Background/Purpose Advocacy for pediatric rheumatology care for Mid-Canadian (MC) provinces (Alberta, Manitoba, Northwest Territories, Nunavut and Saskatchewan) represents a challenge. Although these provinces comprise a large geographic area (>52% of Canada), patient characteristics and pediatric rheumatology workforce are not known.

Our objective was to collect and report data for pediatric population, number of pediatric rheumatologists, patient diagnoses, wait times, allied health support and pediatric rheumatologists’ work-life balance in MC provinces.

Methods Canadian 2012 Statistical data was used to identify population between 0-14 years (Defined as “children” by Statistics Canada) in MC provinces. A survey monkey was sent to each MC pediatric rheumatology center to identify 1) the number of pediatric rheumatology full time equivalents (FTEs) per province for clinical care, education, research and administration; 2) Distribution of pediatric rheumatology diagnoses and wait times, and 3) perceived work-life balance of participants. 

Results

All 3 currently active pediatric rheumatology centers in MC provinces responded (2 in Alberta and 1 in Saskatchewan). Total pediatric MC population aged 0-14 years  (% of all Canadian) was 1.1 million (21.4%). There were a total of 7.7 FTE pediatric rheumatologists: 5.7 in Alberta (0.7 at one center, 5 at the other), 2 in Saskatchewan and 0 in Manitoba, Nunavut and Northwest Territories. Out of 7.7 FTEs, 4.74 were devoted to for clinical care, 1.08 for education, 3.58 for research and 0.8 for administration. Night–time on-call service frequency varied from “not mandatory” to 1:5. Allied health support was variable: nursing, physiotherapy and occupational therapy were available at 2/3 centers, 1/3 center had a social worker and a pharmacist, and 0/3 center had a psychologist. Individual outpatient data was available for Alberta and Saskatchewan and included 1225 active outpatients. The most common diagnoses (% total) were juvenile idiopathic arthritis (65-82%), systemic lupus erythematosus (4-6%), autoinflammatory disorders (3-7%) and vasculitis (2-4%). Wait time data was available for Saskatchewan and Alberta and ranged from 1 to 8 weeks for patients classified as “urgent” and from 2 weeks to 6 months for “semi-urgent”.  One center was not able see routine patients. Regarding wellness, 30% of responders reported their work and personal lives were “well balanced”, 50% ”struggled occasionally”, 40% reported adverse impact on personal life and non-clinical work activities, and 60% reported their family/friends had commented on their “stress levels”.

Conclusion

The MC provinces provide a unique challenge for provision of pediatric rheumatology care due to the vast geographic area and high proportion of children and low numbers of pediatric rheumatologists. Currently 3 out of 5 provinces are without a pediatric rheumatologist. The small number of rheumatologists per individual center resulted in unequal wait-times, and had an adverse impact on physician wellness. Our results underline a need for a network/collaboration to help address pediatric rheumatology care in these provinces.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/advocating-for-pediatric-rheumatology-care-in-the-mid-canadian-provinces-large-geographic-area-large-pediatric-population-low-number-of-pediatric-rheumatologists-and-allied-health-workers-identifie/