Environmental Scan - Government of Nova Scotia

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Physician Resource PlanningAn Environmental ScanThe above analysis suggests latent major and minor surgical procedure capacity exists within the current NovaScotia surgical workforce. This observation is consistent with the earlier analysis on access to services where awide variation in the volume of surgical procedures per FTE was observed across the DHAs.24.2 LiteratureThe American Board of Surgery recently updated its ongoing record of surgical volumes per general surgeon.Findings for the period 2007 to 2009 found an average 533 surgical cases per full-time general surgeon (n of3,362 general surgeon detailed operative logs) 99 . This finding adds further support to the preceding Canadiannational analysis of CIHI data which found an average 490 cases per general surgeon FTE. The American Boardof Surgery further found surgical subspecialties performed 15-33% of all core general surgery procedures.Conversely; general surgeons performed 46% of all vascular, 16% of thoracic, 30% of pediatric, and 33% ofplastic surgery operations. Rural surgeons performed far more endoscopic and gynaecologic procedures andfewer abdominal, alimentary tract, and laparoscopic procedures than urban counterparts.Structural measures such as procedure volume provide an indirect measure of surgical quality. In some cases,procedure volume may provide an adequate proxy for outcome, as is seen with coronary-artery bypass graft,abdominal aortic aneurysm repair, coronary angioplasty, esophagectomy, and carotid endarterectomy (CEA) 100where mortality is reduced through increased volume per surgeon. For other procedures, the relationshipbetween procedure volume (either for the hospital or the surgeon) and outcome is much less clear 101 . Thefollowing figure (Birkmeyer, 2004) distinguishes between high/low caseload hospitals and high/low baselinerisk associated with the surgical procedure.Figure 181 High/low caseload hospitals and high/low baseline risk associated with the surgical procedure (Birkmeyer, 2004)99 Valentine, R.J., Jones, A., et.al., General Surgery Workloads and Practice Patterns in the United States, 2007-2009: A 10-Year Update from the American Board of Surgery.100 Birkmeyer JD, Finlayson EV, Birkmeyer CM, Volume standards for high-risk surgical procedures: potential benefits of theLeapfrog initiative, Surgery. 2001 Sep;130(3):415-22.101 Webb, A.L., Fink, A.S., Approaches to Assessing Surgical Quality of Care, Hospital Physician February 2008, 29-37.222 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
Physician Resource PlanningAn Environmental ScanIn Veteran’s Hospital U.S.A., the procedure and surgical specialty volume in eight 102 prevalent operations ofintermediate complexity are not associated with risk-adjusted 30-day mortality rate from these operations, orwith the risk-adjusted 30-day stroke rate from CEA 103 .24.3 Specialty SpecificFigure 182 Surgical FTEs 2009/10 – Nova Scotia (Source: MSI)24.3.1 AnaesthesiaCurrently, and in comparison to, Nova Scotia:• There are 109.4 Anaesthetist specialist FTEs or 1.0 FTE per 8,618 population in Nova Scotia. In NS it is109/264 or 0.41 per surgeon (inc. O&G) FTE.• Benchmark(s)• In southern Alberta in 2006 there was a ratio of 0.50 Anaesthetist FTE per surgeon (inc. O&G). Thesouthern Alberta ratio is consistent with the Ryten study for the Assoc. of Canadian UniversityDepartments of Anaesthesia.• A New Zealand study reported an average number of cases per FTE anaesthetist per year of 738.3with a range of 350-1500 104 . 236,000 total cases were performed with 320 anaesthetist FTE. In NSsurgeons performed 73,000 major and minor procedures in 2007/08 (Source: CIHI) which equatesto 667 cases per FTE anaesthetist.• A benchmark of 0.44 Anaesthetist FTE per surgeon (inc. O&G) FTE was applied to the Base Caseforecast in the Final Report.Engen, et.al. 105 , based on a national survey of hospitals, concluded that there is a substantial current andworsening future shortage of anesthesia providers in Canada. Their study did not extend beyond a simple102 i.e. Nonruptured abdominal aortic aneurysmectomy, vascular infrainguinal reconstruct, carotid endarterectomy (CEA),lung lobectomy/pneumonectomy, open and laparoscopic cholecystectomy, partial colectomy, & total hip arthroplasty103 Khuri, S.F., Stremple J.F., et. al., Relation of surgical volume to outcome in eight common operations: results from theVA National Surgical Quality Improvement Program, Ann Surg. 1999 Sep;230(3):414-29104 King, S.Y., Anaesthesia Medical Workforce in New Zealand, Anaesth Intensive Care 2006; 34: 261-265.105 Engen, D.A., Morrewood, G.H., Ghazar, N.J., et.al., A Demand-based assessment of the Canadian Anaesthesia workforce– 2002-2007, Can J Anesth 2005; 52:18-25223 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
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3 KEY OBSERVATIONS3.1 IntroductionP
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7 CONCEPTUAL MODELS7.1 Methodologie
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Figure 23 Population per Physician
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11 POPULATIONPhysician Resource Pla
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INCIDENCEPhysician Resource Plannin
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PHYSICIAN SERVICESPhysician Resourc
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12.5 Renal DiseasePhysician Resourc
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Environmental Scan - Government of Nova Scotia

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