Canadian Post-MD Education Registry Research Articles

The Physician Anesthesia Workforce in Canada From 1996 to 2018: A Longitudinal Analysis of Health Administrative Data.

A robust anesthesia workforce is essential to the provision of safe surgical, obstetrical, and critical care but information describing the physician anesthesia workforce and volume of clinical services delivered in Canada is limited. This study examines the Canadian physician anesthesia workforce, exploring trends in physician characteristics and activity levels over time. Practice patterns of specialist anesthesiologists and family physician anesthetists (FPAs) working in urban and rural communities were of particular interest. Physicians who provided anesthesia care between 1996 and 2018 were identified using health administrative data from the Canadian Institute of Health Information (CIHI). In addition, data from the Canadian Post-MD Education Registry (CAPER) were used to characterize physicians pursuing postgraduate anesthesia training (1996-2019). Descriptive analyses of physician demographics, training, location, specialty designations, and volume of clinical services were undertaken. Between 1996 and 2018, the anesthesia workforce grew 1.8-fold to 3681 physicians, including 536 FPAs. Over the same time, nerve block services increased 7-fold, and payments for other anesthesia services increased 5-fold. The average age of the anesthesiology workforce increased by 2.3 years and the annual retirement rate was 3%. The workforce has become more gender balanced but remains predominantly male (73% in 2018). The proportion of physicians who were trained internationally (about 30%; 38% in rural areas) remained stable (and higher than that in the overall physician workforce). FPAs provided most anesthesia care in rural Canada and their attrition rate was generally 2- to 3-fold higher than specialists. Physicians in the rural anesthesia workforce provided anesthesia services more intensively over time. Relatively few FPAs who left the anesthesia workforce entered full retirement and they instead contributed other medical services to their communities. This study provides foundational information regarding anesthesia workforce capacity over a 22-year period, including insights into demographics, locations of practice, and clinical volumes. The results do not quantify the gap between service capacity and need; however, they support the need for a national workforce strategy to achieve equitable access to sustainable anesthesia services in Canada, particularly for rural communities.

Representation of Women in Canadian Radiation Oncology Trainees and Radiation Oncologists: Progress or Regress?

PurposeThe study objective was to determine the representation of women in Canadian radiation oncology (RO) trainees and the radiation oncologist workforce over time. Methods and MaterialsGender data for Canadian RO trainees (residents and fellows) and radiation oncologists were collected from the Canadian Post-MD Education Registry (1994-2021) and Canadian Medical Association (1994-2019). Visa trainees were excluded. Gender parity was defined as a 1:1 female-to-male ratio. Descriptive statistics were used to summarize the data. ResultsFemale trainee proportions varied with 2 rising trend periods (1994-1998: 38%-43%, P = .93; 2002-2014: 35%-51%, P = .53) and 2 regression trend periods (1998-2002: 43%-35%, P = .83; 2014-2021: 52%-35%, P = .011). Gender parity was observed in RO trainees between 2012 and 2016. The annual number of RO trainees ranged from 66 to 173 with 2 near-parallel periods of gender-associated growth (1994-1996; 2002-2008) and regression (1997-2001; 2009-2016) followed by gender divergence (2017-2021) with increasing male and decreasing female trainees. Nearly all Canadian regions, except Ontario, reached 50% or higher female representation in RO trainees during the study period. In the radiation oncologist workforce, female representation increased from 20% (54/271) to 37% (217/582) between 1994 and 2019, and all regions and age groups demonstrated higher female representation over time. Within radiation oncologist subgroups, age <35 years old and Quebec region cohorts reached gender parity. ConclusionsRepresentation of women varied in Canadian RO trainees and has fallen since 2014, whereas female representation generally increased in the radiation oncologist workforce over time. Gender parity was observed in RO trainees, radiation oncologists <35 years old, and radiation oncologists in Quebec. Recent declining female representation among RO trainees is worrisome, and further study is warranted to identify potential gender-based barriers in attracting women to the specialty.

