Arthritis Community Research and Evaluation Unit, Toronto Western Research Institute, Main Pavilion 10-316, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada.
J Bone Joint Surg Am. 2011 May 4;93(9):863-70. doi: 10.2106/JBJS.I.01782.
The aging population and increasing obesity rates will increase the prevalence of musculoskeletal conditions. Reports of orthopaedic surgeon shortages raise concerns about the ability of the health-care system to meet current and future demand in orthopaedics. A survey of all orthopaedic surgeons in Ontario, Canada, was carried out in 2006 to (1) update provision estimates of orthopaedic surgeons; (2) examine practice characteristics and perceived barriers to service; and (3) relate geographic availability of surgeons to population utilization of office-based and surgical orthopaedic services.
A two-part questionnaire was sent to all orthopaedic surgeons in Ontario in 2006. Provision data in hours per week and full-time equivalents and practice patterns were analyzed by health region. Population-based data on the use of orthopaedic services were obtained from health service administrative databases.
There were 396 practicing orthopaedic surgeons in Ontario in 2006, equivalent to 2.43 full-time equivalents per 100,000 population, a finding similar to surveys in 1997 and 2000. Most surgeons were male, with a mean age of forty-nine years, with mainly adult practices; 48% reported having a subspecialty. Provision varied across Ontario, with an average of 112 hours per week of direct clinical time per 100,000 population (50% in the office, 30% in the operating room, 20% working on call). Many surgeons also reported time for administration, teaching, and research. Most respondents reported barriers to timely surgery, notably a lack of resources (operating room time, anesthesia, nursing, and/or bed capacity). Low orthopaedic provision was associated with lower utilization of office-based and surgical services, after controlling for neighborhood income and type of residence (urban or rural).
Shortages and geographic variation in the supply of surgeons mean that access to care continues to be a challenge in Ontario. In regions with fewer surgeons, residents are more likely to be deprived of office-based services, potentially affecting access to surgery and to orthopaedic expertise. In light of a potential shortage of surgeons, alternative methods of service provision may be needed to respond to the aging of the baby boomer population and an anticipated growth in the demand for surgery.
人口老龄化和肥胖率的增加将导致肌肉骨骼疾病的患病率上升。关于骨科医生短缺的报告引起了人们对医疗保健系统满足当前和未来骨科需求能力的担忧。2006 年对加拿大安大略省的所有骨科医生进行了一项调查，目的是：（1）更新骨科医生的供应估计数；（2）检查实践特征和服务障碍；（3）将外科医生的地理可用性与基于办公室和外科的骨科服务的人口利用情况联系起来。
2006 年，向安大略省的所有骨科医生发送了一份两部分的调查问卷。按卫生区域分析每周每小时和全职等效时间的供应数据以及实践模式。从卫生服务管理数据库获得基于人群的骨科服务使用数据。
2006 年，安大略省有 396 名执业骨科医生，相当于每 10 万人中有 2.43 名全职等效人员，这一发现与 1997 年和 2000 年的调查相似。大多数外科医生是男性，平均年龄为 49 岁，主要从事成人手术；48%的人报告有专业。安大略省各地的供应情况各不相同，每 10 万人每周平均有 112 小时的直接临床时间（50%在办公室，30%在手术室，20%在值班）。许多外科医生还报告了管理、教学和研究时间。大多数受访者报告了及时手术的障碍，特别是资源不足（手术室时间、麻醉、护理和/或床位容量）。在控制邻里收入和居住类型（城市或农村）后，低骨科供应与基于办公室和手术服务的利用率较低相关。
外科医生的供应短缺和地域差异意味着在安大略省，获得医疗服务仍然是一个挑战。在外科医生较少的地区，居民更有可能被剥夺基于办公室的服务，这可能会影响手术和骨科专业知识的获取。鉴于外科医生可能短缺，可能需要采用替代的服务提供方式，以应对婴儿潮一代的老龄化和预计手术需求的增长。
