ACCESS TO ORTHOPAEDIC CARE IN ONTARIO: A CROSS-SECTIONAL ANALYSIS

To evaluate the demographic, geographic, and practice characteristics of active orthopaedic surgeons in Ontario, and to discuss how these factors may impact access to care among rural and urban populations. Using publicly available data from the College of Physicians and Surgeons of Ontario (CPSO) physician register, all active orthopaedic surgeons in Ontario as of October 2024 were included for review. The primary practice location as listed on the CPSO register was used to calculate a Rurality Index for Ontario (RIO) score, categorized as 0 (urban), 1–39 (suburban), and >39 (rural). The RIO score is determined by a community's population and density, travel time to the nearest basic referral center, and travel time to the nearest advanced referral center, with each factor contributing 28.6%, 47.6%, and 23.8% respectively to the overall score. Higher RIO scores are associated with remote and rural regions. Secondary characteristics collected for each orthopaedic surgeon included reported gender, spoken language(s), location of medical school training, and year of graduation from medical school. Physician characteristics were linked using unique, anonymized, encoded identifiers to ensure privacy and confidentiality. Of the 802 active orthopaedic surgeons listed on the CPSO register, 725 were included in the analysis, with 77 being excluded due to having either no practice location or practice locations outside of Ontario. Less than one percent (n = 7) of orthopaedic surgeons had their primary practice in rural locations (RIO >39), with 36.4% (n = 264) and 62.6% (n = 454) practicing in suburban (RIO 1–39) and urban (RIO 0) areas, respectively. In terms of gender distribution, only 11% (n = 77) of orthopaedic surgeons were female, and accounted for 14% (n = 1) of rural practices. Regarding medical school location, 76% (n = 549) of orthopaedic surgeons graduated from Canadian medical schools. The most common second languages were French (n = 110), Arabic (n = 27), and Hindi (n = 18). Compared to orthopaedic surgeons practicing in rural areas, who had a mean of 31.28 years since graduation, those in urban and suburban areas had slightly fewer years of experience, at 24.4 and 24.7 years since graduation, respectively. Geographic disparities in the distribution of orthopaedic surgeons across Ontario remain a significant challenge, with most surgeons practicing in urban and suburban areas. Rural and remote communities are disproportionately affected by these disparities, as evidenced by longer travel distances for office visits and increased wait times compared to those in urban areas. Multi-stakeholder approaches to improving access, such as increasing funding for rural practices, incorporating telemedicine and electronic consultations, and expanding healthcare infrastructure, could provide potential solutions for prioritizing and optimizing orthopaedic care for those in historically underserved regions.