Updated inventory and projections for Canada's ophthalmology workforce

ObjectifMettre à jour les données sur l'effectif des ophtalmologistes au Canada et établir des prévisions pour l'avenir. NatureÉtude transversale. ParticipantsOphtalmologistes exerçant au Canada entre 1968 et 2019. MéthodesL'effectif et les données démographiques des médecins du Canada proviennent de l'Institut canadien d'information sur la santé. Le nombre de médecins en formation est issu du Répertoire canadien sur l’éducation post-M.D. On a déterminé les prédictions futures en ce qui a trait à l'effectif des ophtalmologistes à partir des projections démographiques de Statistique Canada. RésultatsEn 2020, on recensait 1323 ophtalmologistes au Canada : 27,3 % étaient des femmes et 20,9 % avaient au moins 65 ans. Dans l'ensemble, on comptait 3,48 ophtalmologistes par 100 000 habitants. Les distributions provinciales s’échelonnaient comme suit : de 2,32 au Manitoba à 5,00 en Nouvelle-Écosse. Pour la population de 65 ans et plus, on comptait 19,35 ophtalmologistes par 100 000 habitants. Si la variation annuelle du nombre d'ophtalmologistes demeure semblable à celle des 10 dernières années, on s'attend à ce que le nombre d'ophtalmologistes par 100 000 habitants diminue légèrement pour atteindre 3,21 en 2068 dans un scénario de forte croissance, et qu'il augmente à 4,08 et à 5,08 dans un scénario de moyenne croissance ou de faible croissance, respectivement. Pour la population de 65 ans et plus, les prédictions correspondantes se chiffrent à 14,00 dans un scénario de forte croissance, à 17,72 dans un scénario de croissance moyenne et à 18,40 dans un scénario de faible croissance. ConclusionsOn estime que le rapport entre le nombre d'ophtalmologistes et la population âgée de 65 ans et plus, soit la principale cohorte que soignent les ophtalmologistes, diminuera de 4,9 % et de 27,7 % dans un scénario de faible croissance et de forte croissance, respectivement, ce qui risque d'entraîner des problèmes en matière de prestations de soins de santé visuelle. Une légère hausse du nombre de postes de résidents en ophtalmologie pourrait remédier à la situation.

Canadian medical oncology workforce and cancer incidence trends: Supply and proxy demand analyses from 1994 to 2020.

e13526 Background: It is unclear whether the Canadian medical oncology workforce has kept pace with the country’s rising cancer incidence over the last three decades. This study sought to characterize the national and provincial trends in the medical oncologist (MO) and MO trainee workforce during the last 27 years and explore the relationship between workforce and cancer incidence. Methods: Publicly available databases from the Canadian Medical Association (CMA; 1994-2019) and Canadian Institute of Health Information (CIHI) database (1994-2020) were utilized to estimate the number, demographics, and regional distribution of practicing MOs in Canada from 1994 to 2020. Cancer incidence by province was obtained from Statistics Canada for the period 1990 to 2018, except for Quebec where only 1990-2010 data was available, and then projected to 2020 across five regions (The West Coast, The Prairies, Ontario, Quebec and Atlantic Canada) using Canadian population statistics from Statistics Canada and age-period-cohort modeling. To estimate changes in demand for, and supply of, medical oncology services over time, annual cancer incidence to MO provider ratios were calculated. Finally, the Canadian Post MD Education Registry (CAPER) database (1994-2020) was used to characterize the number of MO trainees. Results: Between 1994 and 2020, annual cancer incidence nationally rose from 120,255 cases to 225,800 cases (88%), while the number of MOs increased from 161 to 642 (298%). Incident cancer cases to medical oncologist (MO) ratio dropped from 749:1 in 1994 to 352:1 in 2020. This ratio fell in all five analyzed regions from 1994 to 2020 (Atlantic Canada 1836:1 to 447:1, The Prairies 1257:1 to 377:1, The West Coast 909 to 261:1, Ontario 682:1 to 411:1 and Quebec 543:1 to 300:1). In 1994, 24% of MO providers were ≥ 50 years old compared with 40% in 2020. Nationally, the MO workforce has nearly reached gender parity with 46% female in 2020 versus 25% in 1994. Trends in Canadian MO trainees have largely mirrored MO trends with a 203% increase in the annual trainee cohort from 34 in 1994 to 103 in 2020. In 1994, 34% of trainees were female compared with 63% in 2020. The largest proportion of the country's MOs (34% in 2020) and MO trainees (49%) are located in Canada’s most populous province, Ontario. Conclusions: Although the Canadian MO workforce has shown considerable growth between 1994-2020, a higher proportion of MO providers are nearing retirement age and may influence future workforce trends. Moreover, our study was not able to take into consideration referral patterns or the increasing number and complexity of systemic therapies that also influence MO workload. Ongoing monitoring of human resource levels in medical oncology and cancer incidence data are key metrics to meaningfully inform MO training programs of an appropriately sized trainee cohort and ensure future demands for MO services in cancer care are met.

