Research ArticleArticle
Open Access
Encounters with Rheumatologists in a Publicly Funded Canadian Healthcare System: A Population-based Study
Jessica Widdifield, Sasha Bernatsky, Janet E. Pope, Vandana Ahluwalia, Claire E.H. Barber, Lihi Eder, Bindee Kuriya, Vicki Ling, J. Michael Paterson and J. Carter Thorne
The Journal of Rheumatology June 2019, jrheum.190034; DOI: https://doi.org/10.3899/jrheum.190034
Jessica Widdifield
From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women’s College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph’s Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada. This study was funded by an operating grant from the Canadian Initiative for Outcomes in Rheumatology Care, which played no role in the design or conduct of the study other than providing peer review of the study proposal. This study was supported by ICES (www.ices.on.ca), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed in the material are those of the authors and not necessarily those of CIHI, and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. SB holds a career award from the Fonds de la recherche en santé du Québec. J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph’s Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women’s College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre. Address correspondence to Dr. J. Widdifield, Holland Bone and Joint Research Program, Sunnybrook Research Institute, 2075 Bayview Avenue MG 352, Toronto, Ontario M4N 3M5, Canada. E-mail: jessica.widdifield@utoronto.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication June 7, 2019.
Sasha Bernatsky
From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women’s College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph’s Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada. This study was funded by an operating grant from the Canadian Initiative for Outcomes in Rheumatology Care, which played no role in the design or conduct of the study other than providing peer review of the study proposal. This study was supported by ICES (www.ices.on.ca), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed in the material are those of the authors and not necessarily those of CIHI, and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. SB holds a career award from the Fonds de la recherche en santé du Québec. J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph’s Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women’s College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre. Address correspondence to Dr. J. Widdifield, Holland Bone and Joint Research Program, Sunnybrook Research Institute, 2075 Bayview Avenue MG 352, Toronto, Ontario M4N 3M5, Canada. E-mail: jessica.widdifield@utoronto.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication June 7, 2019.
Janet E. Pope
From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women’s College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph’s Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada. This study was funded by an operating grant from the Canadian Initiative for Outcomes in Rheumatology Care, which played no role in the design or conduct of the study other than providing peer review of the study proposal. This study was supported by ICES (www.ices.on.ca), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed in the material are those of the authors and not necessarily those of CIHI, and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. SB holds a career award from the Fonds de la recherche en santé du Québec. J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph’s Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women’s College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre. Address correspondence to Dr. J. Widdifield, Holland Bone and Joint Research Program, Sunnybrook Research Institute, 2075 Bayview Avenue MG 352, Toronto, Ontario M4N 3M5, Canada. E-mail: jessica.widdifield@utoronto.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication June 7, 2019.
Vandana Ahluwalia
From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women’s College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph’s Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada. This study was funded by an operating grant from the Canadian Initiative for Outcomes in Rheumatology Care, which played no role in the design or conduct of the study other than providing peer review of the study proposal. This study was supported by ICES (www.ices.on.ca), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed in the material are those of the authors and not necessarily those of CIHI, and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. SB holds a career award from the Fonds de la recherche en santé du Québec. J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph’s Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women’s College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre. Address correspondence to Dr. J. Widdifield, Holland Bone and Joint Research Program, Sunnybrook Research Institute, 2075 Bayview Avenue MG 352, Toronto, Ontario M4N 3M5, Canada. E-mail: jessica.widdifield@utoronto.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication June 7, 2019.
Claire E.H. Barber
From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women’s College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph’s Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada. This study was funded by an operating grant from the Canadian Initiative for Outcomes in Rheumatology Care, which played no role in the design or conduct of the study other than providing peer review of the study proposal. This study was supported by ICES (www.ices.on.ca), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed in the material are those of the authors and not necessarily those of CIHI, and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. SB holds a career award from the Fonds de la recherche en santé du Québec. J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph’s Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women’s College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre. Address correspondence to Dr. J. Widdifield, Holland Bone and Joint Research Program, Sunnybrook Research Institute, 2075 Bayview Avenue MG 352, Toronto, Ontario M4N 3M5, Canada. E-mail: jessica.widdifield@utoronto.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication June 7, 2019.
