GP Surgery And Anesthesia In BC Dr. Stuart Iglesias January 5, - - PowerPoint PPT Presentation

▶
gp surgery and anesthesia in bc
SMART_READER_LITE
LIVE PREVIEW

GP Surgery And Anesthesia In BC Dr. Stuart Iglesias January 5, - - PowerPoint PPT Presentation

Nov 30, 2023 568 likes •901 views

GP Surgery And Anesthesia In BC Dr. Stuart Iglesias January 5, 2012 Does It Matter? Infrastructure/cornerstone of rural health care Programs (Maternity, ER) Recruitment and retention Inclination to care for the reasonably ill

slide-1
SLIDE 1
  • Dr. Stuart Iglesias

January 5, 2012

GP Surgery And Anesthesia In BC

slide-2
SLIDE 2

Does It Matter?

  • Infrastructure/cornerstone of rural health care

– Programs (Maternity, ER) – Recruitment and retention – Inclination to care for the reasonably ill patients – Community economic and social resource

2

slide-3
SLIDE 3

Has the Delivery of Rural Surgery Changed ?

  • New data
  • 1. List of FPA’s by community (LP- RCCBC)
  • 2. List of GPS by commuity

1. Incomplete data on their scope of practice 2. Nothing on their location/scope of training

3

slide-4
SLIDE 4

Talking Points

  • Changes in Rural Surgery 1995 – Present
  • Significance for FPA
  • Significance for GPS
  • How We Might Move Forward? FPA
  • How We Might Move Forward? GPS
  • Role for RCCBC?

4

slide-5
SLIDE 5

Changes in Rural Surgery: 1995 - Present

1. Hazelton 2. Smithers 3. Burns Lake 4. Vanderhoof 5. Fort St. James 6. Fort St. John 7. Fort Nelson 8. Dawson Creek 9. Kitimat

  • 10. 100 Mile House
  • 11. Golden
  • 12. Revelstoke
  • 13. Creston
  • 14. Castlegar
  • 15. Grand Forks
  • 16. Princeton
  • 17. Fernie
  • 18. Lilloet
  • 19. Bella Coola
  • 20. Bella Bella

5

1995 : BC’s Small Volume Programs-GPS

slide-6
SLIDE 6

Changes in Rural Surgery: 1995 - Present

  • 1. Hazelton

2 Smithers 3 Burns Lake 4 Vanderhoof

  • 5. Fort St. James
  • 6. Fort St. John
  • 7. Fort Nelson
  • 8. Dawson Creek
  • 9. Kitimat
  • 10. 100 Mile House
  • 11. Golden
  • 12. Revelstoke
  • 13. Creston
  • 14. Castlegar
  • 15. Grand Forks
  • 16. Princeton
  • 17. Fernie
  • 18. Lilloet
  • 19. Bella Coola
  • 20. Bella Bella

6

2011: BC’s Small Volume Programs-GPS

slide-7
SLIDE 7

Changes in Rural Surgery: 1995 - Present

1. Hazelton 2. Smithers 3. Burns Lake 4. Vanderhoof 5. Fort St. James 6. Fort St. John 7. Fort Nelson 8. Dawson Creek 9. Kitimat

  • 10. 100 Mile House
  • 11. Golden
  • 12. Revelstoke
  • 13. Creston
  • 14. Castlegar
  • 15. Grand Forks
  • 16. Princeton
  • 17. Fernie
  • 18. Lilloet
  • 19. Bella Coola
  • 20. Bella Bella

7

1995 : BC’s Small Volume Programs-GPS

slide-8
SLIDE 8

Changes in Rural Surgery: 1995 - Present

1. Hazelton

2. Smithers

3. Burns Lake

4. Vanderhoof

5. Fort St. James

6. Fort St. John

7. Fort Nelson

8. Dawson Creek

9. Kitimat

  • 10. 100 Mile House
  • 11. Golden
  • 12. Revelstoke
  • 13. Creston
  • 14. Castlegar
  • 15. Grand Falls
  • 16. Princeton
  • 17. Fernie
  • 18. Lilloet
  • 19. Bella Coola
  • 20. Bella Bella

8

4 Small, now Large, Volume Programs (Spec. Sx)

slide-9
SLIDE 9

Changes in Rural Surgery: 1995 - Present

9

1995* 2011** Small Volume Programs 20 7 FPA 53 12 GPS 41 10 Since 1995: Attrition In Small Volume GPS Programs

* Iglesias et al. Advanced Skills by Canada’s Rural Physicians. Can J Rural Med 199; 4(4):227-31. ** Survey (1) RCCBC, Dr. L. Prinsloo (FPA); (2) Dr. S. Iglesias (GPS)

slide-10
SLIDE 10

Changes in Rural Surgery: 1995 - Present

10

Scope Of Practice Of GPS in Small Volume Programs

1995 2011 c/s only 15

Hypothesis: mostly C/S?

appy only 1 c/s and appy 18 FPA and GPS 7

Total GPS 41 10

slide-11
SLIDE 11

Changes in Rural Surgery: 1995 - Present

1. Cranbrook 2. Nelson 3. Trail 4. Salmon Arm 5. Williams Lake 6. Powell River 7. Sechelt 8. Squamish 9. Duncan

  • 10. Port Alberni
  • 11. Campbell River
  • 12. Prince Rupert
  • 13. Smithers
  • 14. Terrace
  • 15. Vanderhoof
  • 16. Quesnel
  • 17. Fort St. John
  • 18. Dawson Creek

