Perceptions and Impact of the 2017 Canadian Guideline for Opioid Therapy and Chronic Noncancer Pain: A Cross-Sectional Study of Canadian Physicians.

Background: Physician adherence to guideline recommendations for the use of opioids to manage chronic pain is often limited. Objective: In February 2018, we administered a 28-item online survey to explore perceptions of the 2017 Canadian guideline for opioid therapy and chronic noncancer pain and if physicians had altered practices in response to recommendations. Results: We invited 34,322 Canadian physicians to complete our survey, and 1,128 responded for a response rate of 3%; 687 respondents indicated they prescribed opioids for noncancer pain and answered survey questions about the guideline and their practice. Almost all were aware of the guideline, 94% had read the document, and 89% endorsed the clarity as good or excellent. The majority (86%) felt the guideline was feasible to implement, but 66% highlighted resistance by patients, and 63% the lack of access to effective nonopioid treatment as barriers. Thirty-six percent of respondents mistakenly believed the guideline recommended mandatory tapering for patients using high-dose opioid therapy (≥90 mg morphine equivalent per day), and 58% felt they would benefit from support for opioid tapering. Seventy percent of respondents had changed practices to align with guideline recommendations, with 51% engaging some high-dose patients in opioid tapering and 43% reducing the number of new opioid starts. Conclusion: There was high awareness of the 2017 Canadian opioid guideline among respondents, and preliminary evidence that recommendations have changed practice to better align with the evidence. Ongoing education is required to avoid the misunderstanding that opioid tapering is mandatory, and research to identify effective strategies to manage chronic noncancer pain is urgently needed.

Assessing the prospects for physician supply and demand in Canada: Wishing it was rocket science.

"It's not rocket science" is an often used phrase to describe tasks that are not very difficult. Although rocketry has proven to be an exacting science with highly predictable results, the same cannot be said for physician workforce planning in Canada. The "boom" in physician supply in the 1960s and 1970s was followed by a "bust" in the early 1990s and a further boom in the 2000s. A large generational shift in the physician population is anticipated between now and 2030; the proportion of "boomers" (1946-1964) will drop from 43% to 16% of the practising profession. Canada has not been alone in increasing physician supply. Any judgement as to whether too many or too few physicians are being trained must consider the drivers and mitigators of both supply and demand. Although there are current concerns about a shortage of practice opportunities for some specialties, the available data do not indicate a physician surplus on the horizon in Canada.

Report of the Canadian Neurological Society Manpower Survey 2012.

BACKGROUND: The Canadian Neurological Society commissioned a manpower survey in 2012 to assess Canadian neurological manpower and resources. METHODS: Surveys were sent electronically to all Canadian neurologists with available email addresses. Responses were analysed for effects of physician gender, age, geographic location (eastern or western Canada) or type of practice (academic, community). Questions focused on work patterns, neurologic conditions treated, access to or performance of procedures, and service and manpower issues. RESULTS: A total of 694 of 854 neurologists in Canada were surveyed and 219 (32%) responded. Respondents were 70% male with mean age of 50 years. Neurologists worked an average of 57 hours/week and saw a mean of 40 patients per week. There were significant differences in number of patients seen, types of practice, and areas of neurological specialization between community and academic neurologists. Fifty percent of neurologists report shortages of neurologists in their community, particularly of general adult neurologists. Wait times for neurological services exceeded international standards for consultations and also were longer than Canadian averages for other specialists. More community (18%) than academic (5%) neurologists planned to retire within the next 5 years. CONCLUSIONS: The demand for neurological services continues to outstrip resources despite the increased number of neurologists. Impending retirement of community neurologists will exacerbate manpower issues unless adequate numbers of trainees choose general neurologic practice in the community as a career.

The results of the first Canadian national physician assistant survey.

The first Canadian physician assistant (PA) survey was done in 2010 and used to establish baseline information on Canadian PAs' educational background, practices, role, responsibility, and satisfaction with their careers.