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Planning for the Rheumatologist Workforce

Factors Associated With Work Hours and Volumes

Barber, Claire E. H. MD, PhD, FRCPC*†‡§; Nasr, Mina PhD; Barnabe, Cheryl MD, MSc, FRCPC*†‡§; Badley, Elizabeth M. PhD∥¶; Lacaille, Diane MD, MHSc, FRCPC‡#; Pope, Janet MD, MPH, FRCPC**; Cividino, Alfred MD, FRCPC††; Yacyshyn, Elaine MD, FRCPC‡‡; Baillie, Cory MD, FRCPC§§; Mosher, Dianne MD, FRCPC*†§; Thomson, John G. MD, FRCPC¶¶; Charnock, Christine CAE∥∥; Thorne, J. Carter MD, FRCPC***†††; Zummer, Michel MD, FRCPC‡‡‡§§§; Brophy, Julie MD, FRCPC; Ruban, Thanu Nadarajah MD, FRCPC; Ahluwalia, Vandana MD, FRCPC∥∥∥; McDougall, Robert MD, FRCPC¶¶¶; Marshall, Deborah A. PhD†‡§

JCR: Journal of Clinical Rheumatology: April 2019 - Volume 25 - Issue 3 - p 142–146
doi: 10.1097/RHU.0000000000000803
Original Articles

Objective The aim of this study was to evaluate factors associated with rheumatologists' clinical work hours and patient volumes based on a national workforce survey in rheumatology.

Methods Adult rheumatologists who participated in a 2015 workforce survey were included (n = 255). Univariate analysis evaluated the relationship between demographics (sex, age, academic vs. community practice, billing fee for service vs. other plan, years in practice, retirement plans) and workload (total hours and number of ½-day clinics per week) or patient volumes (number of new and follow-up consults per week). Multiple linear regression models were used to evaluate the relationship between practice type, sex, age, and working hours or clinical volumes.

Results Male rheumatologists had more ½-day clinics (p = 0.05) and saw more new patients per week (p = 0.001) compared with females. Community rheumatologists had more ½-day clinics and new and follow-up visits per week (all p < 0.01). Fee-for-service rheumatologists reported more ½-day clinics per week (p < 0.001) and follow-ups (p = 0.04). Workload did not vary by age, years in practice, or retirement plans. In multivariate analysis, community practice remained independently associated with higher patient volumes and more clinics per week. Female rheumatologists reported fewer clinics and fewer follow-up patients per week than males, but this did not affect the duration of working hours or new consultations. Age was not associated with work volumes or hours.

Conclusions Practice type and rheumatologist sex should be considered when evaluating rheumatologist workforce needs, as the proportion of female rheumatologists has increased over time and alternative billing practices have been introduced in many centers.

From the *Department of Medicine, Division of Rheumatology and

Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta;

Arthritis Research Canada;

§McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta;

Krembil Research Institute, Toronto Western Hospital;

Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario;

#Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, British Columbia;

**Division of Rheumatology, Department of Medicine, University of Western Ontario, London, Ontario;

††Division of Rheumatology Department of Medicine, McMaster University, Hamilton, Ontario;

‡‡Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta;

§§Division of Rheumatology, Department of Medicine, University of Manitoba;

∥∥Canadian Rheumatology Association;

¶¶Division of Rheumatology, Department of Medicine, University of Ottawa, Ottawa, Ontario;

***University of Toronto, Toronto, Ontario; and

†††The Arthritis Program at Southlake Regional Health Centre, Newmarket, Ontario;

‡‡‡Hôpital Maisonneuve-Rosemont and

§§§The Université de Montréal, Montreal, Quebec;

∥∥∥William Osler Health System, Brampton, Ontario; and

¶¶¶Division of Rheumatology, Department of Medicine, University of Saskatchewan, Regina, Saskatchewan Canada.

J.B. and T.N.R. are rheumatologists, respectively, in Guelph and Markham, Ontario, Canada.

Funding was provided by the Arthur J. E. Child Chair Rheumatology Outcomes Research. In-kind support for administration of the survey and promotion of the project was provided by the Canadian Rheumatology Association.

D.A.M. is a Canada Research Chair in Health Services and Systems Research and the Arthur J. E. Child Chair in Rheumatology Outcomes Research. C. Baillie was the president of the Canadian Rheumatology Association at the time this study was completed. The other authors declare no conflict of interest.

Correspondence: Claire E. H. Barber, MD, PhD, FRCPC, Division of Rheumatology, University of Calgary, HRIC Rm 3AA20, 3280 Hospital Dr NW, Calgary, Alberta, Canada T2N 4Z6. E-mail:

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