Data on the Canadian GI workforce is necessary to ensure that human resources are sufficient to meet needs, to plan recruitment, to anticipate retirement, and to allow advocacy for a sufficient number of trainees to enter residency training. In order for information to be available year over year, a method needs to be developed to allow consistent capture of the data. A number of databases exist, but they measure different aspects of gastroenterology practice and produce differing numbers.
The purpose of this review is to explain the parameters which each database captures, to show the resultant estimates, and to suggest a method for annual capture of numbers without the need for the commission of customized Canadian GI reports.
Who is a Gastroenterologist?
The definition of a gastroenterologist is difficult, since many of the skills, and much of the knowledge, involved in the care of patients with digestive disease is not exclusive to GI specialists. This issue of definition results in a lack of agreement between the databases, which capture GI workforce numbers.
For example, the definition of a gastroenterologist as someone with internal medicine and subspecialty training in digestive disease who provides care for patients throughout the spectrum of cancer care and prevention, nutrition, liver disease, IBD and emergency care might be ideal but would exclude many leaders in the field.
In addition, gastroenterologists work in a variety of roles including clinical, administrative, research and educational. They may be full time, part time, active or retired; paid by fee for service or alternative funding; registered or not; formally certified in a specialty or not (1). The databases capture different aspects of this depending on what they were designed to do.
Available National Databases
The databases which track GI workforce and activities include:
- Canadian Post-M.D. Education Registry (CAPER),
- Canadian Institute of Health Research: National Physician Data Base (CIHI-NPDB),
- Canadian Institute of Health Research: Scott’s Medical Data Base (CIHI-SMDB),
- Canadian Medical Association (CMA) Masterfile,
- The Royal College of Physicians and Surgeons (RCPSC).
In addition, many provinces maintain their own datasets on GI numbers. These can usually be accessed through the provincial medical colleges. In this review, we have focused on national databases.
Canadian Post-M.D. Education Registry (CAPER)
CAPER is maintained by the Association of Faculties of Medicine of Canada and is mandated “to provide accurate information which may be used for physician resource planning on a national basis”. Operating since 1986, data is submitted annually on November 1st from each university postgraduate medical education office. The data is collected from a number of organizations and institutions, such as the Association of Faculties of Medicine of Canada, Resident Doctors of Canada, the CMA, the RCPSC, the Medical Council of Canada, as well as Health Canada, and the provincial and territorial ministries of health.
CAPER’s Annual Census report provides Canadian postgraduate training statistics, including first year trainees and estimated practice entry cohort. CAPER provides data which is likely very accurate since it comes directly from the universities, and the numbers are small. Hence, it is the preferred database for Canadian GI trainee information, but does not reflect the number of GI’s in practice.