RHEUMATOLOGY PROFILE

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1 RHEUMATOLOGY PROFILE GENERAL INFORMATION (Source: Royal College and Pathway Evaluation Program) Rheumatology is concerned with the diagnosis and treatment of rheumatic diseases, which may involve many systems, as well as joint, muscle and skeletal disorders. Specialists in this field have an interest in autoimmune diseases that underlie many rheumatologic conditions. Practice in this specialty is primarily office based with organized community programs relating to rheumatic disease units or regional centres. There are many opportunities for clinical practice, research and teaching. A rheumatologist must be effective in the assessment, investigation, management, and rehabilitation of patients with: acute and chronic forms of arthritis; soft tissue rheumatic disorders; collagen vascular diseases and vasculitides; spinal and regional pain problems; and the musculoskeletal manifestations of systemic disease. Residents in rheumatology may plan a residency program directed to independent private practice in the community or an academic teaching and research career in a university setting. Private practice rheumatologists, and in particular those with university clinical appointments, may also engage in teaching and research activities. Residents wishing to pursue a career in academic rheumatology are encouraged to take additional research training following completion of the core clinical rheumatology program.

2 Traditionally, pediatric patients (usually under age 18) are attended to by pediatricians with subspecialty training in pediatric rheumatology. Adult patients (usually over age 18) are attended to by internists with subspecialty training in adult rheumatology. Therefore, upon completion of medical school, a resident in rheumatology must first have primary certification in internal medicine or pediatrics. Certification training therefore takes approximately 6 years, including: 4 years for certification in either internal medicine or pediatrics; a further 2 years of Royal College approved residency in adult or pediatric rheumatology, a maximum of 1 year of which may be undertaken at the third or fourth year residency level. This period must include: 1 year of Royal College approved clinical residency at a senior level in adult or pediatric rheumatology and a further residency that may include the following: 6 or 12 months of Royal College approved clinical residency in rheumatology; and 6 or 12 months of approved clinical or basic research training relevant to rheumatology; or 1 year of Royal College approved residency or research at a hospital or institution in Canada. For further training requirements go to: Canadian Rheumatology Association

3 Number of physicians and physicians/100,000 population for Rheumatology Province/Territory Physicians Phys/100K pop n Newfoundland/Labrador Prince Edward Island Nova Scotia New Brunswick Quebec Ontario Manitoba Saskatchewan Alberta British Columbia Territories CANADA Source: 2013 CMA Masterfile

4 Physicians/100,000 population for Rheumatology In Canada, 1995 to 2013 Phys/100,000 pop n Source: CMA Masterfile

5 Rheumatologists by gender and year, in Canada 1995 to Total Males Females Source: CMA Masterfile

6 Rheumatologists by age and gender Canada, 2013 Gender Age group Males Females < to to to Unknown Source: 2013 CMA Masterfile

7 Rheumatologists by age and gender Canada, 2013 < to to to Unknown age Male Female Source: 2013 CMA Masterfile

8 Main Work Setting of Rheumatologists Canada, 2013 Private office/clinic 49% Acad H Sc Centre 29% Non AHSC teach hosp Admin office Community hosp University 4% 3% 2% 2% 0% 10% 20% 30% 40% 50% 60% Source: 2013 National Physician Survey. CFPC, CMA, Royal College

9 Practice Organization of Rheumatologists Canada, 2013 Solo Group Interprofessional Source: 2013 National Physician Survey. CFPC, CMA, Royal College

10 Hours worked per week (excluding on call) by Rheumatologists Canada, 2013 Activity Hours worked per week Direct patient care without teaching component 24.1 Direct patient care with teaching component 8.1 Teaching without patient care 2.1 Indirect patient care 7.1 Health facility committees 1.0 Administration 2.8 Research 7.1 Managing practice 1.7 Continued professional development 4.4 Other 0.7 TOTAL HOURS PER WEEK 58.5 Source: 2013 National Physician Survey. CFPC, CMA, Royal College

