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Is the End in Sight for Rheumatologist Shortage in Canada?

There are too few rheumatologists globally. In Canada, where postgraduate rheumatology programs have an unprecedented number of applicants, efforts are underway to re-examine training.

Hands-on experience and early exposure to rheumatology may be the keys to solving Canada's rheumatologist shortage, new research suggests.

Canada is experiencing a rheumatology crisis. As of 2014, the country had a mere 383 practicing rheumatologists, according to the Canadian Medical Association. Some provinces are particularly underserved:  There are no rheumatologists in Prince Edward Island (population 146,283 as of 2014), only four in Newfoundland and Labrador (2014 population 526,977), and only seven in Saskatchewan (home to 1.13 million people in 2014). A 2001 study of future trends in rheumatology in Canada estimated the shortfall in rheumatologists by 2026 at 64 percent.

With current enrollment in rheumatology programs still insufficient, a 2012 grant funded by the Canadian Initiative for Outcomes in Rheumatology Care sought to survey and interview medical students and rheumatologists across Canada to determine what factors made rheumatology attractive or unattractive.  

The results, published online March 1 in the Journal of Rheumatology, revealed that early hands-on experiences and positive messages about work-life balance might be good ways to attract young people to the field. A total of 52 internal medicine residents, fellows and postgraduates and 51 faculty and administrative professional rheumatologists were surveyed and interviewed from nine rheumatology programs.

The results revealed a profession eager for the challenge of rheumatology work and the benefits of the field's work-life balance. One rheumatologist suggested recruiting new doctors to the profession with, "According to a recent survey, we are the happiest specialists. What more do you need to say?"

Rheumatology Network interviewed Diane Crawshaw, the research coordinator for the study and Lynne Lohfeld, an associate professor of clinical epidemiology and biostatistics, both of McMaster University, about the survey findings and the ways that Canada is tackling its rheumatology crisis.

1. Why is there a physician shortage in rheumatology?

Globally, there is a serious shortfall of rheumatologists. The key reasons include an increased number of patients due to an aging population; improved diagnostics; a maldistribution of rheumatologists within smaller communities; and, many practitioners are approaching retirement within the next 10 years. Canada is not unique in needing to address this shortage.

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2. How do you feel about the future of rheumatology in Canada? Do you see signs that the shortage might turn around?

Postgraduate rheumatology programs are facing unprecedented numbers of highly qualified applicants. And while there is an ever-increasing need for additional practitioners, many programs have reached saturation in terms of the number of students they can accommodate for short-term training opportunities. The next phase of our research program will focus on reaching out to more community rheumatologists to serve as mentors and educators.

3. What was the goal of your study? 

The goal of the study was to discover what Canadian rheumatology programs can do collaboratively to increase the number of rheumatologists. To answer this question, we needed to learn why rheumatologists choose rheumatology. We surveyed and interviewed learners, faculty and administrators affiliated with 11 rheumatology post-graduate programs across the country.

4. What were the major take-a-ways from the surveys and interviews? 

We learned there is a pressing need to inform and interest undergraduates and postgraduates in rheumatology. To encourage them to opt for educational experiences in rheumatology, we need to show them the benefits of working in this field, which include challenging diseases, the opportunity for long-term relationships with patients, flexible work arrangements and a healthy work-life balance. 

5. What other efforts could be made to recruit more rheumatologists? 

We need to close the circle between increasing interest and capacity. We are striving to increase the capacity of our programs to offer students an experience in rheumatology before they make a career choice. We know that students benefit from being exposed to a wide range of clinical and research opportunities such as shadowing a rheumatologist. We propose to do this by engaging more practitioners, especially those outside of urban areas.