National Trends in Gender Diversity Among Trainees and Practicing Physicians in Otolaryngology–Head and Neck Surgery in Canada

Monitoring the evolution of gender diversity within medicine is essential to understanding the medical workforce and anticipating its future. To evaluate gender distribution and trends among trainees and practicing physicians in the field of otolaryngology-head and neck surgery (OHNS) across Canada. This cross-sectional study collected demographic data on the Canadian population, medical students, resident physicians, fellows, practicing physicians, and full-time professors from the following publicly available databases: the Canadian Post-MD Education Registry, the Canadian Medical Education Statistics from the Association of Faculties of Medicine of Canada, the Canadian Medical Association Masterfile, the Canadian Resident Matching Service archives, and the Canadian Institute for Health Information from 2000 to 2019. Information about the gender distribution in leadership positions and fellowships was obtained through publicly available websites where gender was either listed or assigned by authors. The primary outcomes were the proportion of women in OHNS and the evolution of gender diversity over time. In 2019, 65 of 155 of OHNS trainees were female (41.9%), whereas female representation among all surgical trainees combined was 1225 of 2496 (49.1%). Female OHNS trainees and practicing physicians are underrepresented despite a 13.3% increase in female trainees and a 14.3% increase in female staff physicians from 2000 to 2019. Proportionally fewer female graduates pursued a fellowship during a 10-year period compared with their male counterparts, with otology and neurotology having the lowest female representation (6 of 27 [22.2%]). A minimal increase occurred in the number of women holding academic leadership positions (eg, 4 of 13 residency training programs had a previous or current female director). Despite the overall increase in the representation of women in the field of OHNS in Canada, these findings suggest that persistent gender gaps remain with respect to academic leadership positions and fellowship training. Continuous monitoring of the surgical workforce is important to highlight and address gender disparities within OHNS.

Recognizing and addressing implicit gender bias in medicine.

KEY POINTS For more than a decade, women have predominated among Canadian medical school graduates, according to data from the Canadian Post-M.D. Education Registry (CAPER). Although, as a profession, medicine still sees pervasive discrimination that disadvantages certain groups over others, one

National Trends and Dynamic Responses in the Canadian Radiation Oncology Workforce From 1990 to 2018

