Original Article
The training paths and practice patterns of Canadian paediatric residency graduates, 2004-2010 Tahir Hameed MD FRCPC FAAP1, Sarah Lawrence MD FRCPC2; for the CPPD-RG3 T Hameed, S Lawrence; for the CPPD-RG. The training paths and practice patterns of Canadian paediatric residency graduates, 2004-2010. Paediatr Child Health 2016;21(3):123-126. Background: The Paediatric Chairs of Canada have been proactive in workforce planning, anticipating paediatric job opportunities in academic centres. To complement this, it is important to characterize the practice profiles of paediatricians exiting training, including those working outside of tertiary care centres. Objective: To describe the training paths and the practice patterns of Canadian paediatric residency graduates. Methods: A survey was completed in 2010 to 2011 by Canadian program directors regarding residents completing core paediatrics training between 2004 and 2010. Data collection included training path after completing core paediatrics training and practice type after graduation. Results: Of 699 residents completing their core training in paediatrics, training path data were available for 685 (98%). Overall, 430 (63%) residents completed subspecialty training while 255 (37%) completed general paediatrics training only. There was a significant increase in subspecialty training, from 59% in earlier graduates (2004 to 2007) to 67% in later graduates (2008 to 2010) (P=0.037). Practice pattern data after completion of training were available for 245 general paediatricians and 205 subspecialists. Sixty-nine percent of general paediatricians were community based while 85% of subspecialists were hospital based in tertiary or quaternary centres. Of all residents currently in practice, only 36 (8%) were working in rural, remote or underserviced areas. Conclusions: Almost two-thirds of recent Canadian paediatric graduates pursued subspecialty training. There was a significant increase in the frequency of subspecialty training among later-year graduates. Few graduates are practicing in rural or underserviced areas. Further studies are needed to determine whether these trends continue and their impact on the future paediatric workforce in Canada. Key Words: Career choice; Paediatrics; Practice patterns; Residency
T
here is a concern that fewer paediatric graduates in Canada are pursuing community paediatric practice, and most work in urban centres, which affects children’s access to health care (1). To date, there have been little data profiling the actual training paths and practice patterns of Canadian paediatric residents. Two studies exploring how well Canadian paediatric residency programs prepared residents for clinical practice showed an approximately equal split between general paediatrics and subspecialty (SS) paediatrics among graduates (2,3). However, the main focus of these studies was on assessing the adequacy of training and not on profiling the career paths of residents. The aim of the present study was to describe the training paths and practice patterns of graduates of Canadian paediatric residency programs.
Les voies de formation et les modes de pratique des diplômés des programmes canadiens de résidence en pédiatrie, de 2004 à 2010 HISTORIQUE : Les Directeurs de pédiatrie du Canada sont proactifs en matière de planification des effectifs. Ils anticipent des possibilités d’emploi en pédiatrie dans les centres universitaires. Pour compléter cette information, il est important de caractériser les profils de pratique des pédiatres qui terminent leur formation, y compris ceux qui travaillent hors des centres de soins tertiaires. OBJECTIF : Décrire les voies de formation et les modes de pratique des diplômés des programmes canadiens de résidence en pédiatrie. MÉTHODOLOGIE : Les directeurs de programmes canadiens ont rempli un sondage pendant l’année 2010 à 2011 au sujet des résidents qui avaient terminé leur tronc commun en pédiatrie entre 2004 et 2010. La collecte des données incluait la voie de formation une fois ce tronc commun terminé et le type de pratique privilégié après la fin des études. RÉSULTATS : Les chercheurs ont obtenu des données sur les voies de formation de 685 des 699 résidents (98 %) qui avaient terminé leur tronc commun en pédiatrie. Dans l’ensemble, 430 résidents (63 %) ont effectué une formation en surspécialité, tandis que 255 (37 %) ont terminé seulement leur formation en pédiatrie générale. La formation en surspécialité a considérablement augmenté, passant de 59 % chez les premiers diplômés (de 2004 à 2007) à 67 % chez les diplômés des dernières années (2008 à 2010) (P=0,037). Les chercheurs ont obtenu des données sur les modes de pratique après la fin de la formation de 245 pédiatres généraux et 205 surspécialistes. Ainsi, 69 % des pédiatres généraux travaillaient en milieu communautaire et 85 % des surspécialistes, dans des centres hospitaliers tertiaires ou quaternaires. Parmi tous les résidents actuellement en exercice, seulement 36 (8 %) travaillaient en milieu rural, éloigné ou mal desservi. CONCLUSIONS : Presque les deux tiers des récents diplômés canadiens en pédiatrie ont effectué une surspécialité. La fréquence des formations en surspécialité a augmenté considérablement dans les dernières années du sondage. Peu de diplômés exercent en région rurale ou mal desservie. D’autres études s’imposent pour déterminer si ces tendances se maintiennent et pour en établir les répercussions sur les futurs effectifs en pédiatrie au Canada.
