Environmental Scan - Government of Nova Scotia

More documents

Recommendations

Info

LEVEL 2Physician Resource PlanningAn Environmental ScanA Level 2 program is appropriate in some regions of the province where volumes do not support a Level 1thoracic centre. In these regions, a Level 2, or secondary care unit, may be established to serve the basicthoracic surgery needs of the population.A Level 2 program should have a minimum of 1 thoracic surgeon performing routine thoracic procedures. Aformal relationship with a Level 1 tertiary centre is needed to which the thoracic surgeon may refer complexthoracic cases. Level 1 program backup in the event of the Level 2 thoracic surgeons’ absence is required.OTHERHospitals not meeting Level 1 or 2 criteria should establish formal relationships with a Level 1 or Level 2 centreto facilitate consultation, appropriate management and referral of patients with thoracic malignancies.MINIMUM COMPETENCY REQUIREMENTSIn 2005 an expert panel in Ontario (the 'Ontario Study'), after extensive research and deliberation, definedcertain standards relevant to maintenance of competency 138 .Level 1 programs should have surgical volumes in the range of 20 esophagectomy cases per unit per year and150 anatomic pulmonary resections per unit per year. This minimum volume is sufficient to maintenance ofcompetency for three thoracic surgeons each performing a minimum of 60 complex lung and esophagealresections per year.Level 2 programs should have surgical volumes in the range of 7 esophagectomy cases per unit per year and 50anatomic pulmonary resections per unit per year. This volume is appropriate for one thoracic surgeon withbackup support from a Level 1 program.Further to the preceding Ontario study recommendations, the following figure 139 prepared by the CanadianAssociation of Thoracic Surgeons identifies the average number of surgical procedures and mean days waiting(and ranges), by type of centre, in Canada.Figure 196 Average number of surgical procedures and mean days waiting (and ranges), by type of centre, in Canada, 2003(Source: Canadian Assoc. Of Thoracic Surgeons)The annual volume of lung and esophageal resections per centre in Non-university (community centres)hospital-based programs, university hospital-based programs, and all settings, are 73, 195, and 147respectively.One of the two thoracic programs in Alberta averages 155 to 170 lung resections and 32 to 37 complexesophageal procedures per annum. The program serves a catchment area of 1.7 million residents with an138 Cancer Care Ontario, Evidence-based series on thoracic surgical oncology standards, Program in evidence-based care,September 9, 2005139 Darling, et.al, Can J Surg, Vol. 47, No. 6, December 2004238 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
Physician Resource PlanningAn Environmental Scanaverage of 425,000 population per surgeon. Each thoracic surgeon averages 47 to 52 lung and esophagealresections per annum, which is less than the Ontario study recommendation of 55 to 60 per annum. Theaverage workweek is forty-eight to fifty hours including time when called back to the hospital while on-call. Thefifty-hour workweek also includes administration and delivery of the thoracic surgeon residency program. Theprogram does not do lung transplantation and currently has excess clinical capacity to meet growth in clinicalneed. Alberta has a lower lung cancer incidence (55 ASR versus 63 ASR nationally) than the national average.Alberta recorded 1,530 actual new lung cancer cases (ASR 55 per 100,000) in 2004. Approximately one in fivenew cases required a lung resection as part of their treatment plan. Five-year survival rates in Alberta based on2001-2003 data was 13% compared to 15% nationally.The Ontario study made an extensive review of the peer-reviewed published literature and concluded that inevery citing, 30-day mortality was reported to be lower in higher volume centres when compared with thelower volume centres. That difference in 30-day mortality was reported to be statistically significant in 16 ofthe 27 comparisons.The General Assemblies of the European Association for Cardio-thoracic Surgery (EACTS) and the EuropeanSociety of Thoracic Surgeons (ESTS) Working Group 140 on Structures in Thoracic Surgery recommends onededicated thoracic surgeon equivalent per 150 major thoracic procedures per year. To achieve this volume asurgeon would require two blocked operating theatre days per week. From this ESTS recommendation one caninfer that the Ontario study recommendation of 60 complex lung and esophageal resections procedures persurgeon per year being a minimum requirement.Figure 197 National Survey Thoracic