Lihi Eder
From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women’s College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph’s Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada. This study was funded by an operating grant from the Canadian Initiative for Outcomes in Rheumatology Care, which played no role in the design or conduct of the study other than providing peer review of the study proposal. This study was supported by ICES (www.ices.on.ca), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed in the material are those of the authors and not necessarily those of CIHI, and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. SB holds a career award from the Fonds de la recherche en santé du Québec. J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph’s Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women’s College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre. Address correspondence to Dr. J. Widdifield, Holland Bone and Joint Research Program, Sunnybrook Research Institute, 2075 Bayview Avenue MG 352, Toronto, Ontario M4N 3M5, Canada. E-mail: jessica.widdifield@utoronto.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication June 7, 2019.
Bindee Kuriya
From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women’s College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph’s Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada. This study was funded by an operating grant from the Canadian Initiative for Outcomes in Rheumatology Care, which played no role in the design or conduct of the study other than providing peer review of the study proposal. This study was supported by ICES (www.ices.on.ca), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed in the material are those of the authors and not necessarily those of CIHI, and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. SB holds a career award from the Fonds de la recherche en santé du Québec. J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph’s Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women’s College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre. Address correspondence to Dr. J. Widdifield, Holland Bone and Joint Research Program, Sunnybrook Research Institute, 2075 Bayview Avenue MG 352, Toronto, Ontario M4N 3M5, Canada. E-mail: jessica.widdifield@utoronto.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication June 7, 2019.
Vicki Ling
From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women’s College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph’s Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada. This study was funded by an operating grant from the Canadian Initiative for Outcomes in Rheumatology Care, which played no role in the design or conduct of the study other than providing peer review of the study proposal. This study was supported by ICES (www.ices.on.ca), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed in the material are those of the authors and not necessarily those of CIHI, and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. SB holds a career award from the Fonds de la recherche en santé du Québec. J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph’s Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women’s College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre. Address correspondence to Dr. J. Widdifield, Holland Bone and Joint Research Program, Sunnybrook Research Institute, 2075 Bayview Avenue MG 352, Toronto, Ontario M4N 3M5, Canada. E-mail: jessica.widdifield@utoronto.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication June 7, 2019.
J. Michael Paterson
From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women’s College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph’s Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada. This study was funded by an operating grant from the Canadian Initiative for Outcomes in Rheumatology Care, which played no role in the design or conduct of the study other than providing peer review of the study proposal. This study was supported by ICES (www.ices.on.ca), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed in the material are those of the authors and not necessarily those of CIHI, and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. SB holds a career award from the Fonds de la recherche en santé du Québec. J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph’s Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women’s College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre. Address correspondence to Dr. J. Widdifield, Holland Bone and Joint Research Program, Sunnybrook Research Institute, 2075 Bayview Avenue MG 352, Toronto, Ontario M4N 3M5, Canada. E-mail: jessica.widdifield@utoronto.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication June 7, 2019.
