Where are orthopedic surgery graduates practising? A critical look at the last 30 years in Ontario

BACKGROUND: There has been considerable discussion regarding the demand for orthopedic surgery care and simultaneously the lack of employment opportunities for new graduates. We sought to understand the practice patterns and locations of orthopedic surgeons trained in Ontario. METHODS: We invited 618 surgeons trained between 1992 and 2020 to participate in a survey investigating their current practice location, practice patterns, available resources, and reasons for emigration if practising outside of Canada. RESULTS: A total of 253 surgeons responded (40.9%), with 242 full responses. Emigration out of Canada and number of fellowships did not change with time; however, those who graduated more recently were more likely to leave out of necessity rather than interest. Graduates of the University of Ottawa were more likely to work in the United States and more likely to settle farthest from their school if they stayed in Ontario. Graduates of the University of Toronto were more likely to work within 50 km of their training program than graduates of other schools. Most surgeons described themselves as specialists (community or academic), with very few self-described generalists (12%). CONCLUSION: We found an effect of school on the probability of leaving Canada, with surgeons who graduated more recently leaving out of necessity. This suggests that more recent graduates believe there are not enough opportunities, with graduates of the University of Ottawa being the hardest hit. We also found that almost no one viewed themselves as a generalist, which suggests a re-evaluation of the goals of residency education.