MeasuringandMappingtheRheumatologyWorkforceinCanadaAnupdatefor:RoyalCollege- NationalSpecialitySocieties

HumanResourceforHealthDialogueJune2nd 2017

Dr.DianneMosher

TheburdenofarthritisinCanada

• 1%oftheCanadianpopulationhasrheumatoidarthritis(RA)• Ratesareexpectedtoincreaseoverthenext30years• RAisaleadingcauseofdisabilityandisalsoassociatedwithincreasedmortality

TheImpactofArthritisinCanada:TodayandOvertheNext30Yearswww.ArthritisAlliance.ca

ArthritisStakeholdersfromAcrossCanadahaveworkedtoDevelopToolstoImproveAccesstoand

DeliveryofCare

3

ToolforDevelopingandEvaluatingModelsofCare

Apan-CanadianApproachtoInflammatoryArthritisModelsofCare

InflammatoryArthritisCarePath

System-LevelPerformanceMeasurement

Manuscripton“APan-CanadianCoreDatasetforRA”

Identification SpecializedAccess

MedicalManagement Ongoingcare

MeasuringaModelofCareforInflammatoryArthritis

PatientselfManagement

Arepatientsgettingtotherheumatologyclinicinatimelymannerfordiagnosis?

Howmanypatientsarenotgettingseen?

Arepatientsaregettinglosttofollow-up?

Arepatientsbeingtreatedappropriately?Istreatmenttimelyoncediagnosismade?

WORKFORCECAPACITY

Barberetal.JRheum201643(3):530-40Allrightsreserve

Whatisourworkforce capacity?

PerformanceMeasure6:RheumatologistsperCapita

Reporting:• Reportthenumberofrheumatologistsper100,000population• ReportthenumberofFTErheumatologistsper100,000population

Measuredescription: Howmanyrheumatologistsper100,000population

Benchmark 1/75,000

Barberetal.JRheum201643(3):530-40

HowmanyrheumatologistsareinCanada

• Literaturereviewofpublished,unpublishedandonlinedatabasessearchedtodeterminepotentialsourcesofdata• Datasourcesincluded

• Membershipdatabases• Accreditationdatabases• Licensingdatabases• Physiciandirectories• CIHI• NationalWorkforceSurveys(NationalPhysicianSurvey,CanadianCouncilofAcademicRheumatologists,CCARetc.)

• ProvincialWorkforceSurveys(BCrheumatologySociety)• Other:e.g.theArthritisSociety,AlbertaRheumatologyWebsite

Brophyetal.JRheumatol 2016;43;1121-1129

Academicrheumatologistsonly

Provincialnumbersonly

Pediatricrheumatologistsonly

Missingsomerheumatologists

Brophyetal.JRheumatol 2016;43;1121-1129Allrightsreserve

Limitationsofavailablesourcesforworkforceinformationinrheumatology• LimitedinformationonFTEclinicalpractice(esp.innon-academicsettings)• Paucityofinformationontheuseofalternativemodelsofcareincluding:• Collaborationwithotherhealthcareprofessionals• Useoftravellingclinics• Telehealth• eConsultation

StandUpandBeCounted

• SurveylaunchedbytheCRAin2015• PrimaryObjective:

ØTomeasureandmaptheRheumatologyworkforceinCanadaandtoestimatethenumberofRheumatologistFTEsper100,000population

ØSecondaryobjectives:Ø ToobtaindemographicinformationandretirementprojectionsontheRheumatologyworkforceacrossCanada

Ø ToobtainestimatesoftheuptakeofEMRsinRheumatologypracticesØ ToobtainestimatesonRheumatologistparticipationintravellingclinics,Tele-RheumatologyandeConsultation

Ø ToobtaininformationhowwecollaboratewithalliedhealthprofessionalsinRheumatologyclinicsØ ToobtaininformationonhowwedelivercaretoCanadianIndigenousPopulations

BarberC.E.H.etalJRheumatol 2017;44(2)

1. LiteratureReview• IdentifyexistingCanadiansurveystoidentifygaps

• National&ProvincialsurveysThematicstudies(PediatricsandIndigenousPopulations)

4.ElectronicSurvey• LaunchedMarch9th2015

• CompleteAugust23rd2015

3.IdentifyRheumatologists• CRAmembership• Cross-referencedwithRoyalCollegelist,provincialcolleges,websites,andlocalchampions

2.QuestionnaireDevelopment• Draftquestions• QuestionnairereviewedbyRheumatologistsacrossCanada:AdultandPediatric,AcademicandCommunity

UniversityofCalgaryEthicsID:REB14-2135

Methods

Barber C.E.H. et al J Rheumatol 2017;44(2)

Demographics• Age,sex,yearspracticing,retirementplans,training&certification

PracticeSetting• Affiliation,callcoverage,location,Tele-health,travellingclinics,eConsultation

AlliedHealthProfessionals• TypesofAHPsinclinics&collaborativeroles

ElectronicMedicalRecords• Use,hospitalbased,type

Rheumatological DiseasesTreated• inflammatoryarthritis,pediatricpatients,multi-morbidities,specialtyclinics

ProvisionofCareforCanadianIndigenousPopulations• Proportionofpatientsinpractice,Tele-health,travelingclinics

Surveyquestions

Barber C.E.H. et al J Rheumatol 2017;44(2)

Surveyresponserate

TotalValidResponses(N=409)

AdultRheumatologists/Internists(N=304)Responserate*:65%PediatricRheumatologists(N=51)Responserate*:93%

AnalysisCohort(N=355):Responserate:68%*

Excluded(N=54)asnotcurrentlypracticing

Noresponse:273;InvalidResponse:15ParticipantsSentSurvey(N=697)*

*Note:CRAEstimatedDenominator(N=525):Adultrheumatologists/Internists(N=470);Pediatricrheumatologists(N=55)

