Delivery models of rural surgical services in British Columbia (1996-2005): are general practitioner-surgeons still part of the picture?
OBJECTIVE
To define the models of surgical service delivery in rural communities that rely solely on general practitioner (GP)-surgeons for emergency care, to examine how they have changed over the past decade and to identify some effects on communities that have lost their local surgical program.


METHODS
We undertook a retrospective study using the Population Utilization Rates and Referrals For Easy Comparative Tables database (versions 6.0 and 9.0) and telephone interviews to hospitals that we identified. We included all hospitals in rural British Columbia with surgical programs that had no resident specialist surgeon and that relied on general practitioner-surgeons (GP-surgeons) for emergency surgical care. We examined surgical program characteristics, community size, distance from referral centre, role of itinerant surgery, where GPs were trained, their age and years of experience and referral rates for appendectomies and obstetrics.


RESULTS
Changes over the past decade include a decrease in the total number of GP-surgeons operating in these communities, more itinerant surgery and the loss of 3 of 12 programs. GP-surgeons are older, are usually foreign-trained and have more than 5 years of experience. Communities with no local program or that rely on solo practitioners refer more emergencies out of the community and do less maternity care than those with more than a single GP-surgeon.


CONCLUSIONS
GP-surgeons still play an integral role in the provision of emergency and elective surgical services in rural communities without the population base to sustain resident specialist surgeons. As GP-surgeons retire and surgical programs close, there is no accredited training program to replace them. More outcome comparisons between procedures performed by GP-surgeons and general surgeons are needed, as is the creation of a nationally accredited training program to replace these practitioners as they retire.
Humber
Nancy
N
Department of Family Practice (Research Division), University of British Columbia, Vancouver, BC. Saffron2@telus.net
Frecker
Temma
T
D001062:Appendectomy / Q000706:statistics & numerical data; D001955:British Columbia; D003695:Delivery of Health Care / Q000458:organization & administration; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005194:Family Practice / Q000458:organization & administration*; D005550:Foreign Medical Graduates; D013502:General Surgery / Q000458:organization & administration*; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010819:Physician's Role; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D019035:Rural Health Services / Q000458:organization & administration*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D000078329:Workforce