What are specialists doing?
CMAJ 1997;157:852
© 1997 Canadian Medical Association
In 1995 the Royal College of Physicians and Surgeons of Canada conducted a survey of all certified specialists. With 19 924 active respondents, the survey achieved a response rate of 76.3%.
It asked physicians to list areas or other disciplines in which they practised that were outside their certified specialty. The list of 400 interests that physicians submitted was collapsed to 64 categories such as pain management, chronic care and child psychiatry. Just over 19% of specialists indicated that they spent 50% or more of their time in disciplines other than their certified specialty. Most of these activities involved further subspecialization within the certified field; this was especially prevalent in the areas such as general internal medicine and general pediatrics.
Almost 50% of general internal medicine respondents reported spending more than half their time in other disciplines. Of those general internists, 86.4% were involved in different aspects of subspecialized internal medicine such as cardiology, endocrinology, rheumatology and respiratory medicine. The remaining 13.6% spend most of their time providing care either outside the field of internal medicine or in disciplines that are not certified by the Royal College, such as critical/intensive care or AIDS/HIV care.
Of the physicians who possessed certification in an internal medicine subspecialty, only 8% reported spending 50% or more of their time either in areas outside their subspecialty or in a "super" subspecialty such as neuro/electrophysiology (EEG). Less than 1% of respondents reported spending 50% or more of their time providing primary care.
| Selected certified specialties |
Proportion of specialists reporting they spend 50% or more of their time in other disciplines |
| General internal medicine |
49.5% |
| General pediatrics |
30.9% |
| Psychiatry | 13.5% |
| General surgery | 13.1% |
| Obstetrics,gynecology | 13.1% |
| Orthopedic surgery | 8.6% |
| Otolaryngology | 8.5% |
| Plastic surgery | 8.4% |
This column was written by Lynda Buske, chief, physician resources information planning, CMA. Readers may send potential research topics to Patrick Sullivan (sullip@cma.ca; 800 663-7336, x2126; fax 613 523-0937).
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