Spring 2022 (Volume 32, Number 1)
Evolution of the Canadian
Rheumatology Workforce
By Stephanie Kulhawy-Wibe, MSc, MD
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The future of rheumatology in Canada will undoubtedly
be shaped by the feminization of our workforce.
Our specialty is already more than half female, but
this female predominance will become even more pronounced,
as women now account for 75% of rheumatologists
under 45 years of age.1 This has implications for
workforce planning, but also has the potential to evoke
positive change in how rheumatology is practiced. This
trend also exists in the United States, but we are about
10 years ahead in Canada, which presents us with the opportunity
to become leaders in supporting women in the
workforce in novel and bold ways.1,2 Below are a few areas
where we might better support women in the rheumatology
workforce:
- Gender inequity is still an issue in our field: women
make less money, publish fewer first- and last-author
publications, get less grant funding, and are less
likely to be promoted to associate or full professor
than their male counterparts.3,4 So, how can we
rethink remuneration for services? How can we
better support women to publish and attain grant
funding? What are the barriers to promotion?
- Half of rheumatologists in Canada report burnout,
and women are disproportionately more affected.
Women are also less likely to perceive their
workplace as supportive.5 Historically, rheumatology
prided itself on being a happy specialty, but we
now report among the highest levels of burnout of
all medical specialties.6 What are the modifiable
drivers of burnout? How can we address this critical
issue to protect and retain our current workforce?
- Female rheumatologists have different work
patterns. They are more likely to work part-time,
and even when working the same number
of hours per week, they see fewer patients.3,5
This could affect our ability to keep up with the
already high demand for rheumatology services.
Are there creative ways to meet service demands
without necessarily working more hours?
- Women are more likely to take leaves of absence.7
How can we help with transitions around
leaves? And how can it not penalize their long-term
goals and future career trajectory?
- Similarly, taking a maternity leave during residency
has become more acceptable and common in
recent years. However, some residents may not be
able to afford to defer their staff salary any longer.
Furthermore, each year your salary is deferred, you
are giving up not your first, but your last earning year
which typically accounts for a greater proportion of
lifetime income. With the introduction of competency
by design, could there be some flexibility for earlier
advancement if competency standards are met?
Rheumatology in Canada is not yet equitable, but the
feminization of our workforce provides an impetus for
change. Together we can shape a future that provides
equitable opportunity for professional advancement, compensation,
and wellness for all members of our diverse
workforce.
Stephanie Kulhawy-Wibe, MSc, MD
R5 Rheumatology,
Cumming School of Medicine
University of Calgary
Calgary, Alberta
References:
1. Canadian Medical Association (CMA). Canadian Specialty Profiles – Rheumatology Profile. Available
at surveys.cma.ca/en. Accessed February 16, 2022.
2. Battafarano DF, Ditmyer M, Bolster MB, et al. 2015 American College of Rheumatology Workforce
Study: Supply and Demand Projections of Adult Rheumatology Workforce, 2015-2030. Arthritis
care & research. 2018; 70:617-26.
3. Widdifield J, Gatley JM, Pope JE, et al. Feminization of the Rheumatology Workforce: A Longitudinal
Evaluation of Patient Volumes, Practice Sizes, and Physician Remuneration. J Rheumatol. 2021;
48(7):1090-1097.
4. Jorge A, Bolster M, Fu X, et al. The Association Between Physician Gender and Career Advancement
Among Academic Rheumatologists in the United States. Arthritis Rheumatol. 2021;73(1):168-172.
5. Kulhawy-Wibe S, Widdifield J, Lee J, et al. Results from the 2020 Canadian Rheumatology Association’s
Workforce and Wellness Survey. J Rheumatol. In Press.
6. Kane L. "Death by 1000 Cuts": Medscape National Physician Burnout & Suicide Report 2021.
Available at www.medscape.com/slideshow/2021-lifestyle-burnout-6013456#1. Accessed February
16, 2022.
7. Weizblit N, Noble J, Baerlocher MO. The feminisation of Canadian medicine and its impact upon
doctor productivity. Med Educ. 2009; 43:442-8.
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