The changing face of academic paediatrics in Canada

1 downloads 0 Views 54KB Size Report
in many academic and subspecialty positions that could not be filled by Canadians. Beginning about 10 years ago, the. Canadian government and licensing ...
ADVOCACY

The changing face of academic paediatrics in Canada Robert HA Haslam MD FAAP FRCPC1, Robert M Issenman MD FRCPC2

n 1999, the Canadian Paediatric Society (CPS) conducted a nation-wide study of paediatricians to determine their practice patterns, location of practice, workload, and the time that they spend directly related to patient care, teaching, research, administration and self-learning (1). The results of the study were alarming and pointed to a looming national paediatrician resource crisis for the following reasons. The paediatric work force is aging and that by the year 2010, 40% of today’s paediatricians will have retired. There are simply not enough medical school entry positions or paediatric training positions to offset the number of retiring paediatricians. In addition, contemporary paediatricians work more hours per week than those in the past. However, younger paediatricians work fewer hours than the pediatricians who will retire during the coming decade. Finally, there is an increasing number of female paediatricians entering the work force. The study indicated that female paediatricians prefer to work in large, urban centres, with an approximately equal distribution between academic and community practice. Using data that were obtained from the CPS survey, the present article focuses on the impact of these findings on academic paediatrics in Canada. For the purpose of this article, an academic paediatrician is defined as “a paediatrician whose source of income for their work is from a recognized department of paediatrics in one of Canada’s medical schools and whose significant amount of activity is spent in research, teaching or administration in that institution”. In the past, shortages of academic paediatricians and subspecialists were met by recruiting well-trained individuals from abroad. These paediatricians had undergone training experiences similar to those of their Canadian colleagues and provided leadership in many academic and subspecialty positions that could not be filled by Canadians. Beginning about 10 years ago, the

I

Canadian government and licensing authorities made it difficult for these individuals to practise in Canada due to immigration and licensing restrictions. Fortunately, those restrictions seem to have eased in the recent past. Furthermore, with the government cutbacks in paediatric training positions, also beginning about a decade ago, the number of paediatricians who complete training in Canada has been significantly decreased to approximately 60 each year, which does not come close to meeting the shortage of paediatricians in this country. It is important to note that it requires a minimum of six to nine years to train an academic paediatrician after graduation from medical school. Approximately 43% of paediatricians in Canada are based in university academic positions. Interestingly, the most populous provinces in Canada have the fewest academic paediatricians, with Ontario having 34%, British Columbia having 39% and Quebec having 47%, which is slightly above the national average. It is noteworthy that each of the departments of paediatrics in all 16 of Canada’s medical schools have identified a large number of vacancies of subspecialty and academic faculty positions. Not only is it difficult to recruit these individuals, it is equally difficult to retain them because of competing market forces. The shortage of paediatricians will effect the availability of expert child health care, both in community and university centres. The CPS survey (1) indicated that more recently trained paediatricians are attracted to an academic career. For example, currently, 50% of paediatricians between the ages of 31 and 40 years are located in academic settings compared with 38% of their colleagues aged 51 to 60 years. This is due, in part, to available positions, an increased emphasis on research and subspecialty training in Canadian departments of paediatrics, and a move toward competitive funding of such individuals.

1Department

of Pediatrics, University of Toronto, Toronto, Ontario, 2Professor of Pediatrics, McMaster University, Hamilton, Ontario Correspondence: Canadian Paediatric Society, 2204 Walkley Road, Suite 100, Ottawa, Ontario K1G 4G8. Telephone 613-526-9397, fax 613-526-3332, Web sites www.cps.ca, www.caringforkids.cps.ca Paediatr Child Health Vol 7 No 5 May/June 2002

307

Advocacy

Another interesting finding was the increasing number of female paediatricians entering the workforce. At present, 47% of women paediatricians identified their employers as academic departments of paediatrics compared with approximately 40% working in community paediatrics. This pattern follows a trend for a greater number of female paediatricians that was first reported 10 years ago (2). The number of women aged 31 to 40 years currently engaged in academic paediatrics is slightly greater than 50% compared with those female paediatricians in the age range of 61 to 70 years, where only 28% identify an academic practice base. The reasons for these changes are multiple and include an increasing number of women who are committed to a research career, and the flexibility to plan and raise a family compared with the community paediatrician, and the emersion of several new subspecialties and research directions that are of special interest to women. Furthermore, many female paediatricians have young families, and it may not be feasible to work in a small community or rural area during this time of increased family responsibility. Paediatricians are Canada’s specialists in the health care of children. Most academic paediatricians are specialized physicians who work as members of teams of skilled allied health professionals in university medical centres and children’s hospitals across Canada. Their responsibilities include patient care, research, and the teaching of medical students and doctors in training. There is an impending crisis in their abilities to provide care to children with complex physical and behavioural problems. These problems include the care of children with chronic diseases such as asthma, diabetes and epilepsy, and involves treating children who have survived premature birth, cancer and trauma. At present, these highly trained professionals are stretched thin, working an average of 56 h/week and then serving ‘on call’ in addition to these work hours. These older specialists are experiencing ‘burn out’, with insufficient new trainees to replace those who are slowing down or retiring. Alternate funding plans that reimburse pediatricians in academic centres by a salary rather than ‘fee-for-service’ may help to stabilize the funding crisis that academic paediatricians face, but increased training positions are urgently required to deal with the lack of access to specialized care for infants, children and youth with serious health and behavioural problems. The greatest change affecting academic departments of paediatrics throughout North America relates to the funding

308

of these departments. It is well known that many paediatric departments in the United States are on the brink of bankruptcy. While the situation in Canada is not quite so critical, the fact is that many departments are struggling financially. The reasons for these trying financial times are obvious. The CPS survey indicated that approximately 22% of an academic paediatrician’s time is devoted to nonremunerative activities, including research, teaching and administrative duties. These nonpatient care activities are supported by clinical earnings by the paediatric faculty. It has become virtually impossible to practise exemplary patient care while supporting the equally important academic responsibilities from billings derived from patient encounters. The survey also looked at the methods of financial support for the academic departments across Canada. Interestingly, 42% of the departments’ income was derived by salaried clinical work, whereas 33% came from fee-forservice. Although the questionnaire did not break down the sources of funding for the salaried physicians, it is likely that the majority of funds are directed to alternative funding plans (3). In contrast, community paediatricians derive over 84% of their funding bases from fee-for-service. The change in the financial support of paediatric departments, particularly with the emergence of alternative funding plans, has occurred in the past five to 10 years. It is likely that the number of salaried academic paediatricians will increase in the near future because several departments are in active negotiations with their governments. In summary, the recent study of Canadian paediatricians showed that academic paediatrics is currently undergoing dramatic changes that could adversely affect the future health care of Canadian children. There is a current shortage of academic paediatricians due to several factors, some of which we have reviewed. Furthermore, the precarious funding of many Canadian paediatric departments puts the survival of several Canadian departments of paediatrics at risk.

REFERENCES 1. Planning a Healthy Future for Canada’s Children and Youth. Report on the 1999-2000 Paediatrician resource Planning Survey. Ottawa: Canadian Paediatric Society, 2001. 2. Reider MJ, Hanmer SJ, Haslam RHA. Age and gender-related differences in clinical productivity among Canadian Paediatricians. Pediatrics 1989;85:144-9. 3. Haslam RHA, Walker NE. Alternative funding plans: Is there a place in academic medicine? CMAJ 1993;148:1141-6.

Paediatr Child Health Vol 7 No 5 May/June 2002