Surgery 2009Measure perSurgeon 1.0FTE1. #Hoursworked/ week(includes callbacktime)2. # Lung &esophagealresections/FTE3. # ComplexMajorprocedures/FTECanada Alberta Nova Scotia Ontario50.0 (ex. hours oncallbut includes callbackhours)65 47-52 55-60 (min. of 13oesophageal)79.0 77.0-82.0 75.0-80.04. Call Rotation 1 in 3 when not sharing callwith General Surgery.5. # OR daysper week6. Populationper FTE9.0 to 16.0 OR hours perweek and 2-3 endoscopyhr/week.Actual range is 1:150,000 to1:500,000. Recommended1 in 4 with GeneralSurgery and 1 in 3without GeneralSurgery10 OR hours perweek. Will also assistin 1 in 10 cases e.g.,esophagectomy.1:400,000 in Alberta(9 & 3.5m). Includes1:157,000 (6surgeons)1 in 3 or 1 in 4.1:300,000140 Klepetko, W., Torkel, H.J., Aberg, A., et. al., Structure of General Thoracic Surgery in Europe By The EACTS/ESTSWorking Group on Structures in Thoracic Surgery, Eur J Cardiothorac Surg 2001;20:663-668.239 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
Page 1 and 2:
Social Sector Metrics Inc. & Health
Page 4 and 5:
Physician Resource PlanningAn Envir
Page 6 and 7:
Page 8 and 9:
Page 10:
3 KEY OBSERVATIONS3.1 IntroductionP
Page 13 and 14:
KEY OBSERVATIONSPhysician Resource
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
4.4 ConsultantPhysician Resource Pl
Page 33 and 34:
4.8 Methodology Guiding PrinciplesP
Page 35 and 36:
ContextooPhysician Resource Plannin
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
7 CONCEPTUAL MODELS7.1 Methodologie
Page 45 and 46:
7.4 BenchmarkingPhysician Resource
Page 47 and 48:
Figure 23 Population per Physician
Page 49 and 50:
Page 51 and 52:
8 NATIONAL ENVIRONMENT8.1 Quality o
Page 53 and 54:
All communities in all LHAs:oo−
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
8.4.3 NationalPhysician Resource Pl
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
9.5 Canadians Studying AbroadPhysic
Page 81 and 82:
Figure 53 Net in/(out) migration by
Page 83 and 84:
9.7 Worked HoursPhysician Resource
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
11 POPULATIONPhysician Resource Pla
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
INCIDENCEPhysician Resource Plannin
Page 99 and 100:
PHYSICIAN SERVICESPhysician Resourc
Page 101 and 102:
12.5 Renal DiseasePhysician Resourc
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
−−Physician Resource PlanningAn
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
−−−−−−−Physician Reso
Page 151 and 152:
POPULATION NEEDPhysician Resource P
Page 153 and 154:
• Specific Disciplines−−−
Page 155 and 156:
Background DataPhysician Resource P
Page 157 and 158:
Key (selected) ChallengesooooooPhys
Page 159 and 160:
Page 161 and 162:
Background DataPhysician Resource P
Page 163 and 164:
Page 165 and 166:
• Social-economic−Physician Sup
Page 167 and 168:
−Physician Resource PlanningAn En
Page 169 and 170:
Page 171 and 172:
−−−−−−Physician Resourc
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
19.1.2 GenderPhysician Resource Pla
Page 179 and 180:
Page 181 and 182:
19.1.4 Language - FrenchPhysician R
Page 183 and 184:
Page 185 and 186:
Page 187 and 188: Physician Resource PlanningAn Envir
Page 189 and 190: 22 FAMILY MEDICINE22.1.1 NationalPh
Page 191 and 192: PRIMARY CARE NETWORK - COORDINATED
Page 197 and 198: 23 MEDICAL DISCIPLINES23.1 National
Page 207 and 208: • Benchmark(s):Physician Resource
Page 217 and 218: • Benchmark(s)Physician Resource
Page 219 and 220: 23.3.3 Paediatrics - PsychiatryPhys
Page 233 and 234: 24.3.9 Orthopaedic SurgeryCurrently
Page 237: Physician Resource PlanningAn Envir
Page 245 and 246: Residency ProgramsPhysician Resourc
Page 249 and 250: Medical BiochemistryPhysician Resou
Page 253 and 254: −Physician Resource PlanningAn En
Page 255 and 256: −−−Physician Resource Plannin
Page 259 and 260: −−−Physician Resource Plannin
Page 263 and 264: PHYSICIAN SUPPLY• Critical mass
Page 269 and 270: −Physician Resource PlanningAn En
Page 271 and 272: −−−−−Physician Resource P
Page 273 and 274: • Social-economic−−PHYSICIAN
Page 275 and 276: 26.5.3 OphthalmologyPhysician Resou
Page 289 and 290:
Page 291 and 292:
Page 293 and 294:
27.3.3 General - Not Cited - Papers
Page 295 and 296:
Page 297 and 298:
28 Interview 16-Aug Department ofHe
Page 299 and 300:
information18 Preliminarymeeting fo
Page 301 and 302:
20 Preliminarymeeting forinformatio
Page 303 and 304:
Page 305 and 306:
Page 307 and 308:
Page 309 and 310:
Page 311 and 312:
Page 313 and 314:
Page 315 and 316:
Page 317 and 318:
Page 319 and 320:
Page 321 and 322:
Page 323 and 324:
Page 325 and 326:
Page 327:
show all

Environmental Scan - Government of Nova Scotia

Create successful ePaper yourself

Delete template?

Save as template?