METHODS
A survey was sent to all program directors of accredited paediatrics residency programs in Canada for completion by Canadian and international medical graduates who completed three years of core paediatrics training during the study period (2004 to 2010). Visa trainees sponsored by foreign countries were excluded. One program (Northern Ontario School of Medicine, Sudbury, Ontario) was excluded because it was a new program at the time the survey was distributed. Three training paths were identified: four years of general paediatric training; four years of general paediatric training followed by SS training; or three years of core training followed by SS training. Practice patterns were classified according to clinical
1Section
of General Pediatrics, Department of Pediatrics, King Abdullah Specialized Children’s Hospital, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs Riyadh, Saudi Arabia; 2Division of Endocrinology and Metabolism, Children’s Hospital of Eastern Ontario and Department of Pediatrics, University of Ottawa, Ottawa, Ontario; 3Canadian Pediatric Program Directors Research Group Correspondence: Dr Tahir Hameed, Section of General Pediatrics, Department of Pediatrics, King Abdullah Specialized Children’s Hospital, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, PO Box 22490 – Mail Code 1940, Riyadh, Saudi Arabia 11426. Telephone 96611-801-1111 ext 53580, fax 96611-801-1111 ext 53555, e-mail [email protected] Accepted for publication July 27, 2015
Paediatr Child Health Vol 21 No 3 April 2016
©2016 Pulsus Group Inc. All rights reserved
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focus (general or SS paediatrics) and practice type (community or hospital based, with the latter implying work in a tertiary/ quaternary centre). Community-based practices could either be in a rural/remote/underserviced area or in an urban centre. Rural practices were not specifically defined. For urban practices, general paediatrician practices were identified as ≥50% consulting paediatrics or ≥50% primary care and SS practices. Please refer to Appendix 1 for details regarding training paths and practice pattern categories. Program directors (or their designees) were asked to complete the surveys about their own graduates. Regarding practice type, they were asked to choose only one category (the primary practice pattern of the graduate). Ethics approval for the present study was obtained from the Research Ethics Board at the Children’s Hospital of Eastern Ontario, Ottawa, Ontario. The survey instrument was piloted in one program and then mailed to all paediatric programs in the country in 2010. The survey was slightly modified and, in 2011, resent to the program directors via e-mail and distributed at the annual program directors meeting to gather updated data. Training and practice patterns are presented as frequencies. Data analysis was performed using SPSS version 22 (IBM Corporation, USA). The χ2 test was used to compare frequencies according to years of training and size of training program; differences with P50% primary care pediatrics) General pediatrics, hospital-based in a tertiary/quaternary centre Subspecialty pediatrics, community-based in a rural/remote/underserviced area (practice affiliated with a community hospital) Subspecialty pediatrics, community-based in an urban centre (associated with a community hospital or 50% of time) Still in training Practicing pediatrics outside of Canada Not practicing pediatrics Other (please describe) Completed training, practice profile unknown
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The training paths and practice patterns of Canadian paediatric residency graduates, 2004-2010 Tahir Hameed MD FRCPC FAAP1, Sarah Lawrence MD FRCPC2; for the CPPD-RG3 T Hameed, S Lawrence; for the CPPD-RG. The training paths and practice patterns of Canadian paediatric residency graduates, 2004-2010. Paediatr Child Health 2016;21(3):123-126. Background: The Paediatric Chairs of Canada have been proactive in workforce planning, anticipating paediatric job opportunities in academic centres. To complement this, it is important to characterize the practice profiles of paediatricians exiting training, including those working outside of tertiary care centres. Objective: To describe the training paths and the practice patterns of Canadian paediatric residency graduates. Methods: A survey was completed in 2010 to 2011 by Canadian program directors regarding residents completing core paediatrics training between 2004 and 2010. Data collection