ParticipantsSentSurvey(N=697)*

SurveySent(N=695)*

TotalValidResponses(N=409)

AnalysisCohort(N=355):Responserate:68%***

AdultRheumatologists/Internists(N=304)Responserate***:66%PediatricRheumatologists(N=51)Responserate***:93%

Excluded(N=54)asnotcurrentlypracticing

Noresponse273;Invalidresponse15**

*IncludesineligibleindividualswhoareCRAmembers(retired,notinclinicalpractice,trainees).**Responsesdeemedinvalidifindividualconsentedbutdidnotanswerasinglequestion.***Responserate355/519=68%basedonCRAestimatednumberofpracticingrheumatologists(464adultrheumatologists/internists,55pediatricrheumatologists

Barber C.E.H. et al J Rheumatol 2017;44(2)

Medianage(IQR) 50(46,55)*

Male(%) 47%

Practicesetting(n=353)University-basedCommunity-basedclinicwithacademicappointmentSolo-basedcommunitypracticewithhospitalprivilegesSolo-basedcommunitypracticenohospitalprivilegesGroupcommunitypracticewithhospitalprivilegesGroupcommunitypracticenohospitalprivilegesOther

158(45%)59(17%)67(19%)21(6%)34(10%)8(2%)6(2%)

Fundingforclinicaltime(n=352)FeeforserviceBlendedAlternativefundingplan/salary

214(61%)76(21%)62(18%)

Demographics

*ProvincialrangeofmedianageinyearsBarber C.E.H. et al J Rheumatol 2017;44(2)

RheumatologistsbilldifferentlydependingontheprovinceBillingasarheumatologistn=355 N(%)BritishColumbia 40(78%)Alberta 17 (33%)Saskatchewan 6(55%)Manitoba 10(91%)Ontario 118(87%)Quebec 67(97%)Atlanticprovinces 17(74%)Locationnot specified 2(67%)Total 275(78%)

Barber C.E.H. et al J Rheumatol 2017;44(2)

Workcharacteristic Median(IQR)½days perweekdoingclinicalwork 6(4,8)½daysperweekonpaperwork 2(1,2)Weeksworkedperyear 46(44,48)Hoursworkedper week 50(40,60)Newpatientsseenperweek 10(5,20)Follow-uppatientsseen perweek 45(25,60)Proportionofpracticecomprisedofpatientswithinflammatoryarthritis

70%(50%,80%)

Workcharacteristics

BarberC.E.H.etalJRheumatol 2017;44(2)

Timeallocation

70

10 7 10

0

10

20

30

40

50

60

70

80

90

100

Timeallocation

Clinical

Research

Admin

Teaching

Percentallocationoftime:Medianof70%allocatedtoclinicalduties(IQR55,90)

Barber C.E.H. et al J Rheumatol 2017;44(2)

Mappingrheumatologists(methods)

• NationalclinicalFTEbasedonsurveyquestionaskingrespondentstoreportthe%oftimeallocatedtoclinics(seepreviousslide)• Becauseofanincompleteresponserate,this%wasappliedtothenumberofrheumatologistspracticingineachprovincefromtheCMA2015data(n=398)• Thiswasmapped• ThenthenumberofFTErheumatologists(adultandpediatriccombined)requiredineachprovincetomeetthe1/75,000thresholdwasdetermined• The1/75,000isaCRAbenchmark

Barber C.E.H. et al J Rheumatol 2017;44(2)

Ø Legendreferstonumberofrheumatologistsper75,000

ØNoprovincecurrentlymeetsthebenchmarks

ØDeficitnumberofFTErheumatologistsshownintextontopoftheprovince

Ø (rangefrom1-77)ReprintedwithpermissionfromTheJournalofRheumatology,BarberC.etalJRheumatol 2017;44(2)Allrightsreserve

32%ofRheumatologistshaveplanstoretirewithinthenext10years.

Percentageofrheumatologistsreportingplanstoretire

15 17

68

0

20

40

60

80

100

Retirein5years Retirein10years Noplanstoretire

Barber C.E.H. et al J Rheumatol 2017;44(2)

Limitationstothesurvey

• Hardtoidentifysomerheumatologists,totaldenominatorachallenge• Incompleteresponseratesmeantwecouldn’tdirectlymaprespondersandhadtouseCMAdata(whichhadadifferentdenominator)• EstimateofFTEbasedonself-report%clinicalactivities,wedidnotincludeotheracademic/researchinourestimate• Unclearwhatbenchmarkshouldbetoserveapopulation:1/75,000hasbeensuggestedbutnotprovenasabenchmark

StandUpandBeCountedConclusions

• ThereisacurrentshortageofrheumatologistsinCanadawithadeficitofapproximately203rheumatologists• Thereareonlyapproximately34rheumatologyresidencypositions• Shortagemayworseninthenext10yearsduetopotentialretirementsincloseto1/3oftheworkforce

Barber C.E.H. et al J Rheumatol 2017;44(2)

Nextsteps

• Additionalworkdonetolookatpredictorsofworkload(manuscriptsubmitted)• Workforcesurveylaunchedforalliedhealthprofessions(StandUpandBeCountedToo!)tobettercapturemodelsofcareininflammatoryarthritis• WorkunderwaycurrentlytomapservicedeliveryforrheumatologyinAlbertageographicallytodetermineappropriateratiosofprovidersandalsotoevaluategapsinservicedeliveryintheprovince.• Ongoingnationalworkonmodelsofcaretodefineaneconomiccasefordifferentmodelsandongoingevaluationofdifferentmodelsofcareacrossthecountry.

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