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Winter 2020 (Volume 30, Number 4)

Report from the Human Resources Committee

By Jessica Widdifield, PhD; and Claire Barber, MD, PhD, FRCPC

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A sustainable rheumatology workforce is essential to achieving the mission of the CRA. This past year, the Committee has prepared a technical report on the Canadian rheumatology workforce. Several activities were undertaken to develop this working technical report.

First, we ascertained data profiles on the number of rheumatologists, residents, trainees and fellows in Canada using national databases. The quantitative data were derived from four data sources, including the Canadian Medical Association and the Canadian Institute of Health Information Scott’s Medical Database for number of rheumatologists; the Canadian Post-M.D. Education Registry for trainee and fellow counts; and the Canadian Resident Matching Service data for applicants to postgraduate rheumatology training programs. From these data sources, several important rheumatology workforce trends were identified. The first notable trend is the growth in the number of rheumatologists in Canada over the past decade, though overall this fails to meet the target benchmark of 1 rheumatologist per a population of 75,000 (Barber et al., 2014), and rheumatologist distribution is not equal across Canada. Another notable trend is the continued growth in the number of female and foreign-trained rheumatologists entering the workforce. There is also an increasing number of available rheumatology residency positions being offered and fewer unfilled training positions over time. As a result of the increase in available rheumatology residency positions, the numbers of trainees and fellows in adult and pediatric rheumatology training programs have significantly increased between 2000 and 2018 and, as of 2018, there were 82 residents and 27 fellows in Canada. Twenty percent of these were visa trainees (who are expected to return to their country of origin after training).

Second, we further curated the evidence base (via a scoping review) to identify Canadian rheumatology workforce research to examine the extent, range, and nature of research activities related to the rheumatology workforce, and to identify research gaps in the existing literature. Studies evaluating components of Canada’s rheumatology workforce, including the supply, demand, and medical education aspects, have revealed many noteworthy findings. While the overall supply of rheumatologists has increased, changing workforce demographics and other factors may be negatively impacting the clinical capacity to meet the demands of the increasing volume of patients. Increasing early exposure to rheumatology is vital to attracting new trainees to rheumatology. Although there is widespread literature on the Canadian workforce, many fundamental questions remain unanswered, including accurately understanding the current full-time equivalent (FTE) supply and forecasting the future rheumatology workforce supply needs.

Third, we conducted an environmental scan to identify current rheumatology evidence-based clinical practice guidelines or recommendations that specifically state the role for rheumatologists in the care of patients with rheumatic and musculoskeletal diseases (RMDs). Twenty-five national and regional guidelines for RMDs were reviewed. Eleven guidelines and two white papers contained 21 recommendations describing the central role for rheumatologists in the care of patients with rheumatic diseases. However, only three Canadian guidelines explicitly stated the role of rheumatologists in the care of RMDs.

The workforce technical report (which will be posted on the CRA website [rheum.ca/about-us/leadership-committees/ human-resources-committee/] in early 2021) was undertaken to inform the CRA’s Workforce Position Statements (currently being prepared by the Committee).

Finally, the launch of the 2020 Rheumatology Workforce and Wellness Survey was delayed until Fall 2020. This new launch timeline has permitted the addition of questions to better understand the impact of the pandemic on rheumatology practices including the use of virtual care. All rheumatologists are encouraged to complete the electronic survey being distributed by the CRA via email to CRA members.

References:
Barber C, Marshall D, Mosher D, et. al. Developing System-Level Performance Measures for Evaluation of Models of Care for Inflammatory Arthritis Framework. 2014. Retrieved from www.arthritisalliance.ca/images/PDF/Final%20Background%20MOC_Nov6.pdf

Jessica Widdifield, PhD
Co-chair, CRA Human Resources Committee
Scientist,
Sunnybrook Research Institute, ICES
Assistant Professor, University of Toronto,
Institute of Health Policy, Management & Evaluation
Toronto, Ontario

Claire Barber, MD, PhD, FRCPC
Co-chair, CRA Human Resources Committee
Assistant Professor, Rheumatologist,
University of Calgary, Calgary, Alberta



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