To report radiation oncology (RO) workforce and cancer incidence trends in Canada and explore the relationship between the two. Canadian radiation oncologist, trainee, and cancer incidence data from 1990 to 2018 were collected from the following publicly accessible administrative and health information databases: Canadian Post-MD Education Registry (1990-2018), Canadian Medical Association Physician Data Centre (1994-2018), Canadian Institute for Health Information/Scott's Medical Database (1990-2017), Canadian Cancer Registry (1990-2017), and Statistics Canada (1990-2017). Descriptive statistics were used to summarize the data. The Canadian RO workforce grew from 240 radiation oncologists in 1990 to 567 in 2018, with the largest growth period from 2005 to 2015 adding 207 radiation oncologists. Regional analyses revealed steady or stepwise growth in all Canadian regions, except in Québec, where the number of radiation oncologists decreased from 86 in 1990 to 57 in 2003 before rising to 139 by 2018. Trainee totals were between 54 and 173 per year with 2 periods of growth (1990-1996 and 2001-2008) and regression (1996-2001 and 2008-2018), signifying trainee supply variability. Female proportions of the workforce and trainees, respectively, rose steadily from 18% to 38% and 28% to 50%, while the workforce proportion with non-Canadian medical degrees decreased from 40% to 26%. Radiation oncologists younger than 40 years increased from 70 to 171, whereas those age 60 years and older decreased from 85 in 1990 to 31 in 2002 and then increased to 108 in 2017. Annual cancer incidence rose steadily from 103,780 to 206,290 cases/year. The annual cancer incidence-to-provider ratio fluctuated (364-475:1) and trended lower with time, and proportional cancer incidence-to-provider ratios varied between 0.7:1 and 1.6:1 in Canada's regions before approaching 1:1. Our study demonstrates the challenges and successes of managing the Canadian radiation oncologist workforce. These data will inform policy makers and other stakeholders to ensure that the profession meets the current and future needs of Canadian cancer patients.

Results from the 2017 Survey of Radiation Oncology Residents in Canada

Previous Pan-Canadian surveys of Radiation Oncology (RO) residents performed in 2003 and 2009 identified job availability as a major concern, and characterized a perceived decline in employment opportunities for radiation oncologists in Canada. The Canadian post-MD education registry indicates that Canadian RO trainee levels rose from 130 in 2003 to reach a peak of 209 in 2009 before declining to approximately 130 in 2017. Recognizing that RO has entered another period of transition, we investigated resident perspectives among a more contemporary cohort of RO trainees in Canada. Surveys were distributed electronically to residents at each RO training program in Canada. Surveys consisted of 116 multiple choice and open-ended questions assessing center demographics, motivations for choosing RO, clinical experiences, didactic learning, research experiences, professional relationships, resident satisfaction, and career aspirations. Questions were constructed based on the 2003 and 2009 Canadian survey, and on previous Association of Residents in Radiation Oncology reports from the United States. Anonymized, aggregate responses from completed surveys were abstracted, and descriptive statistics were calculated. Out of 128 eligible residents, 84 completed the survey (65.6% response rate) with representative sampling from each training year (17.1% - 22.4% each year). Demographics reveal 52.6% were male, 68.4% were Canadian medical school graduates (CMGs), 22.4% held either a master’s degree or doctorate, and 2.6% held additional medical certification. Nearly all respondents (97.9%) were satisfied with their specialty and training program. The most frequently perceived weakness in training was feeling unprepared to be competitive in the job market (42.6%), and 78.7% plan to pursue a post-residency fellowship. Most CMGs (86.1%) plan to practice in Canada, but only 12.8% of respondents believe there is strong demand for RO in Canada. Few respondents believe they can obtain staff positions treating their preferred tumor sites (38.3%), and at their preferred geographic location (27.7%). The job market was perceived by 40.4% to be less competitive than it was 5 years ago, and 59.6% predict it will be less competitive 5 years from now. Canadian RO residents feel adequately trained as competent physicians, and a majority of trainees pursue post-residency fellowships, similar to prior surveys. Although current perceptions of the Canadian job market remain guarded, RO residents are highly satisfied with their choice of specialty and training program, and are more optimistic about their future job prospects. Our survey update provides continued insights into RO residency training in Canada, and identifies opportunities for improvement that could be addressed by the incoming competency-based medical education model for RO.

Management of Medical Oncology Services in Canada: Redefined Workload With a Novel Supply-and-Demand Workforce Projection Model.

