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Critical Shortage of Orthopaedic Services in Ontario, Canada

Investigation performed at the Toronto Western Hospital Research Institute, Toronto, Ontario, Canada

Deborah Shipton, PhD
Elizabeth M. Badley, PhD
Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, 399 Bathurst Street, MP, 10-316, Toronto, ON M5T 2S8, Canada

Nizar N. Mahomed, MD
Division of Orthopaedics, University Health Network, Toronto Western Hospital, EC 1-002, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada. E-mail address: nizar.mahomed{at}uhn.on.ca

In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Ontario Ministry of Health and Long-Term Care and the Arthritis Society. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: Questions regarding the adequacy of the current orthopaedic workforce in Canada to meet the present and future demands for orthopaedic services raise the need for accurate estimates of the supply and demand for orthopaedic services. The present study provides estimates of current supply of orthopaedic services in Ontario, the largest province of Canada, in order to allow for direct comparisons with data on workforce requirements.

Methods: All identified orthopaedic surgeons in Ontario were sent a self-administered questionnaire in 2000, which was similar to a previous survey in 1997. The age and gender of eligible respondents were obtained from the College of Physicians and Surgeons of Ontario. One full-time-equivalent orthopaedist was assumed to have 2200 annual hours of direct patient contact and to provide forty-four weeks of clinical work per year.

Results: The response rate was 94%. The mean age of the 337 active orthopaedic surgeons was forty-nine years, an increase of four years since 1997. Six percent of the respondents were women in both survey years. Approximately twenty-three half days of office and surgery time per 100,000 population were reported, which represents approximately two full-time equivalent orthopaedic surgeons per 100,000 population. On the average, eight half days of combined office and surgery time were reported per surgeon per week.

Conclusions: The estimated supply of orthopaedic surgeons in Ontario (two full-time equivalents per 100,000 population) falls short of the recently calculated requirement in the United States (5.6 full-time equivalents per 100,000 population). These data suggest that there is currently a shortage of orthopaedic services in Ontario, which will be exacerbated by the aging of a profession already working near full capacity.

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