By Kayla Hounsell
The University of Ottawa will increase its number of provincially funded residency training positions for dermatology from one to two, and Ottawa’s skin experts are hoping it will keep them from becoming an endangered species.
“That’s good news. It means a lot of the work I’ve done has paid off,” says Dr. Nordau Kanigsberg, an Ottawa dermatologist who conducted studies to prove the University of Ottawa – the only university for dermatologists in Eastern Ontario – needs exactly this increase.
Ottawa has a serious shortage of dermatologists, with wait lists of five to six months. The number of dermatologists in the city has decreased from 30 to 15 in the last 12 years.
Kanigsberg says his latest study, which was presented to Paul Bragg, assistant dean of the University of Ottawa’s post-graduate medical education faculty, showed that with only one spot for dermatology each year, the number of dermatologists in Ottawa would further decrease to 12 over the next 15 years, assuming only half of the trained dermatologists stay in Ottawa.
Kanigsberg says many students are “out-funded,” meaning they come from different provinces or different countries, and must return there to work. With two provincially funded spots per year, the number of dermatologists in Ottawa will stay at 15 or even increase to 18.
Bragg says this new position, which begins next July, comes because he found out in late September that the university will be expanding all of its post-graduate medical programs. The Ontario Ministry of Health will fund 188 post-graduate medical spots; 55 of which will be in Ottawa, allowing one for dermatology.
Kanigsberg says the problem in Ottawa is just an example of what will become a national problem. He says Ottawa has been hit before other areas of the country because until last year, the University of Ottawa didn’t have any spots for provincially funded dermatology students for more than 10 years.
Approximately 12 years ago the Ontario Ministry of Health and the universities decided there were too many physicians in Ottawa and made cuts which also affected dermatologists, says Dr. Kathleen Moses, president of the Ottawa Dermatological Society.
Kanigsberg says dermatologists recognized the problem, and with the help of private citizens and the National Capital Skin-Disease Foundation, funded one student using money out of their own pockets. Now students must be funded by the province through a residency training program.
Moses says the problem is that when the cuts were made, many of the dermatologists practicing at that time were approaching retirement.
Kanigsberg’s study shows that in 1999 the average age of dermatologists in Eastern Ontario was 51. Today it is 57.
“It’s a demographic time bomb,” he says. “We’re all going to start retiring and there’s nothing to follow us.”
A spokesperson for the Ontario Ministry of Health says the province started working on this problem in 2001, and the number of post-graduate spots in dermatology has increased by 33 per cent since.
But Kanigsberg says this came too late. “It’s fine to say they reacted then, but the fact is they were slow,” he says. “They’ve tried to micro-manage [this problem], to predict just what was needed, and the problem with that is that if you get it right, good, but if you get it wrong it’s a horror.”
Even with the University of Ottawa’s new residency position, Kanigsberg says he still worries it might be too late.
He says it will take at least five years for the new students to graduate and start practicing. In the meantime, Kanigsberg relents he doesn’t know what else can be done.
Some dermatologists have suggested there should be more dermatology training for family physicians so they can deal with more skin problems without making referrals. But that doesn’t seem to be a solution either.
“When I hear these comments I get the idea they come from people who think there are unnecessary referrals, but we do deal with 90 per cent of skin problems that come in here unless it’s patient-generated,” says Dr. David Montoya, a family physician at the Centretown Community Health Centre.
Montoya says that of the all the specialists he refers to, dermatology is more common than any other specialist. He says the physicians at the Centretown Community Health Centre have referred 200 patients to dermatologists in the past 12 months.
Questions and complaints posted on an Ottawa Google group within the past five years suggest patients are feeling the result. Several people requested names of dermatologists without wait-lists, others talked about waiting up to eight months, and still others warned that if you do get in, be prepared for a 10-minute visit.
But both Montoya and Kanigsberg insist the critical cases are being seen to.
“If a doctor calls me and says, ‘I have a melanoma,’ they get seen soon,” says Kanigsberg. “We react to life-threatening situations. So it means most of us are working a lot harder than we ever wanted to.”