Open this photo in gallery The grim job market for orthopedic surgeons in the Maritimes is one of the reasons Daryl Dillman, seen here, chose to take a year of further training as a fellow at an Indianapolis hospital. AJ Mast/The Globe and Mail

Nearly one in five newly certified specialists cannot find a full-time job in Canada, a situation that is leading some young doctors to decamp to the United States while patients in this country languish on waiting lists.

The Royal College of Physicians and Surgeons of Canada, the organization that oversees the medical education of specialists, says more junior specialists are facing bleak job prospects than at any time since the college began studying the problem in 2011.

Nineteen per cent of specialists who passed their certification exams in 2017 reported being unable to find a job right away, with neurosurgeons, radiation oncologists and orthopedic surgeons the likeliest to be unemployed, according to the results of a survey released on Wednesday.

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For Canadian patients who sometimes wait months or years for a coveted specialist appointment, it is difficult to understand why the health-care system is turning away eager new doctors who have more than a decade of taxpayer-supported education and training under their belts.

While doctors’ personal preferences about where to work are part of the explanation, the Royal College and other specialist leaders blame the disconnect on a shortage of public funding for necessities such as operating-room time, recovery beds and nursing support.

“The challenge is accessing the practice resources,” said Danielle Fréchette, executive director of the Royal College’s office of research, health policy and advocacy, and one of the authors of the new employment study. “Those who are already in practice are challenged to find operating-room time. Those who want to practice can’t get their foot in the door.”

The grim job market for orthopedic surgeons in the Maritimes is one of the reasons Daryl Dillman chose to take a year of further training as a fellow at an Indianapolis hospital.

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The 28-year-old grew up in Cole Harbour, N.S., and spent five years training as a resident surgeon at Halifax’s Queen Elizabeth II Health Sciences Centre, where he focused on repairing bones after major traumatic injuries. He was also a finalist on the CBC show Canada’s Smartest Person.

Dr. Dillman said he would love to come home to practice, but “there’s just no room to hire anybody until someone retires and that’s not in the foreseeable future.”

Instead, he has already accepted a full-time job at a Chicago hospital starting at the end of this year. “It’s very frustrating,” Dr. Dillman said. “I want to look after the community that raised me.”

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The Royal College found that in 2017, 43 per cent of new specialists chose to pursue additional training as Dr. Dillman did, in part because of their perceptions of the Canadian job market.

Most of the rest either found a job (33 per cent); decided to pursue extra training after a failed job hunt (7 per cent); or were simply unable to find a full-time job (12 per cent.) The 201 new specialists who fit the latter two categories made up 19 per cent of those who responded to the 2017 survey, higher than the previous peak in 2013, when 159 new specialists, or 18 per cent, reported employment challenges.

However, new specialists can expect their prospects to brighten with time: Of those who reported struggling to find work between 2013 and 2016, 61 per cent had found a job by the time the College issued a follow-up survey a year or more more later.

The Royal College’s employment study is based on surveys of 6,236 new specialists between 2011 and 2017 representing more than a third of all new specialists.

In a separate effort, the Canadian Orthopaedic Association (COA) asked Canada’s 17 medical schools to track orthopedic graduates from 2013 to 2018. The COA found that of 478 graduates over six years, 159 are currently seeking full-time jobs. Another 74 have found full-time work outside of Canada, most often in the United States.

Canadian medical schools have already cut the number of residency posts in orthopedics from 81 in 2011 to 52 last year.

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Mark Glazebrook, the incoming president of the COA and a professor of orthopedic surgery at Dalhousie University, said the unemployment problem in his field is a reflection of the fact that provincial governments don’t have the money to meet the health needs of all patients, particularly those who require elective surgery.

Approximately 30 per cent of Canadians who needed a hip or knee replacement waited six months or more for the procedure in 2018, not including the time they waited to see a specialist in the first place. In Nova Scotia, where Dr. Glazebrook practices and Dr. Dillman would like to, more than 50 per cent of patients waited longer than the national goal of six months for a new hip or knee.

“We have unemployed orthopedic surgeons who are dying to meet this need,” Dr. Glazebrook said. “The government can’t afford it.”