Variations in Pediatric Rheumatology Workforce and Care Processes Across Canada

Jennifer J Y Lee; Ronald M Laxer; Brian M Feldman; Claire E H Barber; Michelle Batthish; Roberta Berard; Lori B Tucker; Deborah M Levy; Pediatrics Committee of the Canadian Rheumatology Association

doi:10.3899/jrheum.201611

Variations in Pediatric Rheumatology Workforce and Care Processes Across Canada

J Rheumatol. 2022 Feb;49(2):197-204. doi: 10.3899/jrheum.201611. Epub 2021 Aug 1.

Authors

Jennifer J Y Lee¹, Ronald M Laxer², Brian M Feldman², Claire E H Barber³, Michelle Batthish⁴, Roberta Berard⁵, Lori B Tucker⁶, Deborah M Levy²; Pediatrics Committee of the Canadian Rheumatology Association

Collaborators

Pediatrics Committee of the Canadian Rheumatology Association:
Daniela Ardelean, Daniah Basodan, Michelle Batthish, Susa Benseler, Roberta Berard, Gilles Boire, Roxana Bolaria, David Cabral, Sarah Campillo, Rafaella Carlomagno, Tania Cellucci, Mercedes Chan, Gaëlle Chédeville, Anne-Laure Chetaille, Julie Couture, Karoon Danayan, Paul Dancey, Chelsea DeCoste, Erkan Demirkaya, Muhammed Dhalla, Dilan Dissanayake, Ciarán Duffy, Tala El Tal, Brian Feldman, Kerstin Gerhold, Tommy Gerschman, Ellen Go, Jaime Guzman, Liane Heale, Linda Hiraki, Kristin Houghton, Adam Huber, Andrea Human, Clare Hutchinson, Mehul Jariwala, Nicole Johnson, Tristan Kerr, Andrea Knight, Raphael Kraus, Piya Lahiry, Bianca Lang, Ronald Laxer, Claire LeBlanc, Jennifer Lee, Deborah Levy, Lillian Lim, Lily Lim, Elizaveta Limenis, Nadia Luca, Tara McGrath, Tamara McMillan, Meghan McPherson, Marie-Paule Morin, Kimberly Morishita, Kate Neufeld, Hon Yan Ng, Kiem Oen, Jonathan Park, Ross Petty, Alisa Rachlis, Suzanne Ramsey, Alan Rosenberg, Evelyn Rozenblyum, Dax Rumsey, Heinrike Schmeling, Rayfel Schneider, Petagay Scott Brown, Rosie Scuccimarri, Earl Silverman, Gordon Soon, Lynn Spiegel, Rebeka Stevenson, Elizabeth Stringer, Herman Tam, Shirley Tse, Paul Tsoukas, Lori Tucker, Marinka Twilt, Ruud Verstegen, Karen Watanabe Duffy

Affiliations

¹ J.J.Y. Lee, MD, FRCPC, R.M. Laxer, MDCM, FRCPC, B.M. Feldman, MD, MSc, FRCPC, D.M. Levy, MD, MS, FRCPC, The Hospital for Sick Children (SickKids), and University of Toronto, Toronto, Ontario; deborah.levy@sickkids.ca.
² J.J.Y. Lee, MD, FRCPC, R.M. Laxer, MDCM, FRCPC, B.M. Feldman, MD, MSc, FRCPC, D.M. Levy, MD, MS, FRCPC, The Hospital for Sick Children (SickKids), and University of Toronto, Toronto, Ontario.
³ C.E.H. Barber, MD, PhD, FRCPC, The Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴ M. Batthish, MD, MSc, FRCPC, McMaster Children's Hospital, and McMaster University, Hamilton, Ontario.
⁵ R. Berard, MD, MSc, FRCPC, London Health Sciences Centre, and Western University, London, Ontario.
⁶ L.B. Tucker, MD, FRCPC, British Columbia Children's Hospital, and University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 34334367
DOI: 10.3899/jrheum.201611

Abstract

Objective: To examine the Canadian pediatric rheumatology workforce and care processes.

Methods: Pediatric rheumatologists and allied health professionals (AHPs) participated. A designee from each academic center provided workforce information including the number of providers, total and breakdown of full-time equivalents (FTEs), and triage processes. We calculated the clinical FTE (cFTE) available per 75,000 (recommended benchmark) and 300,000 (adjusted) children using 2019 census data. The national workforce deficit was calculated as the difference between current and expected cFTEs. Remaining respondents were asked about ambulatory practices.

Results: The response rate of survey A (workforce information) and survey B (ambulatory practice information) was 100% and 54%, respectively. The majority of rheumatologists (91%) practiced in academic centers. The median number of rheumatologists per center was 3 (IQR 3) and median cFTE was 1.9 (IQR 1.5). The median cFTE per 75,000 was 0.2 (IQR 0.3), with a national deficit of 80 cFTEs. With the adjusted benchmark, there was no national deficit, but there was a regional maldistribution of rheumatologists. All centers engaged in multidisciplinary practices with a median of 4 different AHPs, although the median FTE for AHPs was ≤ 1. Most centers (87%) utilized a centralized triage process. Of 9 (60%) centers that used an electronic triage process, 6 were able to calculate wait times. Most clinicians integrated quality improvement practices, such as previsit planning (67%), postvisit planning (68%), and periodic health outcome monitoring (36-59%).

Conclusion: This study confirms a national deficit at the current recommended benchmark. Most rheumatologists work in multidisciplinary teams, but AHP support may be inadequate.

Keywords: care delivery; care processes; models of care; pediatric rheumatologist; practice patterns; workforce.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Canada
Child
Humans
Rheumatologists
Rheumatology*
Surveys and Questionnaires
Workforce