15. Meeting challenges in the delivery of surgical care

L. Sigurdson

Abstract


Canadian surgeons are faced with looming demographic challenges. Shortages in surgical manpower cannot be addressed expediently due to 14-year university requirements. A potential solution is to increase the efficiency of surgeons already in practice. Physician assistants (PA’s), may play a role in this regard by allowing surgeons to concentrate on their core competency, namely operating. The purposes of this investigation are to explore the inefficiencies in a current Canadian surgeon’s practice, examine the feasibility of PA employment and evaluate the financial impacts.
The study was performed in 3 parts. In part 1, operating room plastic surgery Surgiserver® data for 10 years leading up to 2005 were analyzed to determine daily operating time actually used. In part 2, 4 months of detailed time series data were captured prospectively for every patient care event. The data was analyzed using SPSS (ver. 11.5) to determine the percentage and types of events that could be delegated to a PA. In part 3, PA hiring scenarios were developed using formal business case analyses.
Over 3,635 days, mean operating time used in a 10-hour surgical day was 5.93 hours. Of the 806 patients seen in 13 clinics, 53.5% could have been cared for by a PA. In the minor procedure area, 48.8 % of surgical time was spent performing non-essential, PA compatible work. In the main OR, 25.9% of surgical time was PA compatible. Considering the weekly mix of activities, a PA could increase surgical productivity by 36.7%. Hiring a PA was neutrally cost effective at the 37% productivity increase level. However, much greater discounted incremental cash flows, internal rates of return (IRR) and return on investments (ROI) were achieved when PA hiring allowed one surgeon to run 2 OR’s simultaneously.
Employing PA’s, in conjunction with increasing OR capacity, have the potential to markedly increase the capability of surgeons to deal with lengthy wait lists in a cost effective manner.
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DOI: http://dx.doi.org/10.25011/cim.v30i4.2775

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