Environmental Scan - Government of Nova Scotia

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7. ThoracicProgramrange is 1:300,000 to1:500,000. University-basedthoracic practices have anaverage of 2.4 FTE per centre(range 2–5).Should be at least 2, andideally 3, thoracic surgeonsper program.Physician Resource PlanningAn Environmental Scanmanaging a PGResident programand LungTransplantationProgram.4 per program and1:400,000population.[B.C. 1:345,000 or 13for 4.5m*,MB. 1:300,000 or 4for 1.2m*]PRACTICE PROFILEAn Association of American Medical Colleges study suggested that the average age of retirement forcardiothoracic surgeons is 61 years and that 60% of physicians fully retire from clinical practice by age 65. 141 In2008 in Canada there were 332 cardiothoracic surgeons practicing in Canada. Of these 2% are under the age of35, with the majority (57%) aged 35-54. Thirty-nine percent were aged 55 or older. An overwhelming 91% ofCVT surgeons are male and only 9% are female. (Source: 2008 CMA Master File).PREVALENCE AND INCIDENCEIn 2002 20,800 new cases of lung cancer were recorded nationally of whom 88% died. In 2008 23,900 newcases (ASR 59 per 100,000) were recorded of whom 85% died. Annual growth in volume of cases is 2.5%nationally.1. In males, rising incidence and mortality rates began to level off in the mid-1980s (97 per 100,000) andhave been declining ever since (70 per 100,000 in 2004). Rates have dropped significantly by 2.5% peryear since 1999 for incidence and by 2.1% per year for mortality over the period 1995-2004.2. In females, incidence and mortality rates have been increasing since at least 1979 (20 per 100,000), andcontinue to do so by 1.2% per year for both incidence and mortality (42 per 100,000).3. Males continue to have higher incidence and mortality rates than females (67 per 100,000 versus 51 per100,000 and 59 per 100,000 versus 40 per 100,000, respectively). These patterns reflect the drop intobacco consumption that began for males in the mid 1960's and much later – in about the mid-1980's –for females.4. Risk of lung cancer continues after smoking cessation.Surgery is a key component of treatment for patients diagnosed with tumors of the thoracic region (i.e., lungand esophageal cancers). For many patients diagnosed with lung or esophageal cancer, the prognosis is poor.In 2004, it is estimated that in Canada 21,700 patients will be newly diagnosed with lung cancer and 18,900deaths will occur in the same timeframe. The death-to new-cases ratio of 0.87 is one of the highest of all thecancer disease sites. While not as prevalent as lung cancer, esophageal cancer will cause an estimated 1,400new cases in 2004, and esophageal cancer has an even higher death-to-new-cases ratio than lung cancer at1.14. The incidence of lung cancer is expected to increase by approximately 8779 cases by 2014.RESIDENCY PROGRAMSResidency programs currently graduate 6 Thoracic Surgeons into practice per year. Medical school expansion isexpected to increase this to 8 per year by 2011.The current national workforce of 200 requires about 7 replacement surgeons per year at 3.5% rate ofreplacement. National population growth requires another 1 to 2 surgeons per year at 1 per 300,000 growth in141 Shemin, R., Dziuban, S., Kaiser, L., et.al., Thoracic surgery workforce: snapshot at the end of the twentieth century andImplications for the new millennium, Ann Thorac Surg, 2002;73:2014–32.240 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
Physician Resource PlanningAn Environmental Scanpopulation. Total annual requirements are therefore about 9 surgeons per year leaving a shortfall of 1 surgeonper year to be filled by foreign recruitment or further increase in residency positions. This assumes status quoon division of practice between interventional radiology, cardiac surgery, interventional cardiology, andthoracic surgery specialties.KEY OBSERVATIONS1. The complexity of major thoracic surgical procedures requires a minimum number of complex cases to (a)maintain competence, and (b) optimize patient outcomes i.e., 30-day mortality, etc.2. The primary driver of thoracic surgery workload is lung and oesophageal cancer. For these types of cancerNova Scotia has a slightly (3.4%) higher age standardized rate (ASR) than the national average.3. To maintain competence in complex thoracic procedures, the literature, including the Canadian Society ofThoracic Surgeons, recommends 300,000 to 500,000 people per surgeon.4. Call rotation should be the equivalent of 1 week in 3 or less frequent if shared with General Surgery.5. Operating Theatre blocked time should be appropriate to referral population morbidity incidence andprevalence.24.3.14 UrologyCurrently, and in comparison to, Nova Scotia:• There are 16.2 Urologist FTEs or 1.0 FTE per 58,226 population in Nova Scotia.• Benchmark(s)• The national average is 1.0 FTE per 53,317 population (Source: CIHI).• The England RCPS recommends 1.0 WTE per 50,000 population (Source: U.K. NHS Centre forWorkforce Intelligence) made up of a mixture of urologists and urological surgeons. Currentlythere is 1:63,000.Urology service trends in the England NHS include:• Increasing centralisation of complex urological surgery, particularly urological oncology servingpopulations over 1 million. This trend is increasingly applying to other areas of specialist urology.• ‘Office urology’ is evolving. This involves work in clinics and day-case procedures, with much useof endoscopy but no open theatre cases.• Open major surgery is becoming increasingly laparoscopic or robotic.• It is likely that the emphasis towards greater specialisation will continue, especially in the sphereof elective practice.• Robotic surgery is just gaining a foothold in the UK, particularly in the field of radicalprostatectomy. This trend is likely to continue. In the USA fellowship training is required in urologyrobotic surgery.• Medical therapy for many urological conditions (including lower urinary tract symptoms,incontinence, prostate cancer and erectile dysfunction) has been introduced over the past tenyears. It is likely that ever more medical therapies will be developed for the whole range ofurological diseases.• A benchmark of 53,317 population per FTE was applied to the Base Case forecast in the FinalReport.241 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011
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Environmental Scan - Government of Nova Scotia

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