Last month I attended the CMA’s inaugural Health Summit. I was quite taken with the meeting’s focus on the evolving and expanding role of data and technology in health care service and delivery.
For many years, we have heard that “big data” will disrupt patient-physician relationships as we know them and repaint the health care landscape; it appears as though we have begun to catch up with this future vision.
It is probably not all that surprising for many of you that data is facilitating the kind of interventions we once only dreamed about. As these new sources of information proliferate, and technology facilitates improvements in data collection, integration and use; I anticipate that data will gain even more power in medical workforce planning than it has at present.
Anticipating this, the Royal College is investing in evidence-informed knowledge. We believe that more comprehensive data leads to better decision-making through improved monitoring and response.
One of our big data efforts is the Medical Workforce Knowledgebase.
Updating our Medical Workforce Knowledgebase
In June, we released our updated Medical Workforce Knowledgebase (MWK). You may recall that I first introduced this project to you via a blog post in late 2016. This update includes new data points. I encourage you to take a look.
The MWK brings together data from the Canadian Resident Matching Service, the Canadian Post-M.D. Education Registry, the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada and the Canadian Institute for Health Information.
It was created to fill an important data gap. While a lot of organizations produce and track valuable stats, there lacked a central repository to collect this information together and look at bigger workforce trends in context.
Changes in Orthopedic Surgery and Psychiatry
Through the data in the MWK and related efforts, we have seen clear signs that changes are afoot along the physician workforce supply chain. For example, we have observed a significant ramping down of surgical disciplines. The most acute changes were observed in Orthopedic Surgery, which experienced a 32 per cent decrease in quota and new trainees between 2011 and 2015.
Doug Thomson, CEO of the Canadian Orthopaedic Association (COA), explains that data is of critical importance in their work. The COA has been at the forefront of gathering specialty-specific data, starting in the late 2000s when they first heard about employment challenges from their members. They now conduct an annual “employment snapshot” with input from all Orthopedic Surgery program directors. They also gather data from the provinces on their expected hiring practices in the next one and five years, based on likely retirements, subspecialty needs, etc.
It was this data that empowered the COA to successfully advocate government and the universities to slow down the number of new trainees in Orthopedic Surgery to counter declining job opportunities in the profession.
Trinity Wittman, manager of Development and Advocacy at the COA, explains that this reduction is not a perfect solution but was necessary in the short-term. As they continue to evaluate patient needs and the job market, the organization will re-evaluate its position. The COA recognizes that many hospitals lack resources to hire the appropriate number of surgeons to serve the needs of Canadian patients within reasonable wait times. In order to accomplish more with less, the association seeks to promote local innovations that have introduced broad efficiencies, so that more surgeries can be done without further strain on existing resources.
Unlike the declines observed in surgical disciplines, between 2011 and 2015, the number of new trainees in Psychiatry increased by 28.4 per cent. But once again that number doesn’t tell the full story.
Dr. Pamela Forsythe, chair of the Canadian Psychiatric Association’s Board of Directors and local department head in New Brunswick, explains that even if the total number of psychiatrists per 100,000 population looks balanced, like it does in Nova Scotia, that number is skewed — almost all of them are in Halifax. This geographic density strains community practice and limits patient access.
Psychiatry is also a specialty faced with an aging workforce. Dr. Forsythe is herself close to retirement and she worries about recruiting and retaining new graduates to her home province. She is not alone in her concern. A new report released in early August by the Coalition of Ontario Psychiatrists cites a looming psychiatrist shortage in Ontario; many provinces are facing these same issues.
Challenges like these highlight the delicate nature of medical workforce planning. Data must be placed in context for patients and communities to benefit from the efforts.
The distribution of specialists, compensation models, scopes of practice relative to community needs, the age of practitioners, availability of other health professionals, support for innovation and technology… all of these factors (and many others) influence whether or not patient needs are likely to be met.
The MWK is one way that the Royal College is working alongside partners in the health care and research communities to try and add this context. As the MWK matures, we will look to incorporate new health system performance measures and to track progress over time. This development goes hand-in-hand with our work studying specialist employment and under-employment, and our current task force looking at the disruptive role of technology on medical education and health care.
This fall, we will be releasing our latest Royal College Employment Study data (first released in 2013). That forthcoming series of reports will share the results of our ongoing research on how many highly trained specialists have trouble finding work in their specialties following certification, and some of the factors on why this may be.
Ultimately, we hope these information sources will support key stakeholders from across medicine, academia, government and learner organizations, to make and advocate for evidence-informed health workforce decision-making that responds to patient needs and health system realities and constraints.
How does data influence your own practice-based decision-making?
A special thanks to Mr. Doug Thomson, Ms. Trinity Wittman and Dr. Pamela Forsythe for their contributions to this post.
Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer