Background Many countries face a critical shortage of rheumatologists. Based on an accepted benchmark of 1 specialist per 50,000 people as the number needed for effective patient care,1 recent figures show shortages in some EU Member states,2 parts of the US3 and in Canada.4
Objectives This qualitative environmental scan was designed to identify how Canadian rheumatologists are trained, perceived positive aspects of a career in this subspecialty, how programs inform/attract learners and what can be done collectively to attract more trainees.
Methods Individual-level data from faculty/administrators and learners across Canada via an online survey (n=30) and interviews (n=20); program-level data from accreditation reports for the Royal College of Physicians & Surgeons of Canada. Data subjected to Thematic Framework Analysis to identify themes and issues from all sites.
Results 57% of the respondents were female, 80% Canadian-trained and 93% work in teaching hospitals. Half the interviewees are female; most were faculty/administrators (63%) who had on average 14.8 years experience. Learners included undergraduate medical students rotating through a Rheumatology program and postgraduate trainees (PGY4-6). The need for rheumatologists is widely recognized (“La rhumatologie est la spécialité d'avenir au Canada” [L]*). Respondents advocate targeting both undergraduates (“People who influenced me were [role models] I had as a medical student” [F]) and junior Internal Medicine residents. Methods included increasing rheumatology presence in undergraduate programs (lectures, clinical skills sessions, hands-on training, faculty available to shadow or join in research) and postgraduate training (weekend info & training sessions, mandatory rotation in Internal Medicine, internships, career counseling). Messages to brand rheumatology as an attractive specialty included the intellectual challenge (“This field fascinates me” [L]; “novel immunotherapies make it very exciting” [F]), stimulating workday (“nice mix of procedural and cerebral work” [L]), positive relationships with colleagues and patients (“According to a recent survey we are the happiest specialists” [F]), alleviating suffering (“We know how to treat arthritis now” [L]), good quality of life (“excellent work-life balance” [F]) and excellent job prospects (“the health care system needs you” [F].
Key to Quotes *[L] = learner; [F] = faculty.
Conclusions We found consensus on the need to inform potential trainees about rheumatology earlier in their education. The next step will be to develop innovative tools and methods collectively for use in multiple sites. This study will guide a program of research to collaboratively develop, test and evaluate tools across Canada designed to increase the number of future rheumatologists.
Karolinska Institutet/i3 Innovus. (2009) (http://www.comparatorreports.se/RA%20Barrier%20Report_FINAL_050110.pdf).
Deal et al. (2007). Arthritis & Rheumatism 56(3):722-729.
2012 CMA Masterfile (www.cma.ca/multimedia/CMA/Content_Images/Inside_cma/Statistics/02SpecAge.pdf).
Disclosure of Interest None declared