Shortage of Canadian Rheumatologists Linked to Increase in Burnout

The shortage of rheumatologists in Canada may be impacted and/or heightened by the threat of burnout to workforce retention as well as productivity. Strategies to address these issues are urgently needed, according to a study published in The Journal of Rheumatology.¹

“While burnout is prevalent among Canadian physicians, little is known about burnout in Canadian rheumatologists,” investigators stated. “The challenges of an existing rheumatologist workforce shortage, changing workforce demographics, and physician burnout have been compounded by the COVID-19 pandemic.”

The Canadian Rheumatology Association (CRA) created the Workforce and Wellness Survey to learn more about the workforce characteristics of Canadian rheumatologists. The questionnaire, which was provided in both French and English versions, included information about pandemic effects, demographic and practice information, and the Mini Z survey. The Mini Z is a 10-item survey that evaluates stress, burnout, satisfaction, as well as risk factors, also known as “drivers.”

The survey was distributed to members between October 14, 2020, and March 5, 2021. The number of full-time equivalent (FTE) rheumatologists per 75,000 population was determined from the median proportion of time in clinical practice multiplied by provincial rheumatologist numbers from the Canadian Medical Association. Differences between demographic groups (sex/gender, age, career state, type of practice, and ethnicity) were evaluated using univariable logistic regression models.

A total of 183 of 417 (44%) practicing rheumatologists completed the survey (149 adult; 34 pediatric). The median age was 47 years, 62% were female, and 28% planned to retire within the next 5-10 years.

Participants reported that they spent a median of 65% of their time in clinical practice. FTE rheumatologists per 75,000 population were 0.62 nationally, ranging between 0.00 and 0.70 in each province or territory, which represents a deficit of 194 FTE rheumatologists nationally to meet the CRA’s workforce benchmark.

Roughly half (51%) of rheumatologists reported burnout, with women more likely to experience burnout (OR 2.86, 95% CI 1.42–5.93). Women were also more likely to report poor or minimal personal control over their workload and stress due to their job (OR 2.99, 95% CI 1.43–6.55) and were less likely to identify their workplace as a supportive environment when compared with men (OR 0.36, 95% CI 0.16–0.79). Older physicians, regardless of gender, were less likely to experience burnout (OR 0.95, 95% CI 0.92–0.99 per year of age).

Almost all (97%) rheumatologists stated that they were spending more time in virtual care and 74% stated they were spending the same amount of time on research. While 53% of rheumatologists surveyed reported spending more time on clinical paperwork each week, 37% were seeing fewer new patients and 25% had fewer follow-ups per week.

The study was limited by only being distributed to CRA members, eliminating nonmember rheumatologists. Additionally, there is no comprehensive list of rheumatologists in Canada. The Canadian Medical Association (CMA) numbers did not capture any changes to the workforce during the pandemic, such as retirements, as numbers were calculated pre-pandemic. Generalizability may be an issue due to a higher percentage of female respondents and a higher percentage of rheumatologists with academic affiliation when compared with the CMA master file. There is a possibility of response bias as participants may have different opinions and characteristics when compared with nonrespondents. Further, the COVID-19 pandemic may have influenced the survey as it was deployed just after the “first wave” in Canada and the perception of the pandemic’s effect may have changed over the many pandemic waves.

“The pandemic created an immediate threat to the workforce by significantly affecting patient volume, likely affecting rheumatologist remuneration and contributing to delayed care,” investigators concluded. “A further evaluation of the effect of the pandemic and increasing virtual care on rheumatology practices and patient outcomes is warranted. Future advocacy and research efforts should also continue to evaluate the predictors of burnout among rheumatologists as well as to develop strategies to address burnout at local, regional, and national levels.”

Reference:

Kulhawy-Wibe SC, Widdifield J, Lee JJY, et al. Results From the 2020 Canadian Rheumatology Association's Workforce and Wellness Survey. J Rheumatol. 2022;49(6):635-643. doi:10.3899/jrheum.210990