We developed a workforce-planning model to predict Canadian medical oncologist (MO) supply and clinical demand during the next 10 years. A forward calculation model was created to forecast the balance of MO supply and demand. MO supply was estimated by using Canadian Institute for Health Information, Canadian Medical Association, and Canadian Post-MD Education Registry data. Care demand was estimated by using data from Canadian Cancer Statistics and Alberta Cancer Registry. The Canadian Royal College MO Committee confirmed its face validity. The MO workforce is expected to grow from 541 staff in 2016 to 830 staff in 2026. During this period, new hires will increase from 39 to 56 per year, and departures will increase from 15 to 24 per year. Although cancer incidence rates will grow from 202,149 to 257,497, a projected increase in MO supply will mean fewer initial consultations, from an average of 168.5 consultations per MO in 2016 to 129.2 consultations per MO in 2026. The initiation of systemic therapy is projected to remain stable at 102.3 new systemic therapy starts per MO per year. We have developed a forward calculation MO workforce model that predicts a growing Canadian MO workforce and redefines MO workload dynamics. MO providers will increasingly support more follow-up care with the initiation of multiple lines of systemic therapy relative to the medical management of patients at the time of initial cancer diagnosis. Workload metrics, including follow-up and new therapy initiation rates, must be measured to appropriately to meet increasingly complex and growing care demands.

Attitudes and factors contributing to attrition in Canadian surgical specialty residency programs.

We recently studied attrition in Canadian general surgical programs; however, there are no data on whether residents enrolled in other surgical residencies harbour the same intents as their general surgical peers. We sought to determine how many residents in surgical disciplines in Canada consider leaving their programs and why. An anonymous survey was administered to all residents in 9 surgical disciplines in Canada. Significance of association was determined using the Pearson χ2 test. The Canadian Post-MD Education Registry (CAPER) website was used to calculate the response rate. We received 523 responses (27.6% response rate). Of these respondents, 140 (26.8%) were either "somewhat" or "seriously" considering leaving their program. Residents wanting to pursue additional fellowship training and those aspiring to an academic career were significantly less likely to be considering changing specialties (p = 0.003 and p = 0.005, respectively). Poor work-life balance and fear of unemployment/underemployment were the top reasons why residents would change specialty (55.5% and 40.8%, respectively), although the reasons cited were not significantly different between those considering changing and those who were not (p = 0.64). Residents who were considering changing programs were significantly less likely to enjoy their work and more likely to cite having already invested too much time to change as a reason for continuing (p < 0.001). More than one-quarter of residents in surgical training programs in Canada harbour desires to abandon their surgical careers, primarily because of unsatisfactory work-life balance and limited employment prospects. Efforts to educate prospective residents about the reality of the surgical lifestyle and to optimize employment prospects may improve completion rates.

Credentialing and retention of visa trainees in post-graduate medical education programs in Canada

BackgroundVisa trainees are international medical graduates (IMG) who come to Canada to train in a post-graduate medical education (PGME) program under a student or employment visa and are expected to return to their country of origin after training. We examined the credentialing and retention of visa trainees who entered PGME programs between 2005 and 2011.MethodsUsing the Canadian Post-MD Education Registry’s National IMG Database linked to Scott’s Medical Database, we examined four outcomes: (1) passing the Medical Council of Canada Qualifying Examination Part 2 (MCCQE2), (2) obtaining a specialty designation (CCFP, FRCPC/SC), and (3) working in Canada after training and (4) in 2015. The National IMG Database is the most comprehensive source of information on IMG in Canada; data were provided by physician training and credentialing organizations. Scott’s Medical Database provides data on physician locations in Canada.ResultsThere were 233 visa trainees in the study; 39.5% passed the MCCQE2, 45.9% obtained a specialty designation, 24.0% worked in Canada after their training, and 53.6% worked in Canada in 2015. Family medicine trainees (OR = 8.33; 95% CI = 1.69–33.33) and residents (OR = 3.45; 95% CI = 1.96–6.25) were more likely than other specialist and fellow trainees, respectively, to pass the MCCQE2. Residents (OR = 7.69; 95% CI = 4.35–14.29) were more likely to obtain a specialty credential than fellows. Visa trainees eligible for a full license were more likely than those not eligible for a full license to work in Canada following training (OR = 3.41; 95% CI = 1.80–6.43) and in 2015 (OR = 3.34; 95% CI = 1.78–6.27).ConclusionsVisa training programs represent another route for IMG to qualify for and enter the physician workforce in Canada. The growth in the number of visa trainees and the high retention of these physicians warrant further consideration of the oversight and coordination of visa trainee programs in provincial and in pan-Canadian physician workforce planning.

