The shortage of laboratory medicine specialists is becoming so severe Canadians will soon witness delays in the diagnosis of cancer and other diseases, the Canadian Association of Pathologists (CAP) warns.
Dr. Murray Treloar, a general pathologist from Oshawa, Ont., who chairs CAP's Professional Affairs Committee, says the number of laboratory medicine specialists has declined by almost 10% in the past 10 years and job openings are at an all-time high. “The situation is very serious. Twenty-five percent of Canadian pathologists are going to retire in the next 10 years, and delays in treatment and cancer diagnosis are on the horizon.”
Laboratory medicine, which covers 6 specialties ranging from anatomical pathology to medical microbiology, employs 1089 full-time physicians today, down from 1203 in 1993. Treloar says that even though numbers have remained relatively steady for the past 5 years, “the discrepancy between the number of old and young [physicians] is obviously a very major problem, and it is unlike the population distribution in other specialties and family medicine. The situation is much worse than it was in 1993.”
Only 10% of today's laboratory medicine specialists are in the 30-to-39 age group, while the proportion in the pre-retirement category, 50 to 59 years, is approaching 35%. Laboratory medicine remains a distinctly unpopular career choice among Canada's medical students. Of the 1117 students who entered this year's residency match, not 1 made general pathology a first choice, while only 2 chose anatomical pathology.
The recruiting problem is already being reflected by the highest number of job vacancies in recent memory. In the second quarter of 2001, journals like CMAJ carried 31 ads for full-time laboratory physicians, compared with only 5 during the same period in 1997. “They keep advertising the same jobs, but they're not being filled,” Treloar says.
He described the situation in Thunder Bay, Ont., as a “revolving door,” and said that even the University Health Network in Toronto is having trouble finding anatomical pathologists. “That is unheard of,” says Treloar.
These issues are familiar to Dr. Ian White of Winnipeg, past president of the Canadian Anesthesiologists' Society. As late as 1998, 25% of residency slots in anesthesia were going unfilled. In 2002, only 1 of 61 positions went unfilled.
He said the society spent more than $100 000 looking into human resource and recruiting issues and discovered that anesthesia's most serious problem was its image. “We tended to be quite isolated from other physicians and we never communicated. We then took a specific direction and tried to get out more and meet medical students.”
He thinks laboratory medicine specialists have to take a hard look at the image they project. “Of the 70 to 80 students I've worked with over the past 10 years, only 1 indicated an interest in pathology. It's a very rapidly aging, male-dominated specialty at a time when 50% to 60% of new doctors are women — that's where the image problem comes in.”
Treloar says laboratory medicine needs “a concerted effort at the provincial and national level if we are going to turn this around.”
The same can be said for other specialties. Eleven of 49 positions in obstetrics/gynecology went unfilled in the first round of the 2002 residency match, and Dr. Donna Fedorkow, president of the Society of Obstetricians and Gynaecologists of Canada says Canada currently faces an annual shortfall of 45 ob/gyns.
And even though all 64 positions in pediatrics were filled in 2002, the Canadian Paediatric Society says 40% of practising pediatricians plan to retire by 2010 and not enough replacements are being trained. “A crisis is looming,” the society says. — Patrick Sullivan, CMAJ