11

2014: BC’s Large Volume Programs

slide-12
SLIDE 12

Changes in Rural Surgery: 1995 - Present

12

2011: BC’s Rural Surgery

FPA GPS Small Volume (7) 12 10 Large Volume (18) 69 30

slide-13
SLIDE 13

2014: BC’s Rural Surgery

13

FPA GPS

slide-14
SLIDE 14

Changes in Rural Surgery: 1995 - Present

1. Cranbrook 2. Nelson 3. Trail 4. Salmon Arm 5. Williams Lake 6. Powell River 7. Sechelt 8. Squamish 9. Duncan

  • 10. Port Alberni
  • 11. Campbell River
  • 12. Prince Rupert
  • 13. Smithers
  • 14. Terrace
  • 15. Vanderhoof
  • 16. Quesnel
  • 17. Fort St. John
  • 18. Dawson Creek

14

2014: BC’s Large Volume Programs

slide-15
SLIDE 15

Why The Change?

  • Health Policy?

– Few training programs for full service GPS – Regionalization

  • Evolution of Surgery?

– MIS surgery – Imaging, especially CT and U/S – “Superhero” not sustainable – Loss of generalism in Gen Sx

15

slide-16
SLIDE 16

Small Volume Programs by Province

16

PROGRAMS GPS GPA 2000 (2011) 2000 (2011) 2000 (2011) BC 20 (11) 41 (29) 53 (28) AB 41 (27) 70 (63) 85 SK 8 (8) 11 (28) 19 MB 7 (5) 17 (9) 22

slide-17
SLIDE 17

Talking Points

  • Changes in Rural Surgery 1995 – Present
  • Significance for FPA
  • Significance for GPS
  • How We Might Move Forward? FPA
  • How We Might Move Forward? GPS
  • Role for RCCBC?

17

slide-18
SLIDE 18

How FPA Has Changed

  • Expanded Career Tracks For FPAs:

– Family medicine/anesthesia – Anesthesia/ER – Anesthesia

  • CME

– Improved availability, accessibility

  • More volume, more complex cases
  • Improved relationship with specialists (fragile?)

18

slide-19
SLIDE 19

How FPA Has Not Changed

  • Training program:

– Same training for small vs. large volume programs? – No standardized curriculum – No certification

  • Home ?
  • CAGA?

19

slide-20
SLIDE 20

Talking Points

  • Changes in Rural Surgery 1995 – Present
  • Significance for FPA
  • Significance for GPS
  • How We Might Move Forward? FPA
  • How We Might Move Forward? GPS
  • Role for RCCBC?

20

slide-21
SLIDE 21

What Has Changed For GPS

  • Past:

– Broad scope of practice – Small volume programs

  • Present:

– Mostly c/s – Large volume programs – Improved relationship with Specialist OB

21

slide-22
SLIDE 22

What Has Not Changed For GPS

  • Few Training opportunities

– Only in Saskatchewan – BC’s C/S program

  • Relationship with surgeons

– Gen Sx: impossible(except U of S)

  • Credentialling is problematic
  • CME-none at all
  • Home?

22

slide-23
SLIDE 23

Talking Points

  • Changes in Rural Surgery 1995 – Present
  • Significance for FPA
  • Significance for GPS
  • How We Might Move Forward? GPA
  • How We Might Move Forward? GPS
  • Role for RCCBC?

23

slide-24
SLIDE 24

How We Might Go Forward ? FPA

  • Database:

– Survey who is doing what/where

  • Training program

– Cognizant of small vs large volume programs – Largely not community driven

  • CME
  • Home

– Responsive to different constituencies – RCCBC

24

slide-25
SLIDE 25

Talking Points

  • Changes in Rural Surgery 1995 – Present
  • Significance for FPA
  • Significance for GPS
  • How We Might Go Forward? FPA
  • How We Might Go Forward? GPS
  • Role for RCCBC?

25

slide-26
SLIDE 26

How We Might Go Forward? GPS

  • Database:

– Survey who is doing what/where(incl spec) – Site visits

  • Training program

– GP C/S: is there a BC program? – Full service GPS

  • No teaching site in BC
  • Link with Sask-distributed education model?
  • CME-presently none at all
  • Home
  • RCCBC ??

26

slide-27
SLIDE 27

Talking Points

  • Changes in Rural Surgery 1995 – Present
  • Significance for FPA
  • Significance for GPS
  • How We Might Go Forward? FPA
  • How We Might Go Forward? GPS
  • Role for RCCBC?

27

slide-28
SLIDE 28

Role for RCCBC

To provide a home for FPA and GPS:

  • Database (surveys, site visits)
  • List serve/ teleconferences
  • Training Programs-moving the agenda forward
  • CME- organization/sponsor
  • Liaison with other provinces (RPAP, U of S)
  • Advocacy-Ministry, HA’s, Medical Schools
  • Admin support

28

slide-29
SLIDE 29

INTERFACE: GPOB / FPA / GPS

29

GPOB FPA C/S GPS

Specialist Sx (local or itinerant) Diagnostic Imaging

LARGE VOLUME PROGRAMS

slide-30
SLIDE 30

INTERFACE: GPOB / FPA / GPS

30

GPOB FPA GPS

SMALL VOLUME PROGRAMS

slide-31
SLIDE 31

DISTRIBUTED SURGICAL TRAINING PROGRAM ( U of S, UBC )

31

ORTHO ENT CME PARH U of S PLASTICS GYN OB GEN Sx RESEARCH