[haldujai]

The expensive labor isn’t physicians and infrastructure/capital expenditures aren’t the barrier either.

It’s nursing costs and bed counts.

Look at Canada for an example, we have unemployed surgeons and interventional radiologists/cardiologists with surgical backlogs > 1 year.

We have the rooms, the hospital I trained at had 90 operating rooms but only 4 are funded for after-hours and on weekends, the rest run 8am-4am but no nursing money for the OR, recovery room, or patient wards.

[whimsicalism]

Research indicates the "unemployed surgeon" problem in Canada is more folklore than reality. [0] AFAICT, Canada has a shortage of physicians. [1] That unemployed people exist at all is not evidence that there is no labor crunch.

[0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866140/ [1]: https://www.cbc.ca/news/politics/canada-turning-away-home-gr...

That you are not running these rooms as much as possible indicates some failure in pricing/profit seeking, but I have no idea how the Canadian medical system works.

[haldujai]

From the Royal College (our specialty accreditation society)[0]:

> 11-18% of newly certified specialists cannot find work at the time of their certification.

> 75% of those who are continuing training do so because they think this will make them more employable.

[0] https://www.royalcollege.ca/ca/en/health-policy/building-med...

From your first reference:

> Traditional unemployment is rare; underemployment is not.

> Eleven per cent of the cohort described themselves as primarily locum surgeons. When asked why they did locums, the most common responses were “waiting for a job to open up at locum site” (46%) followed by “could not get the staff job that I wanted” (23%).

It's not unemployment in the traditional sense, in the medical community it looks like a liver surgeon (2 years of extra training) doing appendectomies in a small town or a neurosurgeon forced into only doing spine work (both need monitored beds +/- ICU). Or doing multiple fellowships until you find something.

Sure you can work as a locum (temp) or go to [very undesirable location doing general work] if you're in a specialty like general surgery that allows for that kind of practice environment. Tough luck if you're a cardiac surgeon/interventional cardiologist or oncologic subspecialist of any kind that needs high nursing support, inpatient beds and expensive instruments.

Note that these training positions are mostly all funded by the government in Canada and allocated based on their needs assessment (so it's not people choosing some unemployable niche by choice per se).

> AFAICT, Canada has a shortage of physicians.

We have a shortage of primary care physicians (because no one wants to do it), we have enough specialists by body count but no jobs/rooms for them (see underemployment points and how many go to the US).

> I have no idea how the Canadian medical system works.

Hospitals are run by the provincial governments. Physician compensation also comes from the same ministry but not out of the hospital's budget with "fixed professional fees" set by the single payer.

> That you are not running these rooms as much as possible indicates some failure in pricing/profit seeking

This has truth to it, the hospital's incentive is to prioritize their budget and they have little incentive to maximize throughput.

Due to funding nuances they're essentially incentivized to prioritize acute/emergent care (which gets some extra $) and have less throughput for things with consumables (like procedures) that come out of the hospital's budget.

It's pretty common for Canadian surgeons to admit someone to facilitate a surgery so we can use an "emergency OR room" even though they don't need the bed. Entirely wasteful but from the hospital's perspective the bed is paid for (we're constantly at capacity, there's no reality where a bed is unused) and a broken bone admitted unnecessarily doesn't cost anything extra as they don't particularly need nursing or have nearly as many consumable costs like a person hospitalized for acute illness.