reflected in recent cycles, as the number
of available residency positions — which
Job Prospects historically had remained largely unfilled
— were drastically reduced. Thus, the
(Program Directors) competition for the few jobs available is
evident.

Difficult/Very difficult
Job Prospects

Difficult/Very difficult

46
OCCUPATIONAL MEDICINE
Positions Offered in Ontario and
Canada
3

0
2010 2011 2012 2013 2014 2015

#PGY4 CMG positions

of students filled inan
who accepted Ontario
Ontario school
#PGY4
of positions filled in Canada
CMG positions filled in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

0/1 reported Physicians of occupational medicine are
few and far between, with few residency
positions in existence. This has been
Job Prospects the case since 2001. Occupational
medicine specialists often work in either
(Program Directors) private offices/clinics, or administrative
offices. Historically, the residency
position(s) have not been filled (when
offered), although this suggests that
Not reported
any school willing to invest in training
an occupational health specialist would
facilitate finding them employment upon
graduation.

Job Prospects

Good

47
PHARMACOLOGY
AND TOXICOLOGY
Positions Offered in Ontario and
Canada
5

0
2010 2011 2012 2013 2014 2015

#PGY4 CMG positions

of students filled inan
who accepted Ontario
Ontario school
#PGY4
of positions filled in Canada
CMG positions filled in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

1/2 reported There have historically remained very
few residency positions for this specialty.
Job prospects for physicians specialized Regardless, the job market has been
in pharmacology and toxicology have identified as good and the data available
been identified as good, with no suggests that competition for residency
expected change in the coming decade. positions remains quite low – which is
Entry into this sub-specialty may be good news for interested applicants.
becoming more competitive, although Unfortunately, there is a large gap in
very few graduates pursue additional available data, preventing an accurate
training post-graduation. Regarding job prediction as to whether these trends
distribution, most positions are largely will remain.
academic. However, there has been
a significant need identified to have
specialists trained specifically in the Job Prospects
following areas: pharmacogenetics,
drug-drug interactions, drug-approval
and policy development, environmental
and clinical toxicology, and prevention Good
strategies for drug addiction.

Job Prospects
(Program Directors)

Good

48
RESPIROLOGY
Positions Offered in Ontario and
Canada
60

50

40

30

20

10

0
2010 2011 2012 2013 2014 2015

#PGY4
of students who accepted
CMG positions filled inan Ontario school
Ontario
#PGY4
of positions filled in Canada
CMG positions filled in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

0/5 reported The field of respirology experienced
a large growth 20 years ago, with just
under half of specialists finding work in
Job Prospects group-based practices within academic
health science centres, and a smaller
(Program Directors) proportion working in private offices/
clinics. Although difficult to ascertain, the
close mirroring of residency positions
offered in Canada and the number
Not reported
of positions filled strongly suggests
that competition for the field is high.
Unfortunately, at present, this cannot be
corroborated by those in the field.

Job Prospects

Indeterminable

49
RHEUMATOLOGY
Positions Offered in Ontario and
Canada
40
35
30
25
20
15
10
5
0
2010 2011 2012 2013 2014 2015

#PGY4
of students who accepted
CMG positions filled in an Ontario school
Ontario
#PGY4
of positions filled in Canada
CMG positions filled in Canada
#PGY4
of total
CMGpositions in Canada
positions in Canada

Program Director Comments OMSA Summary

2/5 reported Both job prospects and competition
for rheumatology are on the rise in our
Rheumatology is a booming field, with province, and may reach saturation
specialists currently enjoying very in the coming years. Leveraging
good to excellent job prospects without the high likelihood of non-academic
need for additional training. However, rheumatology positions becoming
these trends appear unsustainable — available, this field — which has enjoyed
clinical practice in the Greater Toronto appreciable growth since 1995 — will
Area is becoming saturated, and continue to offer employment to its trained
extra fellowship training here would specialists. Half of rheumatologists
be necessary for full-time academic currently find work in private offices/
positions. However, elsewhere in the clinics, and around a third in academic
province, there will remain a large unmet health science centres. Overall, this
need for rheumatologists for some years is a specialty worth pursuing for those
to come. drawn to the complexity of autoimmune
conditions.

Job Prospects
(Program Directors) Job Prospects

Very good/Excellent Very good/Excellent

50
CONCLUSION
Thank you for reading the first-ever Insights into Physician Workforce Trends in Ontario
published by the Ontario Medical Students Association.

The publication of this Guide presents a major milestone for the Ontario Medical Students
Association. It is clear that medical students today face unprecedented new pressures in their
career planning due to chronic underemployment of the physician workforce. Until now, there
has never been any evidence-based information on Ontario workforce prospects provided
in a clear and succinct format to medical students to assist in their career planning. It is our
hope that this Guide will begin to fill an educational gap voiced by medical students since
2012 that future workforce prospects are an integral component of career planning to ensure
one’s choice of specialty meets the needs and reality of Ontario’s patients.

A huge congratulations and thank you is due to the members of the OMSA Education
Committee and our partner medical student organizations, educational, governmental, and
healthcare organizations nationwide for contributing to this landmark publication for Ontario’s
medical students.

Whether reading this guide is your first experience with OMSA or your seventeenth, we urge
you to continue to remain engaged with us. In fact, this Guide would not have been possible if
not for the ideas and support of grassroots OMSA members like yourselves who brought this
idea to our Council and championed its development! If you have other ideas, thoughts on
how to improve future iterations of this Guide, or are looking for other opportunities to engage
with OMSA please do not hesitate to be in touch with us. You are the future of the medical
profession, and your ideas make OMSA and Ontario’s healthcare and medical education
systems brighter.

While selecting one’s medical specialty is a challenging decision for every medical student
in Ontario, it is also one filled with excitement. We hope that this Guide has provided some
assistance and context in your decision-making process as we all embark on the exciting
journey together.

Wishing you all the best in your future medical career,

Ali Damji & Justin Cottrell

OMSA Co-Chairs, 2016–2017

51