Environmental Scan - Government of Nova Scotia

Physician Resource PlanningAn Environmental ScanFor the group of relatively larger small hospitals, whose inpatient activity ranges from 1,500 to 4,000 weightedcases, the Advisory Group recommends that core services include all of the basic core services identified forvery small hospitals above, PLUS:−Physician specialties of General Surgery and Internal Medicineo General surgery and day surgery program;o Obstetrics program; ando Special Care Units with the ability to accommodate temporarily ventilated patients.Under this criteria twenty three hospitals in Nova Scotia would be classified as very small, none as small, andthe balance as medium or larger i.e., the regional hospitals, IWK, and Queen Elizabeth II Health SciencesCentre. Thus the twenty-three hospitals would provide family practice care.8.2.4 Nova ScotiaNova Scotia will be re-examining clinical service delivery models and plans for the province. The PRP, whilespecifically not a clinical service plan, is expected to be one of a number of initiatives that will help inform thisre-examination.The ‘Better Care Sooner’ Report reviews an emergency services delivery system with collaborative, community,regional, and provincial levels. Access standards will prescribe staffing levels, mix, and availability, andfrequently irrespective of volume and acuity. Improved coordination of services is required, e.g., withCardiovascular program on stroke will be reorganized in hospitals to provide coordinated and comprehensivecare. Quality PRP is both short- and long-term in its time frame. Shifting models of delivery takes time andextensive planning. The practical examples provided in this subsection demonstrate a significant degree ofconsistency.8.3 GeneralismThe Council on Graduate Medical Education noted the decline of interest in the generalist specialties 18 in thecontext of a decline in graduate matching in family practice and general internal medicine and paediatrics.Sheldon et. al. 19 offer a slightly different perspective when they advocate for a future that is focused ondisease management and not specialty-based care. They contend certain services, i.e., trauma and emergencyteams, cardiology and cardiac surgery specialties, and oncology are already functioning in that manner. Inoncology, they note care teams include a patient advocate, clinical nurse specialist, radiologist, radiationoncologist, pathologist, surgeon, plastic surgeons, and medical oncologist. The result according to Sheldon isthe need for a new concept of generalism. Rather than expecting a single practitioner to have some knowledgeof all options, generalism should be a summation of the input of a spectrum of experts. One could interpret thisviewpoint as being centred on tertiary programs but, perhaps, what is intended comes closer to Nova Scotia’sgoal of collaborative care teams.General Internal Medicine (GIM) has re-examined its future in recent years in the face of increasingsubspecialization 20 . The RCPSC CanMEDS project has renewed a common focus on core competencies in themedical education system. Each Canadian Faculty of Medicine is revising curriculum extensively to align withthe core competency focus. A senior representative of one large Faculty of Medicine had the following18 COGME: Update on the Physician Workforce, August 200019 Sheldon, G.G., Anneke, T.S., Supply and demand—surgical and health workforce, Surg Clin N Am 84 (2004) 1493–150920 Canadian Society of Internal Medicine: Care-fully: defining a Plan for General Internal Medicine in Canada. Oct/2005.56 | Page Social Sector Metrics Inc. & Health Intelligence Inc. | 12/31/2011