Environmental Scan - Government of Nova Scotia

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Physician Resource PlanningAn Environmental Scancollaboration, teaching and research, health care management and continuing professional development(RCPSC, 2008).The following table provides comparisons between the current Divisional workforce and separate reports bythe Canadian Institute for Health Information (CIHI), Canadian Medical Association surveys, and independentUSA-based researchers.Figure 183 General Surgery – SurveyIndicator Nova Scotia Alberta Canada U.K. USA1. Median expectedretirement age2. Total # Hoursworked/wk/surgeon3. # Hours per weekper surgeon bycategory4. # Surgery hoursper week persurgeon5. Population perFTE10 hours/week (8.1blocks/mo@5hr/block) – 2 to7 inpatientcases/week,average of 3/week.65.0 (model) 62 (Royal CollegeSurgeons)65.0 11455 58 (CMA 2004) Budget of 50.0 62.0 115(SSO)38 - clinical12 -administration2 - research3 - teaching15 hours (5inpatient and3 ambulatorycases perweek)44 - clinical10 -administration2 - research2–teaching(CMA-2004)13.1 hours(OntarioOrthopedicSurvey 116 )17,487 25,533 17,542 (AllCanada, CIHI FFSplus AFP)34 - clinical6 – administration10 – teach,research,leadership12 hours direct inOR/week (3program units x 4hours) plus 3hours indirect.25,000 (targetU.K. 117 , includesvascular,transplant, &colorectal)17,289to23,502 118Three of the above indicators are noteworthy. In the first indicator, the use of age 65 for surgeons as theexpected retirement age is based on three sources of information: U.K. and U.S.A. survey data and discussionswith surgeons, indicating that they tend to work at or near full capacity up to retirement rather than graduallyslowing down. The American survey data reported only 19% worked part-time prior to retirement.The number of operating hours per week per surgeon (indicator #4) is a good indicator of access to OR whenviewed in context of wait times. Physicians in the American system average three more cases and four morehours per week in the operating room.114 Farley F.A., Kramer, J., Work Satisfaction and Retirement Plans of Orthopaedic Surgeons 50 Years of Age and Older,Sept. 07, Clinical General Surgery and Related Research.115 Kuerer, H.M., et.al, Career Satisfaction, Practice Patterns and Burnout among Surgical Oncologists: Report on theQuality of Life of Members of the Society of Surgical Oncology, Annals of Surgical Oncology 14(11):3043–3053116 University Research Network – in collaboration with Ont. Orthopedic Assoc, 2006 Survey of Orthopedic Surgeons inOntario, March 2007117 England RCPS, 2003118 Jonasson, O,, Kwakwa, F., and Sheldon, G.F., Calculating the workforce in general surgery, JAMA Vol. 274 No. 9,September 6, 1995226 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
Physician Resource PlanningAn Environmental ScanNova Scotia data analysis indicates a range from 6.2 to 13.3 five-hour blocks per month with CDHA average 6.8,equivalent to a range of 8 to 16 hours per week per full-time general surgeon.SpecializationIncreasing specialization has affected the GS workforce. In the USA, approximately 70% of graduating surgicalresidents pursue specialized surgery training, and this percentage may be increasing (119). Currently in Canada,70% of graduating residents pursue specialization."Today, medical students' chief concerns regarding selection of specialty are controllable lifestyle andintellectual challenge"; report Stockinger, et.al 120 . "General surgery in particular has been knocked for its"lacked breadth in expertise, limitations over stress, control over one's time, regularity of schedule, adequacyof leisure time, and income commensurate to workload. "Other specialties considered to have a "poor lifestyle"are also decreasing in popularity. Yet, despite this trend, most general surgeons say they would choose thissame specialty again".Specialization is a threat that further undermines the GS workforce. The preceding subsection figure hasadjusted the practice entry estimates for specialization within GS for vascular, paediatric, transplantation,surgical oncology, and thoracic surgery. The figure has not adjusted for GS fellowships that may furtherspecialization e.g., minimally invasive surgery and breast surgery 121. When surgeons complete fellowships, theynarrow the spectrum of services provided. Consequently, as the phenomenon of progressive specializationevolves, a larger surgical workforce will be needed to provide the breadth of services encompassed by theprimary components of general surgery.Figure 184 Specialty as a Percentage of Total Physician Workforce - USAStrategies to strengthen and sustain GSas a core specialty and as a career trackare required.The key physician workforce planningissues and strategies are:• Increase in OR capacityper surgeon could increase productivityper surgeon by up to 20%;• Minimally invasive androbotic surgical technology will have avery minimal impact going forward;• Change in gender ratiois ongoing but not pronounced;• Specialization hasundermined GS. Strategies tostrengthen GS as a core specialty andcareer track are needed.• No change in scope of practice within GS or between GS and other surgical specialties.119 Fischer, J.E., The Impending Disappearance of the General Surgeon, JAMA, November 14, 2007—Vol 298, No. 18120 Zsolt T., Stockinger, MD, Ellis, M.S., Residents and medical students in the 21st century: Better, Worse, or JustDifferent?, Bulletin of the American College of Surgeons, Nov-2004121 Stitzenberg, K.B., Sheldon, G.F., Progressive specialization within general surgery: adding to the complexity ofworkforce planning. J Am Coll Surg. 2005;201(6):925-932227 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
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INCIDENCEPhysician Resource Plannin
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Environmental Scan - Government of Nova Scotia

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