Specialty Profile

Paediatrics

GENERAL INFORMATION (Sources: Pathway Evaluation Program, the Canadian Medical Residency Guide, and the RCPSC) Paediatricians are specialists who focus on the physical, emotional and social health of neonates, infants, children, adolescents and young adults. This specialty deals with health promotion and prevention, and the detection and management of physical, behavioural, developmental, mental/emotional, environmental and social problems that affect children. The ability to communicate effectively with patients, families, teachers and social service professionals is key to providing effective paediatric care. Paediatricians work closely with a large network of physicians and other health care professionals. Paediatrics provides a fair degree of flexibility in the type of practice you can have. Some paediatricians are affiliated with community hospitals and have consulting general paediatric practices where patients are referred by other primary care physicians such as family physicians, emergency physicians or obstetricians. In many urban centres, consulting paediatricians are affiliated with tertiary care centres. Others choose a subspecialty (see below) and work in university-affiliated hospitals. There are an increasing number of recognized paediatric subspecialties. These provide an opportunity to combine clinical and basic scientific research with the delivery of highly specialized care. Areas of subspecialization in paediatrics include:

• adolescent medicine • paediatric allergy and immunology • paediatric cardiology • paediatric critical care medicine • developmental and behavioural paediatrics • paediatric endocrinology and metabolism • paediatric gastroenterology and nutrition • paediatric hematology and oncology • paediatric infectious disease • paediatric nephrology • paediatric neurology • neonatology (neonatal medicine) • paediatric respiratory medicine • paediatric rheumatology • paediatric emergency medicine • clinical pharmacology • child maltreatment • medical genetics

Upon completion of medical school, to become certified in paediatrics requires an additional 4 years of RCPSC-approved residency training. This training includes:

• 3 core years of approved residency in paediatrics, including management of hospitalized and ambulatory patients, appropriate experience in paediatric subspecialties and increasing responsibility, to include a senior supervisory year with responsibility for supervision of more junior trainees, with the resident reporting directly to a staff paediatrician. Must include in-house call in wards, NICU and PICU

• mandatory core rotations in: community/rural paediatrics; ambulatory/hospital-based out-patient paediatrics; in-patient ward/CTU paediatrics as a junior resident; in-patient ward/CTU paediatrics as a senior resident; developmental paediatrics; neonatal intensive care unit; paediatric intensive care unit; paediatric emergency medicine

• subspecialty selective rotations in at least 7 of the following 14 paediatric subspecialties: adolescent medicine; paediatric allergy/immunology; paediatric cardiology; child neglect/social paediatrics; child psychiatry; paediatric endocrinology; paediatric gastroenterology; paediatric genetics/metabolics; paediatric hematology/oncology; paediatric infectious diseases; paediatric nephrology; paediatric neurology; paediatric respirology; paediatric rheumatology

• other selective rotations where residents should have exposure to: research; anesthesia; dermatology; diagnostic imaging; surgery/surgical subspecialties; pathology; and other electives

• 1 year of RCPSC-approved residency that may be spent in: an additional year of general pediatrics; clinical or basic research in pediatrics; a special area of pediatrics in an accredited residency program OR 1 year in an approved course of study and training which may include a year of residency training in another RCPSC-approved program, and relevant to the objectives of pediatrics

For more detailed training requirements for paediatrics go to: http://rcpsc.medical.org/residency/certification/training/pediat_e.pdf There are currently 2,247 paediatricians practicing in Canada. Of these, 7% are under the age of 35, 52% are 35-54, and 39% are age 55 and older. Approximately half of practicing paediatricians are male (52%) and 48% are female. (Source: 2008 CMA Masterfile). DETAILED INFORMATION The remainder of the data contained in this specialty profile has been extracted from the 2007 National Physician Survey (NPS), unless otherwise stated. All percentages are for respondents only. A total of 782 paediatricians responded (for a response rate of 38%). Complete data tables for paediatrics from the 2007 NPS are available at: http://www.nationalphysiciansurvey.ca/nps/2007_Survey/Results/physician3.1_sp-e.asp For an index to all specialties, go to: http://www.nationalphysiciansurvey.ca/nps/2007_Survey/2007results-e.asp

