Paediatric Chairs of Canada: Academic paediatric workforce survey – Report for the 1999/2000 academic year

For many years, the heads of departments of paediatrics in Canada's medical schools have recognized the need to count and describe accurately the roles of paediatricians working in academic paediatric tertiary care centres. Beginning in 1993, the Paediatric Chairs of Canada (PCC), formerly the Assembly of Canadian University Paediatric Department Heads, led by Dr Judy Hall, initiated an annual survey of practising paediatric subspecialists in Canadian medical schools. From the survey data, Dr Hall compiled the first comprehensive academic paediatric workforce database (1). By expressing the data as the number of sub-specialists per the provincial and national population statistics available from Statistics Canada, Dr Hall was able to provide both provincial and national information on the ratios of various paediatric subspecialists to population. In 1998, the PCC, recognizing both the value of Dr Hall's work and a number of reporting biases introduced by a lack of common definitions, decided to repeat the national academic workforce survey using common reporting criteria. Definitions were developed by consensus that more accurately described clinical and academic roles of individuals working in the various departments. The purpose of this communication is to report the definitions adopted by the PCC and the results of the 1999/2000 survey that used these definitions. The PCC agreed to report all paediatricians appointed within their departments if they were credentialed by either the Royal College of Physicians and Surgeons of Canada or the Collège des Médecins du Québec. Department Heads were asked to report only those individuals working in academic paediatric medical centres who were seen to be meeting essential child health service needs, including on-call activity, as either consulting general or subspecialist paediatricians. Individuals who fulfilled multiple roles in various subspecialties or domains of care were to be reported only once in the practice setting where they spent the majority of their professional time. As a starting point, the six job activity templates originally developed as a component of a strategy for professional compensation at The Hospital for Sick Children, Toronto, under the leadership of Dr Hugh O'Brodovich, were examined (personal communication, Dr H O'Brodovich) (2). For simplicity, the PCC decided to condense their six job activity templates into four profiles as follows: Clinician Specialist Teacher Clinician Educator Clinician Scientist Investigator Clinician Administrator The definitions of each of the above, reflecting consensus of the PCC, are outlined below: Clinician Specialist Teacher: an individual who spends greater than 60% of his/her professional time advancing and promoting excellence in clinical care, with the remainder of his/her activity supporting education and/or research. Clinician Educator: an individual who spends 40% or more of his/her professional time advancing and promoting excellence in education, with the remainder of his/her activity supporting clinical care and/or research. Clinician Scientist Investigator: an individual who spends greater than 50% of his/her time in clinical and/or basic science research, with the remainder of his/her activity supporting clinical care and/or education. Clinician Administrator: an individual who spends greater than 50% of his/her time in administration/management, with the remainder of his/her activity contributing to clinical care, education and/or research. Physicians with primary specialty training in disciplines other than paediatrics and, who in the opinion of the department head were spending the majority of their professional time providing essential paediatric subspecialty consultation, were also reported. Department heads endeavoured to report the workforce in all subspecialty areas perceived to be important to the clinical and teaching functions of an academic paediatric department. Academic general paediatricians who had spent the majority of their time providing clinical care and teaching within an academic medical centre were also reported in the survey, whether or not their offices were physically located in the community or the hospital. However, community paediatricians who spent a minority of time supporting activities in the academic paediatric health centre were not included in the survey. In the spring of 2000, the paediatric department heads of all 16 of Canada's medical schools reported the number of physicians working in their departments using the consensus definitions of academic faculty described above. The results are presented in Table 1. Canadian Assembly of Paediatric Department Chairs Academic Workforce Survey In brackets indicate how many of the total also cover the metabolic service as a component of their activity. 29 In brackets indicate how many of the total also cover the hematology service as a component of their activity. 65 Canadian Assembly of Paediatric Department Chairs Academic Workforce Survey In brackets indicate how many of the total also cover the metabolic service as a component of their activity. 29 In brackets indicate how many of the total also cover the hematology service as a component of their activity. 65 The survey data comprised a total of 987 paediatricians who spent the majority of their time supporting clinical, educational, research and administrative activity within the 16 Canadian medical schools. The majority (68%, n=669) of paediatricians appointed to academic departments of paediatrics function as Clinician Specialist Teachers. Of the remainder, Clinician Scientist Investigators made up a further 17% (n=168) of academic department members and were widely distributed among the subspecialities. A newly emerging group of academic paediatricians with major educational roles, Clinician Educators, were also identified. This emerging group, primarily located in large academic departments, accounted for 8% (n=78) of the total paediatric workforce. Clinical Administrators accounted for less than 5% (n=83) of the workforce. Nonpaediatric subspecialists who spent the majority of their time consulting in paediatrics represented only 3% (n=30) of the total. While paediatric metabolic disease and hematology are recognized disciplines, a significant portion of consultative activity in those fields is covered by geneticists and oncologists respectively (Table 1). As a very crude measure of relative access, the data on subspecialty numbers are expressed in Table 1 as both an absolute national total (head count) and as the “total national population/subspecialty physician” or the “population aged 0 to 14 years/subspecialty physician” (Statistics Canada <www.statscan.ca/english/>). In the future, it would be preferable (the information has not been published by Statistics Canada) to express data as “the population aged 0 to 18/subspecialty discipline”, because that is the age group actually served by paediatricians. It is obvious that many other factors, including the nature and prevalence of disease, the model of health care delivery, socioeconomic issues and the career activity profiles of physicians (to name only a few) interact in a complex manner to influence the perceived need for physicians by discipline. To meet the health care needs of Canadian children and train future specialists in child health care, the PCC believes that Canada's academic workforce needs not only well-trained competent clinicians, but also paediatricians who have the capacity to create new knowledge and transfer that knowledge effectively to the next generation of child health care providers. The survey data outlined in Table 1 suggest that the largest majority of Canada's academic paediatricians are actively engaged in the delivery of specialized child health care and the clinical supervision of undergraduate and postgraduate students. Overall, the data indicate a scarcity of researchers and educators, confirming the results of the recent paediatric resource planning survey completed by the Canadian Paediatric Society (3). The data also indicate that selected paediatric subspecialties face significant human resource shortages with some sub-specialties available only in Canada's largest academic health science centres. Clearly, there is not only a paucity in the number of subspecialists in many disciplines, but also an uneven distribution of workforce across university centres. A number of factors have likely lead to this phenomenon, including reductions in the number of medical students and residents beginning in the late 1980s and early 1990s, reductions in health care funding, problems within the traditional fee-for-service physician compensation system and underfunding of universities (4–7). A recent examination of work life stress among the members of Canadian university departments of paediatrics suggest that these chronic shortages and competing demands on the remaining academic department members are having deleterious effects on the remaining physicians' capacity to care for children and educate students for the future (8). The PCC fully supports the initiative of the Canadian Paediatric Society to work with other national agencies and the human resources department of Canada to build a labour market model that, if implemented, will ensure that the needs of Canada's children are met into the future (9). The PCC believe such a model will require the involvement and cooperation of all Canada's academic paediatric health centres, universities, and provincial and national departments of health to ensure that current hospital utilization patterns and trends in education and research are considered in this important national initiative. We also believe that the labour force model needs to address issues of physician age, lifestyle, sex and practice patterns, as well as emerging child health care needs (1,3–8). We are convinced that only this kind of focused activity and study will ensure Canada's children continue to benefit from access to advanced high quality child health care. Dr Tim Frewen and Dr Brent Scott would like to thank their colleagues in the PCC for providing data and critical appraisal of this document.

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