Winter 2013 (Volume 23, Number 4)

Human Resources Committee

By John Thomson, MD, FRCPC

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Medical workforce issues are very much in the news these days. The Royal College of Physicians and Surgeons of Canada released an employment report in October 2013, which documented disturbing statistics in medical manpower resources primarily to do with unemployment and underemployment in certain medical and surgical specialties and subspecialties in Canada. That this is a complex issue that will require much further study and action is abundantly clear. There are no easy or quick solutions to this unfortunate and serious problem.

Meanwhile in the sub-specialty of rheumatology, by and large, our medical workforce issue is primarily that of under-supply and maldistribution of resources. The fact is that, in most areas of Canada, there is an under-supply of rheumatologists. Most academic centres have positions to fill. Many large cities in Canada are in need of more rheumatologists working in the community. Perhaps the most acute shortages are in medium-sized urban centres. The reasons for the shortages and maldistribution are complex, but are certainly due in part to a relative underexposure of the subspecialty to medical students and internal medical trainees.

The CRA has recognized this shortage for many years, responding with a number of initiatives and ongoing programs designed to ultimately increase the number of practicing rheumatologists in Canada. Medical student preceptorships, both clinical and research-based, have been in place for several years. Medical students from medical schools across Canada apply for summer positions with preceptors, usually after their first or second year of medical school. This has increased the exposure of rheumatology early in medical training and led to many of these students pursuing a career in rheumatology. Dr. Janet Pope has been the champion behind these preceptorships, which are supported by sponsorship from our industry colleagues at Roche and AbbVie.

For many years, CRA has funded a textbook program that provides rheumatology textbooks to all students and residents rotating through rheumatology programs across Canada. Again, this has led to increasing exposure of the specialty and better knowledge of rheumatology by all medical trainees.

Another recent initiative includes increasing the awareness and use of the employment portal on the CRA website, a facility that allows posting of job opportunities from across the country. To-date it is under-used, but we hope to increase its presence. Dr. Jane Purvis, current president of the Ontario Rheumatology Association (ORA), has made medical workforce issues a centrepiece of her presidency. She has initiated innovative measures to help align rheumatology availability (new trainees) with rheumatology opportunities in Ontario. The CRA is working with
Dr. Purvis to hopefully expand the program nationally.

Rheumatology "awareness programs" in various forms have been in place across the country for several years. Internal medical residents in their first and second years of training have been invited to and attended programs in Vancouver, Calgary, London, Hamilton, and Montreal, at which they were made familiar with the specialty of rheumatology and all its attributes, including job availability. There has been a general feeling that internal medical residents have been underexposed to rheumatology or exposed too late in their internal medical training. The CRA is looking to increase the number of these rheumatology "awareness programs" by providing some funding and guidance to centres not yet offering such opportunities.

The good news is that the numbers of trainees in rheumatology seem to be increasing in a sustained fashion. Overall, the number of medical students entering medical school has increased very significantly over the past several years, and these numbers are now being seen in training programs. There is a feeling and hope that recent graduates will recognize the tremendous opportunities that exist in our fascinating sub-specialty and thus help correct the misdistribution of rheumatology personnel.

John Thomson, MD, FRCPC
Chair, Human Resources Committee,
Canadian Rheumatology Association
Assistant Professor,
Department of Medicine,
Division of Rheumatology,
University of Ottawa
Staff, The Ottawa Hospital
Ottawa, Ontario