Graduates from several medical and surgical specialties are having difficulty securing practice opportunities, especially in specialties dependent upon limited resources, according to new research from Queen’s ophthalmologist Robert Campbell.

Specifically, recent ophthalmology graduates performed many fewer cataract surgery procedures after total provincial surgical rates plateaued in Ontario. In 2007, cataract surgery volume entered a period of government-mandated zero growth, impacting cataract operations performed by recent graduates. Established doctors secured the majority of surgery opportunities.

“The magnitude of the results we report suggest a pressing need to evaluate similar policies across many resource-intensive specialties in Canada,” adds Dr. Campbell.

Dr. Campbell and his research team used population-based data from Ontario from Jan. 1, 1994 to June 30, 2013 to compare health services provided by recent graduates and established ophthalmologists. He discovered that between 1994 and 2006, the total number of cataract operations performed in Ontario grew steadily. However, from 2007 onward, the number of operations performed by recent graduates declined sharply while the number performed by established physician continued to grow.

“In many nations, including Canada, cataract surgery, a highly technology-dependent procedure, is the most common operation performed,” says Dr. Campbell. “Consequently, practice opportunities are sensitive to overall constraints on health system resources and serve as an exemplar of issues facing many resource-intensive specialties.”

Dr. Campbell says these numbers are worrying in regards to the future of ophthalmology graduates.

“In these challenging times our findings draw attention to another layer of complexity. As health care resources become increasingly strained, we not only need to worry about today's patients, but in light of our findings, we obviously need to worry about tomorrow as well,” says Dr. Campbell. “While all physicians are affected by health system funding constraints, our unique study of a highly technical and resource-intensive specialty identified a clear link between worsening system constraint and the lack of opportunities for young specialists – the future of our system.”

Dr. Campbell says he wants to use these results to help shape policy in regards to effective career counselling, specifically in the field of ophthalmology, and for use by the Ontario Provincial Vision Strategy Task Force, a group charged with creating a new framework for the eye care system. Current recommendations aim to improve surgical opportunities for recent graduates. “We'll need to take care to be sure we have systems that provide for steady renewal of our highly-trained physician workforce. Our study suggests that much progress remains to be made in this direction.”

The research was published in the Canadian Medical Association Journal.