Evolution of gender representation among Canadian OTL-HNS residents: a 27-year analysis

BackgroundThe proportion of females enrolling into medical schools has been growing steadily. However, the representation of female residents among individual specialties has shown considerable variation. The purpose of this study was to compare the trends of gender representation in Otolaryngology – Head and Neck Surgery (OTL-HNS) residency programs with other specialty training programs in Canada. In order to contextualize these findings, a second phase of analysis examined the success rate of applicants of different genders to OTL-HNS residency programs.MethodAnonymized data were obtained from the Canadian Residency Matching Service (CaRMS) and from the Canadian Post-M.D. Education Registry (CAPER) from 1988 to 2014. The differences in gender growth rates were compared to other subspecialty programs of varying size. Descriptive analysis was used to examine gender representation among OTL-HNS residents across years, and to compare these trends with other specialties. Bayesian hierarchical models were fit to analyze the growth in program rates in OTL-HNS based on gender.ResultsCaRMS and CAPER data over a 27 year period demonstrated that OTL-HNS has doubled its female representation from 20% to 40% between 1990 and 1994 and 2010-2014. The difference in annual growth rate of female representation versus male representation in OTL-HNS over this time period was 2.7%, which was similar to other large specialty programs and surgical subspecialties. There was parity in success rates of female and male candidates ranking OTL-HNS as their first choice specialty for most years.ConclusionsFemale representation in Canadian OTL-HNS residency programs is steadily increasing over the last 27 years. Large variation in female applicant acceptance rates was observed across Canadian universities, possibly attributable to differences in student body or applicant demographics. Factors influencing female medical student career selection to OTL-HNS require further study to mitigate disparities in gender representation and identify barriers to prospective female OTL-HNS applicants.

Shifting tides in the emigration patterns of Canadian physicians to the United States: a cross-sectional secondary data analysis.

BackgroundThe relative ease of movement of physicians across the Canada/US border has led to what is sometimes referred to as a ‘brain drain’ and previous analysis estimated that the equivalent of two graduating classes from Canadian medical schools were leaving to practice in the US each year. Both countries fill gaps in physician supply with international medical graduates (IMGs) so the movement of Canadian trained physicians to the US has international ramifications. Medical school enrolments have been increased on both sides of the border, yet there continues to be concerns about adequacy of physician human resources. This analysis was undertaken to re-examine the issue of Canadian physician migration to the US.MethodsWe conducted a cross-sectional analysis of the 2015 American Medical Association (AMA) Masterfile to identify and locate any graduates of Canadian schools of medicine (CMGs) working in the United States in direct patient care. We reviewed annual reports of the Canadian Resident Matching Service (CaRMS); the Canadian Post-MD Education Registry (CAPER); and the Canadian Collaborative Centre for Physician Resources (C3PR).ResultsBeginning in the early 1990s the number of CMGs locating in the U.S. reached an all-time high and then abruptly dropped off in 1995. CMGs are going to the US for post-graduate training in smaller numbers and, are less likely to remain than at any time since the 1970’s.ConclusionsThis four decade retrospective found considerable variation in the migration pattern of CMGs to the US. CMGs’ decision to emigrate to the U.S. may be influenced by both ‘push’ and ‘pull’ factors. The relative strength of these factors changed and by 2004, more CMGs were returning from abroad than were leaving and the current outflow is negligible. This study supports the need for medical human resource planning to assume a long-term view taking into account national and international trends to avoid the rapid changes that were observed. These results are of importance to medical resource planning.

