Tracking change in medical residencies and the physician workforce Health Systems and Policy, Royal College ICRE, October 20th,2017 The best health for all. The best care for all. I do not have an affiliation (financial or otherwise) with a pharmaceutical, medical device or communications organization. Je n’ai aucune affiliation (financière ou autre) avec une entreprise pharmaceutique, un fabricant d’appareils médicaux ou un cabinet de communication. 2 Delete this box before presenting: Supprimez cette boîte avant de faire votre présentation : Please keep only the applicable statement, shown above is Option Veuillez conserver uniquement l’énoncé pertinent; ci-dessus se 1 with Option 2 to follow on next slide. trouve l’option 1, l’option 2 paraissant à la diapo suivante. Note: Speakers who have no involvement with industry should Note: Les conférenciers qui n’ont aucun lien avec l’industrie inform the audience that they cannot identify any conflict of doivent aviser leur auditoire qu’ils n’ont aucun conflit d’intérêts à interest. déclarer. Workshop Objectives • At the end of this session, participants will be able to: Identify critical data sources utilized in studying physician workforce Interpret physician workforce supply changes in the context of population health needs and the broader health care system Highlight knowledge gaps and propose novel data collection and analytical priorities To start…Who’s participating? Post-graduate dean Program director Clinician educator Fellow Resident Academic/Researcher Epidemiologist/Statistician Other To start…What are you hoping to takeaway from today’s workshop? Learn more about current physician workforce supply trends? Gather knowledge about your particular specialty? Understand the implications of a changing workforce on health care? Other? Agenda Time AGENDA ITEM 15 min Workshop Opening • Background/Purpose • Data Sources/Metrics 35 min Physician workforce supply overview • Overall trends from the Medical Workforce Knowledgebase • Specialty-specific examples 45 min Breakout session • Reactions to the MWK • Moving forward with the MWK 25 min Plenary Debrief • Take-aways and next steps • Final questions and closing remarks Context: Changing Canadian Population Observed and projected estimates of Observed and projected estimates of Canadian population, 1940 - 2040 Canadian population, 1971 - 2040 50 12 Children (aged 14 and under) 45 Elderly (aged 65 and above)* 40 10 35 8 30 25 6 Million Million 20 15 4 10 2 5 0 0 1940 1946 1952 1958 1964 1970 1976 1982 1988 1994 2000 2006 2012 2018 2024 2030 2036 1971 1975 1979 1983 1987 1991 1995 1999 2003 2007 2011 2015 2019 2023 2027 2031 2035 2039 *Data for persons aged 90 to 100 years and over available from 2001 onwards Source: Statistics Canada. Table 051-0001; Table 52-0005 (M1 Medium Growth Scenario) Context: growing the medical workforce New MD Graduates of Canadian Medical Schools, Canada, 1940 - 2017 3250 40.0 3000 2750 35.0 2500 30.0 2250 2000 25.0 1750 1500 20.0 1250 15.0 1000 Million 750 10.0 500 5.0 250 0 0.0 1940 1943 1946 1949 1952 1955 1958 1961 1964 1967 1970 1973 1976 1979 1982 1985 1988 1991 1994 1997 2000 2003 2006 2009 2012 2015 MD Graduates Population Sources: Association of Faculties of Medicine of Canada and Statistics Canada, 2017. Context: comparison to other jurisdictions Comparison of Doctors in OECD countries (2015) 6 Doc:Pop ratios are 5 popl’n used as a broad 4 marker for comparing physician supply. 3 Caution should be used when comparing 2 countries given the variability of health 1 systems and data 0 sources – e.g. private/public, Italy Israel Korea Latvia Spain Number of Doctors, per 1000 Number of Doctors, inclusion/exclusion France Turkey Poland Austria Iceland Mexico Estonia Ireland Norway Canada Belgium Slovenia Hungary Germany Australia criteria. Switzerland Luxembourg New Zealand *United States Slovak Republic United Kingdom Source: OECD (2017), Doctors (indicator). Doi: 10.1787/4355e1ec-en * Data for United States is from 2014 OECD – The Organisation for Economic Co-operation and Development Head Counts vs. FTE (Canadian Institute for Health Information - CIHI) Head counts are often used in HHR studies. This metric does not take into account factors such as physician workload, time allocation, scope of practice, practice organization, patient needs, etc. 2000 1,739 1631 1,618 1363 1500 1,370 1262 1000 779 839 616 500 525 Head Counts (SMDB) Number of Physicians 0 FTE Counts (NPDB) FTE (Full-Time-Equivalent) counts of physicians working fee-for-service Work Hours Physicians' average weekly work hours by Physicians' average weekly work hours by age group, Canada, 1998 and 2014 type of activity and sex, Canada, 1998 and (Excluding on-call hours) 2014 (Excluding on-call hours) 60 70 54.2 54.9 54.7 60 55.5 55 52.3 50.1 48.2 50 17.5 46.3 50 51.0 40 17.8 50.0 49.9 16.5 17.6 45 48.0 43.6 30 20 Hours per week per Hours 38.0 40 32.3 31.7 28.7 Hours per week per Hours 40.9 10 35 0 1998 2014 1998 2014 30 <35 35-44 45-54 55-64 65+ MEN WOMEN 1998 2014 Direct Patient Care Other professional activities Source: 1998 Physician Resource