title: Barriers to providing adequate rheumatology care: implications from a survey of rheumatologists in ontario, Canada.
abstract: OBJECTIVE
  To determine what, if any, barriers exist that prevent rheumatologists from providing adequate rheumatology care.
  
  
  METHODS
  All 158 identified rheumatologists in Ontario were sent a self-administered questionnaire and followed up by telephone.
  
  
  RESULTS
  The response rate was 83%. All but 6 rheumatologists reported at least one barrier to the provision of service. The 3 most commonly reported barriers were the cost of drugs for patients (83%), billing policies and regulations for consultation and followup visits (72%), and long waiting times for patients (61%). Rheumatologists reporting the latter had significantly longer waiting times (12 vs 4 wks) for new non-urgent patients, although there was no difference for new patients with inflammatory arthritis. Nearly three-quarters of respondents had changed the patterns of their practice over the last 3 years, with significant increases in the amount of independent medical services (e.g., third party billing) and pharmaceutical company work. The majority (89%) of responding rheumatologists reported having at least some difficulty in making ends meet from rheumatology practice alone and 28% found it was not possible.
  
  
  CONCLUSIONS
  These results indicate that the majority of rheumatologists face significant barriers to providing adequate care. Given the recruitment and service provision concerns in Canada, these barriers to service need to be addressed to ensure adequate provision of care.
authors.affiliation: Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, Toronto, Ontario, Canada.
authors.forename: Deborah
authors.initials: D
authors.lastname: Shipton
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Badley
authors.forename: Arthur A
authors.initials: AA
authors.lastname: Bookman
authors.forename: Gillian A
authors.initials: GA
authors.lastname: Hawker
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000191:economics* / Q000600:supply & distribution; D001168:Arthritis / Q000188:drug therapy* / Q000191:economics; D016527:Drug Costs; D005260:Female; D006801:Humans; D008297:Male; D009313:National Health Programs / Q000191:economics / Q000592:standards; D009864:Ontario; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012051:Reimbursement Mechanisms; D012219:Rheumatology / Q000592:standards*; D011795:Surveys and Questionnaires; D014850:Waiting Lists; D000078329:Workforce
chemical_list: D018501:Antirheumatic Agents