Choosing paediatrics (2004 NPS Data) In 2004, 26% of paediatricians decided on this specialty as a career choice during their clerkship year (i.e., the last year of medical school), while 26% decided during their residency, 16% decided before medical school, 14% decided during medical school but prior to their clerkship. The most frequently cited reason for deciding to become a paediatricians is for the intellectual stimulation/challenge this specialty provides (81%). Also cited as factors were the quality of the doctor-patient relationship (72%), the influence of a mentor (33%), the availability of teaching opportunities (28%) and the workload flexibility/predictability (26%). From these factors, the quality of the doctor-patient relationship was identified as the single most important career decision-making (34%). Practice Setting Paediatricians work in more than one setting: for just over half (51%) the main work setting is a private office/clinic, while 51% also work in an academic health sciences centre and 32% are in a community hospital. Paediatricians see patients in a variety of settings, with their private office/clinic being the main patient care setting for just under half (42%), followed by an academic health sciences centre (33%). Liking the location was the major influence (57%) on a paediatricians’ selection their current practice location, but the availability of medical support system/resources (53%), the availability of a practice opportunity (49%) and the opportunity for affiliation with a university (44%) were also cited as important influences. Practice Profile Nearly half (45%) of paediatricians work in a group practice where on-call duties, equipment, office space and/or staff are shared amongst the physicians, while 28% say they are in an interprofessional practice setting where physicians and other health professionals have their own caseloads and 27% are in a solo practice setting. In their main patient care setting, 70% of paediatricians share patient care with many other types of health care providers, including:

• pharmacists (72%) • social workers (71%) • family physicians (71%) • physiotherapists (66%) • occupational therapists (65%) • dieticians/nutritionists (64%)

Nearly all paediatricians (94%) feel that this collaboration improves the care that their patients receive and 95% feel it enhances the care that they can deliver. During a typical week, a paediatrician will see approximately 79 patients. The majority of paediatricians (63%) serve mainly an urban/suburban population.

Paediatricians work an average of 53 hours per week on professional activities (excluding on-call). The majority of this time (31 hours per week) is devoted to direct patient care, with or without a teaching component. An additional 6 hours per week is spent on indirect patient care, such as making appointments with specialists, charting, meeting a patient’s family, etc. The remainder of the time is spent on CME/CPD, administration and/or teaching. A large number (68%) of total paediatricians’ make themselves available to their patients (i.e., on-call) outside of their regularly scheduled hours. The majority (82%) is on-call for hospital in-patients, 44% are on-call for non-hospitalized patients either by telephone or by seeing patients as required and 42% do emergency room on-call. Of those who do on-call, the majority (55%) tend to spend up to 120 hours per month on-call, 21% put in between 121 and 180 hours per month and 18% spend more than 180 hours per month on-call. On average, a paediatrician is on-call 136 hours each month. During the time the paediatrician is on-call each month, they spend an average of 49 hours on direct patient care and see an average of 52 patients. Income Over a third (37%) of paediatricians receive 90+% of their income through a blended source (i.e., made up of a combination of 2 or more payment methods like fee-for-service, salary, capitation, sessional, contract, benefits/pensions, on-call remuneration or some other form), while almost an equal number (33%) receive 90+% from fee-for-service. When asked their preferred method of remuneration, over half (54%) would prefer some form of blended remuneration, while 17% preferred a salary only and 12% would prefer fee-for-service only. According to the Canadian Institute for Health Information’s Average Gross Fee-for-Service Payment Report 2005-2006, the average gross fee-for-service payment per paediatrician in 2005-06 was $195,598. Note that this is gross billings and does not take into account deductions for overhead expenses, taxes, etc. To protect their income, physicians take out medical liability coverage in the event that a patient is harmed in a medical misadventure. According to the Canadian Medical Protective Association’s Fee Schedule for 2009, the annual cost for insurance for a paediatrician is:

Quebec Ontario Rest of Canada $ 4,029 $ 4,884 $ 1,968

Satisfaction Most paediatricians (79%) report that they are very or somewhat satisfied with their current professional life. Nearly all (89%) are very or somewhat satisfied with their relationship with their patients, with their relationship with other specialist physicians (82%), but only 69% are very or somewhat satisfied with their relationship with family physicians.

Paediatricians are less likely to be very or somewhat satisfied with finding a balance between personal and professional commitments (58%). They are much also less satisfied with their net revenue per hour compared to other paediatricians (48% are somewhat or very satisfied) and with their net revenue per hour compared with other specialties (50% are very or somewhat dissatisfied). ADDITIONAL INFORMATION Additional information on paediatrics can be found from the: Canadian Paediatric Society at: http://www.cps.ca/