Trends in Matching to Urology Residency in Canada: Are We Becoming Noncompetitive?

Urology is perceived as a competitive specialty choice. Declining undergraduate exposure and the preference for "lifestyle specialties" may jeopardize urology's popularity. Our objective was to assess trends in application and matching rates to urology compared with other surgical specialties. We reviewed data collected by Canadian Residency Matching Service (CaRMS) and the Canadian Post-MD Education Registry since expansion in Canadian medical school enrollment began (2002-2011). The following were examined: applicant preference, number of positions, gender patterns, and match results. "Surgery" included general surgery, orthopedics, plastics, ENT, and urology. From 2002 to 2011 CaRMS applicants increased from 1117 to 2528 (126%). The number of applicants selecting surgery first increased from 178 to 338(90%). The number of surgery positions increased from 138 to 275 (100%). Urology positions increased from 15 to 31 (113%). Applicants to urology increased only 40% (30-42). The proportion of all CARMs applicants selecting urology as their first choice decreased from 2.7% (30) to 1.7% (42). The ratio of first choice urology applicants to positions decreased from 2 to 1.35. The probability of matching urology as first choice increased from 50% to 76%. Female medical graduates increased from 51% to 58%. The female applicants selecting surgery first increased from 21% (49) to 41% (173). In contrast, females selecting urology first rose from 13% (4) to 17% (7). Urology in Canada is becoming less competitive. Residency positions have doubled since 2002 whereas the number of applicants remains static. This trend was not reflected in other surgical specialities. Factors accounting for this may include poor undergraduate exposure, demand for specialties with controllable lifestyles, gender shifts in undergraduate medicine, and lack of role models. The need for undergraduate exposure to urology and vetting numbers of residency positions remains a matter of paramount importance.

Stability of Medical Student Career Interest

To examine the stability and switching patterns of student career interests over the course of medical school. From 2001 through 2004, during the first two weeks of classes, a survey on career interest was distributed to first-year students in 15 classes at eight Canadian medical schools. Students indicated interest in eight broad career paths (emergency medicine, family medicine, internal medicine, obstetrics-gynecology, pediatrics, psychiatry, surgery, and "other") and ranked their top three. Following these students' residency match three to four years later, student residency career choice was linked to their career interest at medical school entry. For students whose career interests switched be-tween medical school entry and exit, switching patterns were examined in terms of careers' matching difficulty scores (MDSs). Of 1,941 eligible students, 1,542 contributed to the final analysis. Family medicine, internal medicine, and surgery had the greatest student interest at both the beginning and end of medical school. Family medicine, surgery, obstetrics-gynecology, psychiatry, and "other" careers showed a net gain of student interest during medical school with the remaining careers showing a loss of interest. The most stable careers were family medicine, surgery, and internal medicine. The least stable were pediatrics and obstetrics-gynecology. Students tended to switch between careers with similar MDSs. Student career choice is relatively stable with a number of careers showing approximately 50% of stability from the entrance to the exit of medical school. Students tend to switch to careers with similar MDS, but some specific switching patterns exist.