J. Carter Thorne
From Sunnybrook Research Institute, Holland Bone and Joint Program; University of Toronto, Institute of Health Policy, Management and Evaluation; ICES; Arthritis Research Canada; Women’s College Research Institute; Sinai Health System, University of Toronto, Toronto, Ontario; McGill University, Department of Epidemiology; Research Institute of the McGill University Health Centre, Montreal, Quebec; William Osler Health System, Brampton, Ontario; The Cumming School of Medicine, University of Calgary, Calgary, Alberta; McMaster University, Department of Family Medicine, Hamilton; Western University, Schulich School of Medicine & Dentistry; St. Joseph’s Health Care London, London, Ontario; Southlake Regional Health Centre, Newmarket, Ontario, Canada. This study was funded by an operating grant from the Canadian Initiative for Outcomes in Rheumatology Care, which played no role in the design or conduct of the study other than providing peer review of the study proposal. This study was supported by ICES (www.ices.on.ca), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). Parts of this material are based on data and/or information compiled and provided by the Canadian Institute for Health Information (CIHI). However, the analyses, conclusions, opinions, and statements expressed in the material are those of the authors and not necessarily those of CIHI, and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. SB holds a career award from the Fonds de la recherche en santé du Québec. J. Widdifield, PhD, Sunnybrook Research Institute, Holland Bone and Joint Program, and University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES; S. Bernatsky, MD, FRCPC, PhD, McGill University, Department of Epidemiology, and Research Institute of the McGill University Health Centre; J.E. Pope, MD, FRCPC, MPH, Western University, Schulich School of Medicine & Dentistry, and St. Joseph’s Health Care London; V. Ahluwalia, MD, FRCPC, William Osler Health System; C.E. Barber, MD, FRCPC, PhD, The Cumming School of Medicine, University of Calgary, and Arthritis Research Canada; L. Eder, MD, PhD, University of Toronto, Institute of Health Policy, Management and Evaluation, and Women’s College Research Institute; B. Kuriya, MD, FRCPC, SM, Sinai Health System, University of Toronto; V. Ling, MSc, ICES; J.M. Paterson, MSc, University of Toronto, Institute of Health Policy, Management and Evaluation, and ICES, and McMaster University, Department of Family Medicine; J.C. Thorne, MD, FRCPC, Southlake Regional Health Centre. Address correspondence to Dr. J. Widdifield, Holland Bone and Joint Research Program, Sunnybrook Research Institute, 2075 Bayview Avenue MG 352, Toronto, Ontario M4N 3M5, Canada. E-mail: jessica.widdifield@utoronto.ca. Full Release Article. For details see Reprints and Permissions at jrheum.org. Accepted for publication June 7, 2019.
Abstract
Objective To quantify population-level and practice-level encounters with rheumatologists over time.
Methods We conducted a population-based study from 2000 to 2015 in Ontario, Canada, where all residents are covered by a single-payer healthcare system. Annual total number of unique patients seen by rheumatologists, the number of new patients seen, and total number of encounters with rheumatologists were identified.
Results From 2000 to 2015, the percentage of the population seen by rheumatologists was constant over time (2.7%). During this time, Ontario had a stable supply of rheumatologists (0.8 full-time equivalents/75,000). From 2000 to 2015, the number of annual rheumatology encounters increased from 561,452 to 786,061, but the adjusted encounter rates remained stable over time (at 62 encounters per 1000 population). New patient assessment rates declined over time from 10 new outpatient assessments per 1000 in 2000 to 6 per 1000 in 2015. The crude volume of new patients seen annually decreased and an increasing proportion of rheumatology encounters were with established patients. We observed a shift in patient case mix over time, with more assessments for systemic inflammatory conditions. Rheumatologists’ practice volumes, practice sizes, and the annual number of days providing clinical care decreased over time.
Conclusion Over a 15-year period, the annual percentage of the population seen by a rheumatologist remained constant and the volume of new patients decreased, while followup patient encounters increased. Patient encounters per rheumatologist decreased over time. Our findings provide novel information for rheumatology workforce planning. Factors affecting clinical activity warrant further research.
In this issue
The Journal of Rheumatology
Vol. 52, Issue 6
1 Jun 2025
Encounters with Rheumatologists in a Publicly Funded Canadian Healthcare System: A Population-based Study
Jessica Widdifield, Sasha Bernatsky, Janet E. Pope, Vandana Ahluwalia, Claire E.H. Barber, Lihi Eder, Bindee Kuriya, Vicki Ling, J. Michael Paterson, J. Carter Thorne
The Journal of Rheumatology Jun 2019, jrheum.190034; DOI: 10.3899/jrheum.190034
Encounters with Rheumatologists in a Publicly Funded Canadian Healthcare System: A Population-based Study
Jessica Widdifield, Sasha Bernatsky, Janet E. Pope, Vandana Ahluwalia, Claire E.H. Barber, Lihi Eder, Bindee Kuriya, Vicki Ling, J. Michael Paterson, J. Carter Thorne
The Journal of Rheumatology Jun 2019, jrheum.190034; DOI: 10.3899/jrheum.190034
