Canadian Association of Pathologists / Association canadienne des pathologistes

FEATURE

Laboratory Medicine Residency Training 2007–2008

Aaron Pollett, MD, FRCPC

Aaron Pollett, MD, FRCPC, is a member of the Professional Affairs Committee, Mount Sinai Hospital, Toronto, Ontario.

The Professional Affairs Committee of the Canadian Association of Pathologists performs a periodic survey of all Canadian laboratories to find the number and specialty of physicians in active practice. As part of this survey, residency program directors are also asked for details of physicians in training. The CAP manpower and resident database is voluntarily maintained and requires accurate responses to the surveys and request for information.

In the past 5 years the number of residency positions available through the Canadian Residency Matching Services (CaRMS) has increased from 37 in 2004 to 65 in 2009 (see Table 1 for a breakdown by discipline for position in 2009). At the same time, the number of laboratory medicine positions available for international medical graduates (IMGs) has increased from seven in 2004 to 15 in 2009. Not all available positions for laboratory medicine trainees are filled through the CaRMS match. In the past 5 years the percentage of positions filled from the primary match ranged from 59% in 2004 to 84% in 2007 (69% of the positions were filled in 2008 after the primary match). Table 2 shows the number of available and filled positions for the various areas of laboratory medicine since 2002.

Table 1. Number of Laboratory Medicine Specialty Positions (Allocated Quota) in the 2009 CaRMS

 CaRMS = Canadian Residency Matching Services; IMG = international medical graduate.           

 Table 2. Adjusted Allocated Positions (quota)/Accepted Positions for Canadian Graduates in Primary CaRMS Match, 2002–2008, for Laboratory Medicine Specialties

CaRMS = Canadian Residency Matching Services.

 If we assume that all positions filled through the primary CaRMS match stay within the program, and that all accepted IMGs are in the program for 5 years, the number of laboratory medicine trainees estimated in 2008 was 222. This is close to the 240 residents currently listed in the CAP manpower database. There has been an approximate year-over-year growth of 29% in 2007 and 12% in 2008 and a 70% increase in the number of laboratory medicine residents compared to 5 years ago (140 pathology residents were in the CAP database in 2003).

Table 3 shows the breakdown of current pathology residents by discipline and training level (PGY year). Of the 240 residents in the database, 87 (36%) are indicated as having entered through the IMG program. Approximately 63 residents are expected to be graduating from residency positions in July 2008.

Table 3. Number of Laboratory Medicine Residents Currently Being Trained in Canada, by Discipline and Program Year

There is rising concern that there will not be sufficient positions for the laboratory medicine residents when they complete their training. While the number of available positions with the residency programs has increased by 70% in the past 5 years, the number of full-time practicing laboratory medicine professionals has increased by approximately 5%. The majority of this increase in the workforce is the result of filling vacant positions. There have been very few new positions created for laboratory medicine professionals in the past 5 years. The majority of full-time practicing pathologists in Canada are now over 50 years of age, with an average age of 53.5. This has lead to the concern that there will be a shortage of pathologists within the next 5–10 years as the number of full-time laboratory medicine practitioners retire.  This retirement replacement need is very difficult to estimate. There is no mandatory age of retirement and approximately 12% of the current full-time pathology manpower is over the age of 60.

The incidence of cancer has increased by approximately 4% per year for the past 5 years. This increase is largely due to the growing and aging population within Canada. Screening programs and cancer wait-time improvement has become a focus of the provincial cancer care organizations. The rising incidence of cancer and other cancer care initiatives have increased the workload within pathology laboratories with essentially no increase in the pathology workforce. Alberta has been successful in the creation of several positions in the past few years, but this has been in response to a growing population and a system strained by large cutbacks which occurred in the 1990s. In Ontario, there have been less than five new positions in the past 5 years, despite large institutions demonstrating an increase in workload by 20–25%. Our training programs have been very successful in growing the laboratory medicine residency programs, and we are in a position to increase the pathology workforce in Canada with highly trained laboratory medicine professionals.  There is a need to increase the number of laboratory medicine positions across the country to handle the increasing workload and ensure that all Canadians have access to high-quality laboratory medicine.