Environmental Scan - Government of Nova Scotia

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Physician Resource PlanningAn Environmental ScanFigure 186 General Surgery – FTE and Case Volume, 2009/10 Nova Scotia by DHA (Source: PARNS)Figure 185 General Surgeon procedures per FTE by DHA & Hospital, 2009/1024.3.5 General Surgical OncologyIn Nova Scotia, General Surgical Oncology is included within General Surgery.The increasing complexity of the cancer problem has made imperative the multidisciplinary team approach tothe management of the cancer patient. Within this team belong general surgeons with special training, interestand expertise in oncology who also have the skills to be teachers and leaders in the field of cancer treatment(RCPSC, 2001).The scope of general surgical oncology generally includes:• Upper GI, Hepatobiliary, Endocrine, Colorectal, and Breast Surgical Oncology• Upper GI cancers i.e., upper digestive system - oesophagus, stomach and duodenum;• Hepatobiliary (liver, pancreas, and bile ducts) system cancer;• Endocrine (thyroid, parathyroid, pancreas, ovaries, testes, adrenal, pituitary and hypothalamus) systemcancer;• Colon (large bowel) and rectum cancer;• Breast cancer;• Bone reconstruction;• Gynaecological cancers e.g., cervix, ovarian, uterus;• Head & Neck Cancer (Surgical oncology of the nose, throat, sinuses, skull base, neck and adjacentstructures). Also includes major benign tumours (glomus, carotid body, etc);• Skin cancer (Surgical oncology – Dermatology);228 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
Physician Resource PlanningAn Environmental Scan• Reconstructive surgery (Surgical oncology – Plastic surgery, Otolaryngology – Head and Neck Surgery(H&N reconstruction).24.3.6 NeurosurgeryCurrently, and in comparison to, Nova Scotia:• There are 9.1 Neurosurgeon FTEs or 1.0 FTE per 103,224 population in Nova Scotia.• Benchmark(s)• The national average is 1.0 FTE per 130,455 population (Source: CIHI).• USA (NERVES) and United Kingdom (SBNS) information suggests mean surgical procedures peryear per FTE of 328 (see next figure for a detail breakdown of the 328 procedures by type) and215 respectively. Minor procedures e.g. ulnar nerve at elbow and carpal tunnel comprise 2.5% ofthe total.• Nova Scotia neurosurgeons perform an average 131 cases per FTE per annum with substantialvariation per surgeon.• A benchmark of 130,455 population per FTE was applied to the Base Case forecast in the FinalReport. The benchmark incorporates academic time and Atlantic province referral workload.Neurosurgical clinical outputs (not outcomes) are typically measured in terms of consultations, minor andmajor procedures, assisted and unassisted procedures, and case complexity/acuity. System constraints, e.g.,operating theatre time andFigure 187 USA - Procedures per Neurosurgeon FTE (source: USA NERVES)CPTCode#RespondMean #Proc.Work RVU/Proc RVUs22554 Neck spine fuse 291 41 19 76963030 Low back disk surgery 296 52 12 62522612 Lumbar spine fuse 228 25 21 52761793 Focus radiation beam 86 31 17 52663047 Removal of spinal lamina 289 34 15 50422630 Lumbar spine fuse 179 23 21 48061700 Brain aneurysm repr , simple 154 8 51 37961510 Remove brain lesion 272 11 28 30463042 Laminotomy, single lumbar 271 17 17 29261559 Excision of skull/sutures 23 5 33 16161512 Remove brain lining lesion 244 4 35 14963056 Decompress spinal cord 140 7 20 14263020 Neck spine disk surgery 199 10 15 14162223 Establish brain cavity shunt 250 9 13 11163012 Removal of spinal lamina 117 7 15 11061343 Incise skull (press relief) 172 3 30 9761548 Removal of pituitary gland 142 4 22 9663045 Removal of spinal lamina 226 6 17 9661583 Craniofacial approach, skull 48 2 36 8763200 Release of spinal cord 55 4 19 8161584 Orbitocranial approach/skull 48 2 35 7962230 Replace/revise brain shunt 197 6 11 6864721 Carpal tunnel surgery 189 12 4 5261600 Resect/excise cranial lesion 37 1 26 3964718 Revise ulnar nerve at elbow 145 3 6 17bed capacity, will affect electiveworkload and outputs.USA (NERVES) and UnitedKingdom (SBNS) informationsuggest mean surgical proceduresper year per FTE of 328 (see nextfigure for a detail breakdown ofthe 328 procedures by type) and215 respectively. Minorprocedures e.g. ulnar nerve atelbow and carpal tunnel comprise2.5% of the total.Nova Scotia neurosurgeonsperform 1,000-1,200 cases in totalper annum. Approximately 4%-7%were out-of-province patients.Approximately 45% of patientsarrived via the emergencydepartment (e.g. trauma orperhaps this is the more efficientpath for admission to hospital).Factors qualifying the preceding328 18 5,932workload analysis includeoperating theatre access for elective procedures e.g. chronic back pain, case-mix complexity e.g. carpal tunnel229 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
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Physician Resource PlanningAn Envir
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3 KEY OBSERVATIONS3.1 IntroductionP
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KEY OBSERVATIONSPhysician Resource
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7 CONCEPTUAL MODELS7.1 Methodologie
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7.4 BenchmarkingPhysician Resource
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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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information18 Preliminarymeeting fo
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Environmental Scan - Government of Nova Scotia

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