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Widdifield J, Bernatsky S, Pope JE, Ahluwalia V, Barber CEH, Eder L, Kuriya B, Ling V, Paterson JM, Thorne JC. Encounters with Rheumatologists in a Publicly Funded Canadian Healthcare System: A Population-based Study. J Rheumatol 2019; 47:468-476. [PMID: 31203224 DOI: 10.3899/jrheum.190034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To quantify population-level and practice-level encounters with rheumatologists over time. METHODS We conducted a population-based study from 2000 to 2015 in Ontario, Canada, where all residents are covered by a single-payer healthcare system. Annual total number of unique patients seen by rheumatologists, the number of new patients seen, and total number of encounters with rheumatologists were identified. RESULTS From 2000 to 2015, the percentage of the population seen by rheumatologists was constant over time (2.7%). During this time, Ontario had a stable supply of rheumatologists (0.8 full-time equivalents/75,000). From 2000 to 2015, the number of annual rheumatology encounters increased from 561,452 to 786,061, but the adjusted encounter rates remained stable over time (at 62 encounters per 1000 population). New patient assessment rates declined over time from 10 new outpatient assessments per 1000 in 2000 to 6 per 1000 in 2015. The crude volume of new patients seen annually decreased and an increasing proportion of rheumatology encounters were with established patients. We observed a shift in patient case mix over time, with more assessments for systemic inflammatory conditions. Rheumatologists' practice volumes, practice sizes, and the annual number of days providing clinical care decreased over time. CONCLUSION Over a 15-year period, the annual percentage of the population seen by a rheumatologist remained constant and the volume of new patients decreased, while followup patient encounters increased. Patient encounters per rheumatologist decreased over time. Our findings provide novel information for rheumatology workforce planning. Factors affecting clinical activity warrant further research.
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Affiliation(s)
- Jessica Widdifield
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada. .,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre.
| | - Sasha Bernatsky
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - Janet E Pope
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - Vandana Ahluwalia
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - Claire E H Barber
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - Lihi Eder
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - Bindee Kuriya
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - Vicki Ling
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - J Michael Paterson
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
| | - J Carter Thorne
- From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women's College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph's Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada.,J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph's Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women's College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre
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