11 On Call Duty Hours per Month for Rheumatology Canada, 2013 Up to 120 hrs/month 121 to 180 hrs/month 181 to 240 hrs/month > 240 hrs/month Time spent on call spent in direct patient care = 25.6 hrs/month Source: 2013 National Physician Survey. CFPC, CMA, Royal College

12 Primary payment method 1 Remuneration for Rheumatology Canada, 2013 Average gross clinical earnings for Int Med & subspecialties in 2011/12 (those earning at least $60,000) = $387, % + fee for service 90% + salary 90% + other* Blended NR Average percent overhead reported by all medical specialists in 2010 = 20% 3 * Other includes capitation, sessional, contract and other methods 1 National Physician Survey, 2013, CFPC, CMA, Royal College 2 National Physician Database, 2010/11, CIHI 3 National Physician Survey, 2010, CFPC, CMA, Royal College

13 Satisfaction among Rheumatology Canada, 2013 Balance of personal & professional commitments 3% 4% 20% 20% 43% 11% Current professional life 4% 7% 6% 56% 28% 0% 20% 40% 60% 80% 100% NR Very dissatisfied Dissatisfied Neutral Satisfied Very satisfied Source: 2013 National Physician Survey. CFPC, CMA, Royal College

14 Total and Ministry funded postgraduate MD trainees in 2012/13 Rheumatology 1 Faculty of Medicine Ministry funded Total Faculty of Medicine Ministry funded Total MUN 0 0 McMaster U 4 4 Dalhousie U 3 3 UWO 4 6 U Laval 3 3 NOSM 0 0 U Sherbrooke 4 4 U Manitoba 0 0 U Montréal 8 9 U Sask 0 0 McGill U 5 6 U Alberta 2 2 U Ottawa 2 3 U Calgary 0 0 Queens U 1 3 UBC 7 10 U Toronto Canada Indicates Rheumatology (Int. Med.) and Rheumatology (Ped.) Source: 2012/13 Annual Census of Post MD Trainees, CAPER

15 PGY 4 and exiting postgraduate MD trainees in 2012/13 Rheumatology Female Male IMG GCMS PGY 4 4 Exits from postgrad 5 0 PGY 4 Postgrad exits Source: 2012/13 Annual Census of Post MD Trainees, CAPER

16 Postgraduate MD trainees in 2012/13 Rheumatology Total of 23 PGY 4 Rheumatology trainees representing 40% of all Rheumatology trainees. Total of 57 Rheumatology trainees representing 0.5% of all Ministry funded trainees. Total of 24 visa trainees in Rheumatology. Total of 25 Rheumatology trainees completed postgraduate training in Source: 2012/13 Annual Census of Post MD Trainees, CAPER

17 Location of 2011 Postgraduate MD exits in 2013 Rheumatology Of the 29 exits in 2011, 24 (83%) were known to be practising in Canada Source: 2012/13 Annual Census of Post MD Trainees, CAPER

18 Stress associated with finding employment at end of residency FM resident 7% 43% 42% 8% Other spec res 6% 20% 50% 25% 0% 20% 40% 60% 80% 100% NR/NA Not stressful Somewhat stressful Very stressful Source: 2012 National Physician Survey of residents. CFPC, CMA, Royal College

19 Number of Rheumatologists who retired in Canada during THREE year period of 2010 to < to to to Males Females Total Source: CMA Masterfile year over year comparisons Note: Retired is based on giving up licence and is therefore excludes those who have retired from clinical practice but are still licensed; it includes physicians who have temporarily given up their licence but may return to practice at a later date.

20 Percentage of Rheumatologists who are Royal College, CFPC or CMQ certified in Canada, % 100% 97% 80% 60% 40% 20% 0% 14% 6% Royal College CFPC CMQ Outside Canada Note: Subset of those who reported a certification. Physicians could indicate more than one certification body. Source: 2013 National Physician Survey. CFPC, CMA, Royal College

21 Links to the organizations supplying information for this document National Physician Survey Canadian Medical Association Association of Faculties of Medicine of Canada Royal College of Physicians and Surgeons of Canada College of Family Physicians of Canada Canadian Institute for Health Information

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