Dr. Henry Averns didn’t want to make his patients wait any longer. So he quit his job.
Friday is the Kingston, Ont., rheumatologist’s last day as an associate professor in the school of medicine at Queen’s University.
On Monday, he will open the doors to a new clinic where he can devote himself full-time to a deluge of mostly baby boomers afflicted with rheumatoid arthritis, some of whom have been trying to score an appointment with the specialist for three years.
“I felt embarrassed and dissatisfied by the length of my waiting time and the difficulty in seeing both new and review patients,” Dr. Averns said. “It just makes you feel bad if you say to a patient, ‘I’ll see you again in two months,’ but you don’t see them for six months.”
Dr. Averns’s dilemma is not uncommon in Ontario, where demand for rheumatologists wildly outstrips supply. A new study from the Institute for Clinical Evaluative Sciences found the number of rheumatoid arthritis patients in the province more than doubled from roughly 43,000 in 1996 to more than 97,000 in 2010, while the number of rheumatologists did not increase at all.
That mismatch extends across the country, according to the Canadian Rheumatology Association. The shortage is especially severe in rural areas – Prince Edward Island has no rheumatologists, Manitoba has none outside Winnipeg – and leaders in the field are warning that the problem will get worse as the population ages.
“What we’re faced with is an onslaught of patients with this disease with very few physicians that have the training and the ability to treat them properly,” said Dr. Claire Bombardier, director of the division of rheumatology at the University of Toronto and senior author of the new paper, published Friday in the Canadian Journal of Public Health.
Long waits to see a rheumatologist are especially troubling because rheumatoid arthritis, an autoimmune disease that causes a crippling inflammation of the joints, can now be successfully treated if caught early, ideally within a few months of the onset of symptoms such as sore, swollen knuckles.
That is a sea change from 20 years ago when doctors had little to offer rheumatoid arthritis sufferers beyond painkillers.
Today, rheumatologists treat their patients with disease-modifying drugs – including methotrexate and an array of biologic medicines – which can actually put the disorder in remission.
When Dr. Bombardier was in training more than 30 years ago, rheumatoid arthritis was “a disease of people that were in hospital in wheelchairs with crooked hands,” she said. “Now, most of our patients are walking in the street and working, with the appropriate drugs. That’s why getting early treatment, early diagnosis, is so important.”
Dr. Averns, the Kingston rheumatologist, has seen first-hand what happens when the disease is not caught in time. He spends about 15 days a year in Northern Ontario, flying into Moose Factory and other remote communities on James Bay to tend to aboriginal people afflicted with the puffy, twisted hands and feet of untreated rheumatoid arthritis.
“It’s horrific,” he said. “It’s not uncommon to see patients with widespread joint destruction who haven’t had access to conventional treatment for years. It’s almost the norm.”
Aboriginal people are believed to have a genetic predisposition to rheumatoid arthritis, which helps to explain why the new study found the disease is more prevalent in rural Northern Ontario than in southern cities.
Yet specialists are not moving to where the need is greatest: There are more then five rheumatologists for every 100,000 people in Toronto, but fewer than one for every 100,000 in the province’s northeast, the study found.
Canada had 371 rheumatologists in 2013, a little more than one for every 100,000 Canadians, according to the Canadian Medical Association. Nearly half are over the age of 55.
Rheumatologists tend not to be as highly paid as some other specialists, and the field has had trouble recruiting in the past.
Although that is changing, Canada cannot possibly train enough rheumatologists to meet the looming need. The grey wave is too much of a tsunami.
The only option is a new model of treatment, one that relies on telemedicine and deeper collaboration with occupational therapists, pharmacists, nurses and family doctors, said Dr. Jane Purvis, a Peterborough, Ont., rheumatologist and president of the Ontario Rheumatology Association.
“We recognize that we have to change the model of care,” she said. “That’s a huge thing that’s happening across the country.”