title: Measuring the Rheumatology Workforce in Canada: A Literature Review.
abstract: The number of rheumatologists per capita has been proposed as a performance measure for arthritis care. This study reviews what is known about the rheumatologist workforce in Canada.
  
  
  
  A systematic search was conducted in EMBASE and MEDLINE using the search themes "rheumatology" AND "workforce" AND "Canada" from 2000 until December 2014. Additionally, workforce databases and rheumatology websites were searched. Data were abstracted on the numbers of rheumatologists, demographics, retirement projections, and barriers to healthcare.
  
  
  
  Twenty-five sources for rheumatology workforce information were found: 6 surveys, 14 databases, 2 patient/provider resources, and 3 epidemiologic studies. Recent estimates say there are 398 to 428 rheumatologists in Canada, but there were limited data on allocation of time to clinical practice. Although the net number of rheumatologists has increased, the mean age was ≥ 47.7 years, and up to one-third are planning to retire in the next decade. There is a clustering of rheumatologists around academic centers, while some provinces/territories have suboptimal ratios of rheumatologists per capita (range 0-1.1). Limited information was found on whether rural areas are receiving adequate services. The most consistent barrier reported by rheumatologists was lack of allied health professionals.
  
  
  
  In Canada there are regional disparities in access to rheumatologist care and an aging rheumatologist workforce. To address these workforce capacity issues, better data are needed including information on clinical full-time equivalents, delivery of care to remote communities, and use of alternative models of care to increase clinical capacity.
authors.affiliation: From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health.
authors.forename: Julie
authors.initials: J
authors.lastname: Brophy
authors.affiliation: From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health.
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Marshall
authors.affiliation: From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Badley
authors.affiliation: From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health.
authors.forename: John G
authors.initials: JG
authors.lastname: Hanly
authors.affiliation: From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health.
authors.forename: Henry
authors.initials: H
authors.lastname: Averns
authors.affiliation: From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health.
authors.forename: Janet
authors.initials: J
authors.lastname: Ellsworth
authors.affiliation: From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Pope
authors.affiliation: From the Department of Community Health Sciences, Cumming School of Medicine, and the Division of Rheumatology, Department of Medicine, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta; Toronto Western Research Institute, University of Toronto, Toronto, Ontario; Dalhousie University, Queen Elizabeth II Health Sciences Center, Halifax, Nova Scotia; Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton; Division of Rheumatology, University of Western Ontario, London, Ontario, Canada.J. Brophy, MD, FRCPC, rheumatologist in private practice, Guelph, Ontario, Canada; D.A. Marshall, PhD, Professor, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, McCaig Institute for Bone and Joint Health; E.M. Badley, PhD, Toronto Western Research Institute, University of Toronto; J.G. Hanly, MD, Professor of Medicine (Rheumatology) and Pathology, Dalhousie University, attending staff rheumatologist, Queen Elizabeth II Health Sciences Center; H. Averns, MB, ChB, FRCP ( UK), FRCPC, rheumatologist in private practice, Kingston, Ontario, Canada; J. Ellsworth, MD, FRCPC, Professor and Head, Division of Pediatric Rheumatology, Faculty of Medicine and Dentistry, University of Alberta; J.E. Pope, MD, MPH, FRCPC, Professor of Medicine, Division of Rheumatology, University of Western Ontario; C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, University of Calgary, Cumming School of Medicine, McCaig Institute for Bone and Joint Health. cehbarbe@ucalgary.ca.
authors.forename: Claire E H
authors.initials: CE
authors.lastname: Barber
mesh_terms: D002170:Canada; D006301:Health Services Needs and Demand; D006801:Humans; D000072140:Rheumatologists / Q000600:supply & distribution*; D012219:Rheumatology; D000078329:Workforce
keywords: ACCESS TO HEALTHCARE; CANADA; MEDICAL STAFF; RHEUMATOLOGY SPECIALTY