The preliminary results from the Paediatrician Resource Survey conducted by the Canadian Paediatric Society (CPS) are worrisome. The survey, conducted in the fall of 1999, was a follow-up to a 1995 study. Mailed surveys are not usually expected to receive more than a 15% response rate; yet, the initial response rate to the 1999 survey from Canadian paediatricians was more than 50%. To make accurate comparisons among provinces and subspecialties, the aim of the Physician Resource Planning Committee of the CPS is to receive at least an 85% response rate; therefore, reminder letters were sent to those individuals who did not respond.
According to the Canadian Medical Association, reasonable conclusions can be made from a survey even with a 30% response rate. Therefore, some of the information already collected for the resource survey, such as the observations that paediatricians are working more hours and fewer trainees are graduating, is probably reliable. The figures are, most likely, accurate. However, breakdowns of the data by province, sex and practice base will be performed when more complete data are available. When preliminary data were presented at the CPS annual general meeting in Ottawa in June 2000, so much interest was expressed in the findings that the CPS decided to publish a brief report about the preliminary results.
Obviously, each subgroup of respondents would like to know details about how its group compared with the total and with other groups. Data were collected by province, age, sex, full-time versus part-time work, academic versus community work, subspecialists versus general paediatricians, type of areas served (rural, suburban, urban, large city, large city with an academic centre), type of hospital affiliation, time spent at various activities, type of remuneration for work, number of hours worked per week and amount of on-call work.
The preliminary survey results show that in 1999/2000, the average paediatrician worked 53.9 h/week, an increase from 49.6 h/week worked in 1995. In a five-year period, paediatricians have added more than 4 h to their work week. There is something very worrisome about adding nearly an extra hour of work a week each year. It seems as if a paediatrician’s workload may be a bottomless pit.
Although good data are not available about on-call work in 1995, in 1999/2000, the average paediatrician was on-call 1.7 nights/week and 1.3 weekends/month. Eighty-seven per cent of respondents indicated that they worked full-time hours and 13% reported that they worked part-time hours. Yet, part-timers worked 36.6 h/week, hardly part-time work by any standard.
Once the complete data are available, they will be analyzed according to various subgroups such as academic versus community paediatricians, general paediatricians versus subspecialists, overall demographics, rural versus urban paediatricians, male versus female respondents, etc. Every effort will be made to maintain confidentiality and to report information so that it cannot possibly be identified with a particular individual.
Both in full-time and part-time categories, women worked at least as many and possibly more hours than their male colleagues.
Since 1995, there has been a shift in demographics, with more community-based paediatricians, more sub-specialist paediatricians and more women paediatricians, but fewer paediatricians per population base.
Survey results will permit a proper analysis of the distribution of time worked by all respondents in categories such as direct care versus indirect patient care, teaching students versus residents, professional development, types of research and types of administration. However, it is already worth noting that, on average, paediatricians teach 5.2 h/week – a remarkable contribution to the future of child and youth health. Paediatricians also undertake 3.3 h/week of personal education – this is an extremely good sign that there will continue to be excellent, up-to-date paediatricians.
Anybody who works as hard as paediatricians do is obviously interested in sources of remuneration; it appears that more than 60% of income for paediatricians is based on fee-for-service, while about 20% is based on salary or alternative funding. It is hoped that the Paediatrician Resource Committee will be able to take a long, hard look at the best way for remuneration to occur in the future. There is concern that the health care system does not really work as well as it can to enhance triage, and the education of appropriate numbers and types of health care providers, and provide the right service in the right setting for the children and youth of Canada.
As if a paediatrician’s increasing workload was not enough, the future looks bleak in terms of the numbers of paediatric residents graduating each year. Averaging the three decades of paediatricians between 30 to 60 years of age, between 65 to 70 paediatricians will retire each year. It is well known that 20% of specialists who are trained do not go into the practice for which they were trained (ie, paediatricians can be expected to go into administration, missionary work or other specialties, such as anesthesia, where they will not provide clinical care in paediatrics). Thus, it is necessary to add 20% to the 65 to 70 individuals who will retire each year to produce an adequate number of replacements. Some type of adjustment in the number of trainees is also needed because women may be less productive than men. It has been said that women’s productivity is 80% compared with that of men. Thus, it is necessary to train between 85 to 90 paediatric residents graduates per year to replace paediatricians who are retiring. At best estimate, in the spring of 2000, only 72 paediatric residents graduated; that is a decrease from 1995. These estimates of the number of paediatric residents who need to be trained do not take into account an increase in population (which is occurring), the decreased willingness of young doctors to work as many hours as paediatricians do at present (this seems to be characteristic of the new generation), the brain drain (which is heard about on a regular basis), or the new and unmet health care needs of children and youth (from adolescents and Aboriginals to the survivors of cancer and premature births, and those children with multiple handicaps).
The intent of the Paediatrician Resource Survey, when more complete data are available, is to review all of the subgroups of respondents and analyze the data in many different ways. It is hoped that the findings will help paediatricians to make a persuasive case for more trainees to address the increasing and unmet needs of the children and youth of Canada. Stay tuned!