Cardiologist numbers in British Columbia: A crisis?
The objective was to determine the adequacy of the number of cardiologists and cardiology residents in British Columbia.
Data source and selection: Number of cardiologists and ages were determined from information provided by the British Columbia College of Physicians and Surgeons, the Royal College of Physicians and Surgeons, and the Canadian Medical Association. Numbers of residents were determined from the Canadian Post MD Education Registry. A simple model was used to predict cardiologist numbers in British Columbia until the year 2020. Comparisons were made with numbers in Ontario, Alberta, and the rest of Canada.
Main results: There are 1.65 cardiologists per 100 000 population and 0.10 non-visa cardiology residents per 100 000 population in British Columbia. These numbers are far below those in Ontario, Alberta, and the rest of Canada. Modeling suggests the number of cardiologists will decrease unless major increases in cardiology training positions are made.
Conclusion: There are too few cardiologists and cardiology residents in British Columbia.
British Columbia already has fewer cardiologists than comparable provinces—and fewer than recommended—and if we don’t increase the number of cardiologists we train per year, we may soon be in a crisis.
National attention has recently focused on the need for more physicians in Canada.[1] Cardiologists in British Columbia have noted signs and symptoms of an acute and chronic shortage of colleagues. These have included increasing waiting list times, inability to recruit cardiologists to replace retiring members, and increasing workloads in both academic and non-academic centres. As well, there does not seem to be an adequate number of cardiology residents being trained in British Columbia to address the issue. Cardiologists fear these factors are currently denying, and will continue to deny, the population of BC acceptable cardiovascular care.
In an audit type format, this study seeks to:
• Determine the number of cardiologists currently in BC
• Determine the adequacy of this number
• Determine the number of non-visa (Canadian citizen or landed immigrants in the core years of their cardiology training) cardiology residents currently training in BC
• Determine the adequacy of this number
• Predict the number of cardiologists in BC over the next 20 years
• Propose an acceptable range of cardiology residents that will need to be trained at the University of British Columbia to generate enough cardiologists to provide adequate cardiovascular care to the population of BC
Cardiologist numbers and demographics in BC, non-visa cardiology residents in BC, as well as similar data for Alberta, Ontario, and the rest of Canada (for comparison) were determined. Populations were determined from Statistics Canada data.[2] We used the mean of the number of cardiologists listed by the British Columbia College of Physicians and Surgeons,[3] the Royal College of Physicians and Surgeons,[4] and the Canadian Medical Association[5] for cardiologist numbers in BC, and the latter two sources for all other provinces. The number of cardiology residents was determined from the Canadian Post MD Education Registry.[6]
Ratios of cardiologists and non-visa cardiology residents per 100 000 population were calculated in BC, Ontario, and Alberta (the traditional Canadian “have” provinces) and the rest of Canada (the traditional Canadian “have not” provinces) for comparison.
A simple model to predict future cardiologist numbers in BC for the next 20 years was developed. Briefly, the ages of the cardiologists currently practising in BC, the number of non-visa cardiology residents who graduated in BC in the last 10 years (and their current location), and the number of non-UBC trained cardiologists who have set up practice in BC in the last 10 years were determined. We assumed cardiologists would retire at age 65, that the same percentage of non-visa cardiology residents who graduate in BC will choose to practise here as have done so in the past 10 years, and the same number of non-UBC trained cardiologists per year will be attracted to the province. A population growth of 2% per year in BC was used. The predicted number of cardiologists in BC per 100 000 population was calculated for 2005, 2010, 2015, and 2020. The number of cardiology residents needed to ensure adequate cardiologist numbers (defined as the lowest of the Royal College of Physicians and Surgeons’ suggested number, or the number of cardiologists in Ontario, Alberta, or the rest of Canada in 1999) was calculated.
The study results are summarized here in Table 1, Table 2, and Figure 1.
The model used to predict cardiologist numbers is simple and fails to take into account potential changes in physician recruitment, retention, and earlier or later retirement that may occur due to political or economic changes. Population demographic assumptions were also simplified. To keep the report brief, inputs into the model were not varied.
There are currently between 64 and 69 cardiologists in BC (1.65 cardiologists per 100 000 population). This number is 45% less than the number recommended by the Royal College of Physician and Surgeons of Canada, 38% less than the number of cardiologists per 100 000 population in the provinces outside Ontario and Alberta, 36% less than the number of cardiologists per 100 000 population in Ontario, and 26% less than the number of cardiologists per 100 000 population in Alberta.
In November 1999 there were four non-visa cardiology residents training at UBC (0.10 non-visa cardiology residents per 100 000 population). This number is 82% less than the number of non-visa cardiology residents per 100 000 population in Ontario and the provinces outside Ontario and Alberta, and 79% less than the number of non-visa cardiology residents per 100 000 population in Alberta. If cardiologists retire at age 65, the same number of cardiologists per year continue to immigrate to BC as have done so in the past 10 years, and UBC continues to train the same number of non-visa cardiology residents as the past 10 years, the number of cardiologists per 100 000 population will decrease by 60% by 2020. Therefore, UBC needs to train a minimum of five, and preferably six, non-visa cardiology residents per year (starting in the 2001–2002 academic year) for the next 20 years to reach an acceptable number of cardiologists by the year 2020. If cardiologist numbers are to increase and fewer than five non-visa cardiology residents are trained, then either the retirement age for cardiologists will need to increase, the number of emigrating cardiology residents will need to decrease, or population growth in BC must slow.
References
1. Sullivan P. Concerns about size of MD workforce, medicine’s future dominate CMA annual meeting. CMAJ 1999;161: 561-562. PubMed Citation Full Text
2. Statistics Canada. Population by age group 1999. www.statcan.ca/english/Pdgb/People/Population/demo02.htm (18 July 2001; retrieved 18 July 2001).
3. The College of Physicians and Surgeons of British Columbia. 1999–2000 Medical Directory. Vancouver, BC: The College of Physicians and Surgeons of British Columbia.
4. Buske L. Canadian Medical Association Master File—Cardiologists in BC, Alberta, and Ontario. Canadian Medical Association, January 2000.
5. Frechette D. Cardiologists in British Columbia, Alberta, and Ontario. The Royal College of Physicians and Surgeons of Canada Registry of Fellows, 21 August 2000.
6. Association of Canadian Medical Colleges. Canadian Post MD Educational Registry. Ottawa, 1999–2000:29.
The Postgraduate Education Cardiology Committee, The University of British Columbia, Vancouver, BC, Canada
Members of the Postgraduate Education Cardiology Committee are Ken G. Gin, MD, FRCPC, Saul Isserow, MB, FRCPC, John Jue, MD, FRCPC, Charles R. Kerr, MD, FRCPC, Brad I. Munt, MD, FRCPC, Paul Novak, MD, Alan Rabinowitz, MB, FRCPC, Salima Shariff, MD, FRCPC, and John G. Webb, MD, FRCPC.