included training path after completing core paediatrics training and practice type after graduation. Results: Of 699 residents completing their core training in paediatrics, training path data were available for 685 (98%). Overall, 430 (63%) residents completed subspecialty training while 255 (37%) completed general paediatrics training only. There was a significant increase in subspecialty training, from 59% in earlier graduates (2004 to 2007) to 67% in later graduates (2008 to 2010) (P=0.037). Practice pattern data after completion of training were available for 245 general paediatricians and 205 subspecialists. Sixty-nine percent of general paediatricians were community based while 85% of subspecialists were hospital based in tertiary or quaternary centres. Of all residents currently in practice, only 36 (8%) were working in rural, remote or underserviced areas. Conclusions: Almost two-thirds of recent Canadian paediatric graduates pursued subspecialty training. There was a significant increase in the frequency of subspecialty training among later-year graduates. Few graduates are practicing in rural or underserviced areas. Further studies are needed to determine whether these trends continue and their impact on the future paediatric workforce in Canada. Key Words: Career choice; Paediatrics; Practice patterns; Residency
T
here is a concern that fewer paediatric graduates in Canada are pursuing community paediatric practice, and most work in urban centres, which affects children’s access to health care (1). To date, there have been little data profiling the actual training paths and practice patterns of Canadian paediatric residents. Two studies exploring how well Canadian paediatric residency programs prepared residents for clinical practice showed an approximately equal split between general paediatrics and subspecialty (SS) paediatrics among graduates (2,3). However, the main focus of these studies was on assessing the adequacy of training and not on profiling the career paths of residents. The aim of the present study was to describe the training paths and practice patterns of graduates of Canadian paediatric residency programs.
Les voies de formation et les modes de pratique des diplômés des programmes canadiens de résidence en pédiatrie, de 2004 à 2010 HISTORIQUE : Les Directeurs de pédiatrie du Canada sont proactifs en matière de planification des effectifs. Ils anticipent des possibilités d’emploi en pédiatrie dans les centres universitaires. Pour compléter cette information, il est important de caractériser les profils de pratique des pédiatres qui terminent leur formation, y compris ceux qui travaillent hors des centres de soins tertiaires. OBJECTIF : Décrire les voies de formation et les modes de pratique des diplômés des programmes canadiens de résidence en pédiatrie. MÉTHODOLOGIE : Les directeurs de programmes canadiens ont rempli un sondage pendant l’année 2010 à 2011 au sujet des résidents qui avaient terminé leur tronc commun en pédiatrie entre 2004 et 2010. La collecte des données incluait la voie de formation une fois ce tronc commun terminé et le type de pratique privilégié après la fin des études. RÉSULTATS : Les chercheurs ont obtenu des données sur les voies de formation de 685 des 699 résidents (98 %) qui avaient terminé leur tronc commun en pédiatrie. Dans l’ensemble, 430 résidents (63 %) ont effectué une formation en surspécialité, tandis que 255 (37 %) ont terminé seulement leur formation en pédiatrie générale. La formation en surspécialité a considérablement augmenté, passant de 59 % chez les premiers diplômés (de 2004 à 2007) à 67 % chez les diplômés des dernières années (2008 à 2010) (P=0,037). Les chercheurs ont obtenu des données sur les modes de pratique après la fin de la formation de 245 pédiatres généraux et 205 surspécialistes. Ainsi, 69 % des pédiatres généraux travaillaient en milieu communautaire et 85 % des surspécialistes, dans des centres hospitaliers tertiaires ou quaternaires. Parmi tous les résidents actuellement en exercice, seulement 36 (8 %) travaillaient en milieu rural, éloigné ou mal desservi. CONCLUSIONS : Presque les deux tiers des récents diplômés canadiens en pédiatrie ont effectué une surspécialité. La fréquence des formations en surspécialité a augmenté considérablement dans les dernières années du sondage. Peu de diplômés exercent en région rurale ou mal desservie. D’autres études s’imposent pour déterminer si ces tendances se maintiennent et pour en établir les répercussions sur les futurs effectifs en pédiatrie au Canada.
