General surgery in Canada: current scope of practice and future needs

General surgery in Canada: current scope of practice and future needs

Can J Surg 2020;63(5):E396-E408 | PDF | Appendix

Travis Schroeder, MD; Caroline Sheppard, PhD; Dawn Wilson; Caitlin Champion, MD, MSc; Shanna DiMillo, MBNF; Roy Kirkpatrick, MD; Stephen Hiscock, MD; Randall Friesen, MD; Lauren Smithson, MPhil, MD; Peter Miles, MD

Abstract

Background: The scope of practice of general surgeons in Canada is highly variable. The objective of this study was to examine the demographic characteristics of general surgeons in Canada and compare surgical procedures performed across community sizes and specialties.

Methods: Data from the Canadian Institute for Health Information’s National Physician Database were used to analyze fee-for-service (FFS) care provided by general surgeons and other providers across Canada in 2015/16.

Results: Across 8 Canadian provinces, 1669 general surgeons provided FFS care. The majority of the surgeons worked in communities with more than 100 000 residents (71%), were male (78%), were aged 35–54 years (56%) and were Canadian medical graduates (76%). Only 7% of general surgeons practised in rural areas and 14% in communities with between 10 000 and 50 000 residents. Rural communities were significantly more likely to have surgeons who were international medical graduates or who were older than 65 years. The surgical procedures most commonly performed by general surgeons were hernia repairs, gallbladder and biliary tree surgery, excision of skin tumours, colon and intestine resections and breast surgery. Many general surgeons performed procedures not listed in their Royal College of Physicians and Surgeons of Canada training objectives.

Conclusion: Canadian general surgeons provide a wide array of surgical services, and practice patterns vary by community size. Surgeons practising in rural and small communities require proficiency in skills not routinely taught in general surgery residency. Opportunities to acquire these skills should be available in training to prepare surgeons to meet the care needs of Canadians.

Résumé

Contexte : La pratique des chirurgiens généralistes au Canada varie grandement. Cette étude visait à examiner les caractéristiques démographiques des chirurgiens généralistes au Canada et à comparer les interventions réalisées selon la spécialité et la taille des collectivités.

Méthodes : Des données de la Base de données nationale sur les médecins de l’Institut canadien d’information sur la santé ont été utilisées pour analyser les soins rémunérés à l’acte dispensés par des chirurgiens généralistes et d’autres fournisseurs de soins au Canada en 2015–2016.

Résultats : Dans 8 provinces canadiennes, 1669 chirurgiens généralistes ont fourni des soins rémunérés à l’acte. La majorité d’entre eux travaillaient dans des collectivités de plus de 100 000 résidents (71 %), étaient des hommes (78 %), avaient entre 35 et 54 ans (56 %) et avaient obtenu leur diplôme de médecine au Canada (76 %). Seuls 7 % des chirurgiens généralistes travaillaient en région rurale et 14 %, dans des collectivités comptant entre 10 000 et 50 000 résidents. En région rurale, la probabilité que les chirurgiens soient des diplômés internationaux en médecine ou aient plus de 65 ans était significativement plus élevée. Les interventions les plus fréquentes étaient la réparation d’une hernie, la chirurgie de la vésicule biliaire et des voies biliaires, le retrait de tumeurs de la peau, la résection du côlon ou de l’intestin et la chirurgie mammaire. De nombreux chirurgiens généralistes ont réalisé des procédures ne faisant pas partie des objectifs de formation du Collège royal des médecins et chirurgiens du Canada.

Conclusion : Les chirurgiens généralistes canadiens réalisent une large gamme d’interventions chirurgicales et leur pratique varie selon la taille de la collectivité dans laquelle ils travaillent. Les chirurgiens exerçant en milieu rural et dans les petites collectivités doivent avoir des compétences qui ne sont habituellement pas enseignées durant la résidence en chirurgie générale. La formation devrait intégrer des occasions d’acquérir ces compétences pour préparer les chirurgiens à répondre aux besoins en matière de soins des Canadiens.


Accepted Dec. 5, 2019

Acknowledgement: The authors acknowledge the Royal College of Physicians and Surgeons of Canada for their support in securing data and developing the study methodology.

Affiliations: From the Division of General Surgery, McMaster University, Hamilton, Ont. (Schroeder); the Cumming School of Medicine, University of Calgary, Calgary, Alta. (Sheppard); the Canadian Association of General Surgeons, Ottawa, Ont. (Wilson); the Division of General Surgery, University of Ottawa, Ottawa, Ont. (Champion); the Royal College of Physicians and Surgeons of Canada, Ottawa, Ont. (DiMillo); the Northern Ontario School of Medicine, Huntsville District Memorial Hospital, Huntsville, Ont. (Kirkpatrick); the University of British Columbia, Shuswap Lake General Hospital, Salmon Arm, B.C. (Hiscock); the Department of Surgery, University of Saskatchewan, Victoria Hospital, Prince Albert, Sask. (Friesen); the Department of Surgery, Charles S. Curtis Memorial Hospital, Labrador-Grenfell Health, St. Anthony, Nfld. (Smithson); and the Department of Surgery, University of Alberta, Queen Elizabeth II Hospital, Grande Prairie, Alta. (Miles).

Competing interests: T. Schroeder, D. Wilson, C. Champion, R. Kirkpatrick, S. Hiscock, R. Friesen, L. Smithson and P. Miles are members of the Rural Surgery Committee of the Canadian Association of General Surgeons. No other competing interests were declared.

Contributors: T. Schroeder, C. Sheppard, C. Champion, R. Kirkpatrick, S. Hiscock and P. Miles designed the study. T. Schroeder, D. Wilson, S. DiMillo and P. Miles acquired the data, which T. Schroeder, C. Sheppard, C. Champion,S. DiMillo, R. Kirkpatrick, S. Hiscock, R. Friesen, L. Smithson and P. Miles analyzed. All authors critically revised the manuscript and gave final approval of the version to be published.

Disclaimer: The views expressed in this article do not necessarily respresent the official position of the Royal College of Physicians and Surgeons of Canada or the Canadian Association of General Surgeons. Parts of this material are based on data and information provided by the Canadian Institute for Health Information. However, the analyses, conclusions, opinions and statements herein are those of the authors and not those of the Canadian Institute for Health Information.

DOI: 10.1503/cjs.004419

Correspondence to: P. Miles, Queen Elizabeth II Hospital, 10409 98 St, Grande Prairie AB T8V 2E8, pkabmiles@gmail.com