Fall 2016 (Volume 26, Number 3)

The Pediatric Rheumatology Labour Force

By Janet Ellsworth, MD, FRCPC

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Just as kids are not just little adults, pediatric rheumatologists are not just little adult-rheumatologists. The recent Stand Up and Be Counted survey, conducted by the Canadian Rheumatology Association (CRA), highlighted some important differences between the practices of adult and pediatric rheumatologists in Canada.

By my count, there are currently 54 pediatric rheumatologists practicing in Canada. In contrast to adult rheumatologists, the majority (60%) of whom practice in community settings, more than 80% of pediatric rheumatologists practice in an academic health centre, as members of a university department of pediatrics. As is typical of physicians in academic practice, pediatric rheumatologists have fewer clinics per week and see fewer total patients but, because of smaller division numbers, spend more time “on-call” than their adult-rheumatologist counterparts. Those who are in community practice must combine pediatric rheumatology with other clinical activities, mostly general pediatrics.

The care of pediatric rheumatology patients takes more time: taking a history from multiple perspectives (child, parents, other family members and friends), examining children at various stages of cooperativeness, and dealing with parental anxieties are just a few unique aspects of pediatric practice. We depend heavily on allied health providers, including nurses, physical therapists (PTs), occupational therapists (OTs) and social workers, and tend to work in teams rather than independently. We also spend time teaching learners at all levels, from medical students to rheumatology residents, and most are part of the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) and participate in collaborative multicentre research, with a significant number engaging in independent research as well.

The pediatric committee of the CRA does a comprehensive survey regarding its labour force every three to five years, which highlights the variability across the country in terms of numbers of pediatric rheumatologists per population served and funding for allied health. This survey helps provide a benchmark and is useful for those advocating for resources in their centre.

What are the current labour force issues with respect to pediatric rheumatology?
1. Even though most pediatric rheumatologists must practice in an academic setting, funding for positions through the university and hospitals is competitive and can be difficult to secure.

2. There are only three pediatric rheumatology residency programs in Canada – at McGill University, University of Toronto and the University of British Columbia. The number of Canadian graduates from these programs annually is small, and in some years is not adequate to fill the faculty positions available, especially if new graduates from these large programs are not able and/or willing to relocate to a smaller centre.

3. Many programs struggle with small numbers of faculty – with only six out of 14 divisions of pediatric rheumatology having three or more full-time equivalent (FTE) physicians. As a result, it can be difficult to balance clinical responsibilities, including provision of clinical service 24/7, with academic requirements of research, teaching and administration. Although funding positions is a barrier, it is my opinion that sustainable pediatric rheumatology divisions require a critical mass of faculty in order to survive.

4. There are large areas of the country, particularly in the north, where patients are disadvantaged by having to travel large distances to receive pediatric rheumatology services. The need for outreach clinics in those areas is great, but is also hard to fund.

5. About 25% of pediatric rheumatologists plan to retire in the next five to 10 years.

These are some of the challenges we face as pediatric rheumatologists, but we are a collaborative and supportive community, actively working together to advocate for equitable care of pediatric rheumatology patients across the country.

Janet Ellsworth, MD, FRCPC
Professor of Pediatrics, University of Alberta
Pediatric Rheumatologist,
Stollery Children’s Hospital and Glenrose Hospital,
Director of the Division of Pediatric Rheumatology
Edmonton, Alberta