From the University of British Columbia, Faculty of Medicine, Vancouver, B.C.
From the University of British Columbia, Faculty of Medicine, Vancouver, B.C
Can J Surg. 2024 Mar 7;67(2):E91-E98. doi: 10.1503/cjs.007023. Print 2024 Jan-Feb.
Rural general surgeons perform many procedures outside the conventional scope of the specialty. Unique to British Columbia, the Rural Practice Subsidiary Agreement (RSA) formally defines rurality in the province. Our goal is to understand the scope of practice for BC's rural general surgeons and whether it has been affected over time by changing privileging guidelines.
Medical Services Plan (MSP) data were collected from 2011 to 2021 for procedures billed by general surgeons in communities defined by the RSA as rural. We categorized codes from the MSP based on surgical specialty. For each community, we calculated the totals for these categories considering what other surgical specialties were present as well as changes over time.
From 2011 to 2021, 222 905 procedures were performed in 23 rural communities in BC. Colonoscopies were the most frequently performed procedure ( = 80 114, 35.9%), followed by colorectal ( = 23 891, 10.7%) and hernia procedures ( = 20 911, 9.4%). The most common unconventional procedures were plastic surgeries ( = 8077, 3.6%). Classification within the RSA did not significantly influence the percentage of unconventional general surgery procedures performed ( = 0.4). When another surgical specialty was present, there was often a decrease in the number of that specialty's procedures performed by general surgeons. Over the past decade, rural general surgeons performed fewer unconventional general surgery procedures ( < 0.001).
General surgeons working in rural communities perform a variety of procedures based on resources, community need, and access to other specialists. Over the last decade, this appears to have been influenced by new privileging guidelines. Understanding the scope of rural general surgery can inform training opportunities and, as there is a migration away from rural surgeons performing as many unconventional procedures, can elucidate the implications on patients and communities.
农村普通外科医生在传统专业范围之外进行许多手术。在不列颠哥伦比亚省，农村实践附属协议（RSA）将农村地区正式定义为独特的。我们的目标是了解不列颠哥伦比亚省农村普通外科医生的实践范围，以及随着时间的推移， privileging 指南的变化是否对此产生了影响。
从 2011 年到 2021 年，我们收集了 MSP 数据，这些数据是由 RSA 定义为农村的社区中的普通外科医生开具的。我们根据外科专业对 MSP 中的代码进行了分类。对于每个社区，我们考虑到其他外科专业的存在以及随时间的变化，计算了这些类别的总数。
从 2011 年到 2021 年，不列颠哥伦比亚省的 23 个农村社区共进行了 222905 例手术。结肠镜检查是最常见的手术（=80114，35.9%），其次是结直肠（=23891，10.7%）和疝手术（=20911，9.4%）。最常见的非常规手术是整形手术（=8077，3.6%）。RSA 中的分类并没有显著影响普通外科医生进行的非常规普通外科手术的比例（=0.4）。当存在另一个外科专业时，普通外科医生进行该专业手术的数量通常会减少。在过去的十年中，农村普通外科医生进行的非常规普通外科手术数量减少（<0.001）。
在农村社区工作的普通外科医生根据资源、社区需求和获得其他专家的机会，进行各种手术。在过去的十年中，这似乎受到了新 privileging 指南的影响。了解农村普通外科的范围可以为培训机会提供信息，并且由于农村外科医生进行的非常规手术数量减少，这可以阐明对患者和社区的影响。