METHODS
A survey was sent to all program directors of accredited paediatrics residency programs in Canada for completion by Canadian and international medical graduates who completed three years of core paediatrics training during the study period (2004 to 2010). Visa trainees sponsored by foreign countries were excluded. One program (Northern Ontario School of Medicine, Sudbury, Ontario) was excluded because it was a new program at the time the survey was distributed. Three training paths were identified: four years of general paediatric training; four years of general paediatric training followed by SS training; or three years of core training followed by SS training. Practice patterns were classified according to clinical
1Section
of General Pediatrics, Department of Pediatrics, King Abdullah Specialized Children’s Hospital, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs Riyadh, Saudi Arabia; 2Division of Endocrinology and Metabolism, Children’s Hospital of Eastern Ontario and Department of Pediatrics, University of Ottawa, Ottawa, Ontario; 3Canadian Pediatric Program Directors Research Group Correspondence: Dr Tahir Hameed, Section of General Pediatrics, Department of Pediatrics, King Abdullah Specialized Children’s Hospital, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, PO Box 22490 – Mail Code 1940, Riyadh, Saudi Arabia 11426. Telephone 96611-801-1111 ext 53580, fax 96611-801-1111 ext 53555, e-mail [email protected] Accepted for publication July 27, 2015
Paediatr Child Health Vol 21 No 3 April 2016
©2016 Pulsus Group Inc. All rights reserved
123
Hameed et al
focus (general or SS paediatrics) and practice type (community or hospital based, with the latter implying work in a tertiary/ quaternary centre). Community-based practices could either be in a rural/remote/underserviced area or in an urban centre. Rural practices were not specifically defined. For urban practices, general paediatrician practices were identified as ≥50% consulting paediatrics or ≥50% primary care and SS practices. Please refer to Appendix 1 for details regarding training paths and practice pattern categories. Program directors (or their designees) were asked to complete the surveys about their own graduates. Regarding practice type, they were asked to choose only one category (the primary practice pattern of the graduate). Ethics approval for the present study was obtained from the Research Ethics Board at the Children’s Hospital of Eastern Ontario, Ottawa, Ontario. The survey instrument was piloted in one program and then mailed to all paediatric programs in the country in 2010. The survey was slightly modified and, in 2011, resent to the program directors via e-mail and distributed at the annual program directors meeting to gather updated data. Training and practice patterns are presented as frequencies. Data analysis was performed using SPSS version 22 (IBM Corporation, USA). The χ2 test was used to compare frequencies according to years of training and size of training program; differences with P50% primary care pediatrics) General pediatrics, hospital-based in a tertiary/quaternary centre Subspecialty pediatrics, community-based in a rural/remote/underserviced area (practice affiliated with a community hospital) Subspecialty pediatrics, community-based in an urban centre (associated with a community hospital or 50% of time) Still in training Practicing pediatrics outside of Canada Not practicing pediatrics Other (please describe) Completed training, practice profile unknown
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