2009 Canadian Radiation Oncology Resident Survey

Statistics from the Canadian post-MD education registry show that numbers of Canadian radiation oncology (RO) trainees have risen from 62 in 1999 to approximately 150 per year between 2003 and 2009, contributing to the current perceived downturn in employment opportunities for radiation oncologists in Canada. When last surveyed in 2003, Canadian RO residents identified job availability as their main concern. Our objective was to survey current Canadian RO residents on their training and career plans. Trainees from the 13 Canadian residency programs using the national matching service were sought. Potential respondents were identified through individual program directors or chief resident and were e-mailed a secure link to an online survey. Descriptive statistics were used to report responses. The eligible response rate was 53% (83/156). Similar to the 2003 survey, respondents generally expressed high satisfaction with their programs and specialty. The most frequently expressed perceived weakness in their training differed from 2003, with 46.5% of current respondents feeling unprepared to enter the job market. 72% plan on pursuing a postresidency fellowship. Most respondents intend to practice in Canada. Fewer than 20% of respondents believe that there is a strong demand for radiation oncologists in Canada. Respondents to the current survey expressed significant satisfaction with their career choice and training program. However, differences exist compared with the 2003 survey, including the current perceived lack of demand for radiation oncologists in Canada.

Chance and the Prepared Mind — Attracting Trainees into Rheumatology

> In the fields of observation, chance favors only the prepared mind. > > — Louis Pasteur, University of Lille, December 7, 1854 What is the influence of a chance encounter in a training program? As the Rheumatology community grapples with the average age of practitioners in the mid-50s and a flat rate of already low recruitment of rheumatology trainees (RT) from internal medicine (IM) training programs, does type and timing of exposure to rheumatology have a predictive value? In an intriguing article in this issue of The Journal 1, Drs. Katz and Yacyshyn have data-mined the Canadian Post-MD Education Registry (CAPER) (which enables anonymous tracking of RT based on their IM residency training site), and examined the relationship of mere availability of a rheumatology rotation in each postgraduate year to the number of eventual RT generated. Curriculum information was obtained from the Canadian Residency Matching Service over a 3-year period; because programs were under major review during this period, no changes were likely to be implemented, assuring homogeneous atomic data. Using advanced logistic regression techniques, Katz and Yacyshyn assigned the availability of a rheumatology elective a numeric value from 0 (no chance of completing a rotation over a given month) to 1 (mandatory completion). They address program restrictions in selectivity (a choice between rheumatology and another rotation would be 0.5), and accordingly, if rheumatology were one choice among 10 rotations, the score would be 0.1. While statistical purists might argue the validity of this construct, it is an attempt to quantify existing data, as the number of rheumatology electives would not be considered a normally distributed value across IM training sites and in each postgraduate year, due to local variations in curriculum, full-time faculty equivalents, or participating community rheumatologists, as they ably demonstrate in their Table 1. There was a positive relationship (Figure 1) between postgraduate year 1 rheumatology opportunities … Address correspondence to Dr. McCarty. E-mail: gmccarty{at}mainehospital.org

Canadian anaesthesia physician resource planning — is it possible?

This study was undertaken with the objective of assessing current sources of information for anaesthesia Physician Resource Planning (PRP). Four major data bases, the annual reports of Health and Welfare Canada (H&W), the education statistics from the Canadian Post-M.D. Education Registry (CAPER), the Royal College of Physicians and Surgeons of Canada (RCPSC) and the Physician Resource Data System of the Canadian Medical Association (PRDS), were examined for the period 1982 to 1991. The ratio of the number of surgical (S) to anaesthesia (A) clinicians decreased over this period despite an increase in the S:A ratios for trainees and certificants. The number of female anaesthetists has progressively increased. A steady decline in the number of rural anaesthetists has occurred. Age distribution of active certified anaesthetists revealed marked inter-regional differences. Little change was noted in the total mean hours worked per week. Each database provided valuable, but limited, data. The PRDS data is useful in assessing trends (age, sex and practice activity). Information provided by H&W tends to underestimate anaesthesia resource information by at least 10%. While information obtained from RCPSC and CAPER is accurate, the current mode of presentation of data limits their usefulness. Integrating data from all the databases appears to provide a meaningful assessment for PRP rather than assessing each database in isolation. Interpretation of the information and its value must take into account the limitations of the data being provided. Assessing present and planning future needs based on the current information structure will prove extremely difficult.