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Rheumatology, it seems, is a hot specialty among medical students and residents in Canada these days. The greying of the Canadian population means work is plentiful. And the availability of new drugs such as biologics to combat previously untreatable conditions, definitely makes the specialty more clinically appealing. But augmenting that is the fact that it’s a specialty with lifestyle appeal for younger doctors seeking a work–life balance.
According to the Canadian Residency Matching Service, in 2010, only 15 positions for rheumatology residents in Canada were filled. In 2014, 27 new residents entered the field, bringing the number of rheumatology residents training in Canada to 66. And membership in the Canadian Rheumatology Association has surged from 285 in 1999, to 479 active and 140 nonactive members in 2015.
Anecdotes paint the same picture. Eleven years ago, Dr. Jason Kur says he was the only resident in British Columbia to begin training in rheumatology. Now, as president of the BC Society of Rheumatologists, he says there are “consistently” three or four new residents in rheumatology each year.
Dr. Sara Haig was the only rheumatology resident in Ottawa 10 years ago. Today, in London, Ontario, where she practises, there are seven residents, with multiple applicants competing for every position.
This surge of interest is a good thing according to Dr. Alfred Cividino, division head of rheumatology at McMaster University in Hamilton, Ont., because the average age of practising rheumatologists in Canada is now “53 years and climbing”; a substantial percentage are considering retiring soon. One study has suggested that over the next decade, the number of rheumatologists is expected to fall 64% short of the number required for the Canadian population.
Indeed, there are already documented shortfalls. Surrey, British Columbia does not have a single rheumatologist. Newfoundland and Labrador has three, serving the entire province. All of Ontario, with the exception of Toronto, is considered an area underserved by rheumatology services by the Ministry of Health.
Meanwhile, the 2011–2012 Royal College employment report found that 43% of ophthalmologists, 40% of urologists, 33% of gastroenterologists and 25% of orthopedic surgeons could not find positions in their specialties. For cardiac surgeons and nephrologists, job prospects are even worse.
If there is a downside to this career choice, it’s that rheumatologists may be among the lowest-paid specialists in Canada. The median fee-for-service billing for Ontario rheumatologists was $276 500 in 2013–2014.
For some though, there are more important factors. Dr. Janet Pope, division head of rheumatology at St. Joseph’s Health Care, in London, said “lifestyle” considerations are driving much of the new-found enthusiasm. Rheumatologists can practise in the community, with just an office and an examination room. Office hours are predictable, with little on-call, weekend or emergency work. Her colleague, Haig, works part-time, which allows her to spend more time with her three children, all of whom accompanied her to the office when they were newborns.
Some medical students cite additional reasons for rheumatology’s appeal.
Nicole Perrier, a second-year student at the Schulich School of Medicine and Dentistry in London, says she values the exposure to “weird and severe, multisystem diseases.” Also, she said, rheumatologists typically follow patients for the long term; they don’t simply treat and dismiss. “You can treat the function and get them back to doing their usual activities, and that can be very satisfying.”
Tehmina Ahmad, also a second-year student at Schulich, said she is “fascinated” by complex diseases, and she wants to delve into their pathophysiology in the lab. “Knowing the science behind these diseases and how they get woven into so many aspects of the patients’ lives is so important, and you have to be able to explain it to the patients.”
“Rheumatology is the practical application of immunology,” Dr. Sara Haig said. “Rheumatologists treat function. We try to get the patient’s normal function back, and the patients thank us for it. Cardiologists don’t get thanked for lowering a patients’ cholesterol or their blood pressure.”