Questionnaire, Canadian Medical Association (CMA); 2014 National Physician Survey, CMA, College of Family Physicians of Canada, Royal College of Physicians and Surgeons of Canada. Scope of Practice Physicians (%) who reduced/increased their • Scope of practice is an increasingly scope of practice in the last two years, by important factor as the health age group workforce grows and diversifies 25.0% Reduced Increased 20.0% • “Increasing flexibility around scopes of practice and models of care is 21.5% 15.0% required to meet the changing population health needs and the diversity represented in communities 10.0% across Canada” (Canadian Academy of Health 12.3% % of physicians 11.3% Sciences, 2014) 11.1% 9.7% 10.2% 5.0% 8.7% 7.7% 2.0% 6.2% 6.1% 0.0% 5.2% <35 35-44 45-54 55-64 65+ ALL Age group Source: Nelson S, Turnball J, Bainbridge L, Caulfield T, Hudon G, Kendel D, Mowat D, Nasmith L, Postl B, Shamian J, Sketris I. 2014. Optimizing Scopes of Practice: New Models for a New Health Care System. Source: CMA, CFPC & Royal College, 2013, National Physician Survey Canadian Academy of Health Sciences. Physician Workforce Supply Overview Residency New New Licensed Quota Trainees Certificants physicians Migration Retirement Death The MWK© pulls the data together… Residency New Licensed New Trainees Quota Certificants physicians (CAPER) (CaRMS) (RCPSC & CFPC) (CIHI) MWK 2.0 - Data sources and metrics Residency Quota Medical (CaRMS) Workforce Knowledgebase Physician Supply New Trainees (CAPER) Outputs Geographic distribution Specialties • Year over year Newly certified changes (# and %) physicians Sex • Five-year trends (# (Royal College and CFPC) Age and %) Subspecialties • Slope of change Licensed physician Province workforce (CIHI) Faculty of Medicine Physician Workforce Supply Overview Part 1: Overall Trends •Broad-Level •Specialties and Subspecialties Part 2: Specialty-specific examples •Orthopedic Surgery •Cardiology (IM) Residency New Licensed New Trainees Quota Certificants physicians (CAPER) Residency Quota (CaRMS) (RCPSC & CFPC) (CIHI) Specialties by Year (2011-2015) Subspecialties by Year (2011-2015) Residency Quota Residency Quota 0 500 1000 1500 2000 0 500 1000 Family Medicine Family Medicine (EM) 20.4% 12.9% Laboratory -2.5% Internal Medicine (subspec) Medical 2.0% 8.9% Pediatric (subspec) Surgical -11.4% -0.6% 2011 2012 2013 2014 2015 2011 2012 2013 2014 2015 CaRMS - Canadian Resident Matching Service Note: Data only available for Family Medicine, Internal Medicine and Pediatric subspecialties Residency New Licensed New Trainees Quota Certificants physicians (CAPER) New Trainees (CaRMS) (RCPSC & CFPC) (CIHI) Specialties by Year (2011-2015) Subspecialties by Year (2011-2015) New Trainees New Trainees 0 500 1000 1500 2000 0 250 500 Family Medicine Family Medicine 19.3% 12.4% Laboratory Internal Medicine 22.7% 0.0% Medical Pediatric 8.3% -7.6% Surgical Surgical -11.6% 10.5% 2011 2012 2013 2014 2015 2011 2012 2013 2014 2015 CAPER - Canadian Post-MD Education Registry Note: Laboratory Subspecialties and Other Medical Subspecialties not shown here; Family Medicine - R-1 Quota and PGY-1 Trainees by Faculty of Medicine, 2015 200 164 161 158 164 163 152 122 100 100 103 93 94 93 100 89 86 78 77 87 77 74 69 6670 59 57 67 33 55 58 43 33 36 41 35 0 Family Medicine R1 Quota Family Medicine PGY-1 Trainees Medical Specialities - R-1 Quota and PGY-1 Trainees by Faculty of Medicine, 2015 200 189 183 133130 108 100 107 93 90 78 79 77 82 80 72 81 75 72 71 77 76 75 65 59 53 50 59 48 46 46 47 32 31 15 0 Medicine R1 Quota Medicine PGY-1 Trainees Residency New Licensed New Trainees Quota Certificants physicians (CAPER) (CaRMS) (RCPSC & CFPC) (CIHI) New Certificants Specialties by Year (2011-2015) Subspecialties by Year (2011-2015) Newly-certified physicians Newly-certified Physicians 0 500 1000 1500 2000 0 250 500 Family Medicine Family Medicine 46.2% 11.0% Laboratory Internal Medicine 38.7% 48.5% Medical Pediatric 26.0% 53.7% Surgical Surgical 14.5% 47.2% 2011 2012 2013 2014 2015 2011 2012 2013 2014 2015 CFPC - The College of Family Physicians of Canada; RCPSC - Royal College of Note: Laboratory Subspecialties and Other Medical Subspecialties not shown here; Physicians and Surgeons of Canada Residency New Licensed New Trainees Quota Certificants physicians (CAPER) (CaRMS) (RCPSC & CFPC) (CIHI) Licensed Physicians Specialties by Year (2011-2015) Subspecialties by Year (2011-2015) New Trainees New Trainees 0 10000 20000 30000 40000 50000 0 2000 4000 6000 8000 Family Medicine Family Medicine 12.4% 22.7% Laboratory Internal Medicine 8.7% 25.7% Medical Pediatric 11.1% 82.1% Surgical Surgical 9.3% 31.0% 2011 2012 2013 2014 2015 2011 2012 2013 2014 2015 CIHI – Canadian Institute for Health Information Note: Laboratory Subspecialties and Other Medical Subspecialties not shown here; Residency New Licensed New Trainees Quota Certificants physicians (CAPER) Age distribution (CaRMS) (RCPSC & CFPC) (CIHI) Inflows: Newly Licensed All Licensed Physicians, CIHI (2015) Physicians • Average age of estimated practice entry cohort* • Family Medicine: 30.1 • Medical Disciplines: 33.3 65+ <35 • Lab Med.