Ryten Report

Conclusions

This section will be brief. Many conclusions have been drawn in the various sections of this report, and they will not be repeated here.

The principal conclusion that does need to be stressed is that it is feasible to conduct specialty specific workforce planning. Methods to do so have been described and illustrated. A theoretical model has been proposed for the specialty of anesthesia. It has emphasized the need to find an improved, credible method of estimating future requirements.

The proposed method was tested by making demand projections for each of the provinces based on future population projections for the year 2016. In order to demonstrate the potential of the model, projections were also made for 1999. What is reported is strictly the numbers that came out of the model. Persons familiar with the situation in each province can judge for themselves whether the projections seem credible. If they are, we have a tool we can work with. If not, we may have to find out what went wrong and go back to the drawing board.

Many problems with data were identified. These problems included a total absence of many relevant flow statistics and in cases where data series do exist, several whose quality needs improvement. Concern with data quality and involvement with the improvement of data are long term concerns. Indeed, operating and implementing a physician workforce planning model requires a long-term commitment, with dedicated resources and qualified personnel. This kind of work is usually done in either a university or governmental setting.

The use of billings data to study in depth, the fields of activity and the utilization of specific types of health care services is promising. It is an area of research that should be continued.

This study has demonstrated very starkly that the analysis of utilization of health care services must transcend the simple, uncorrected use of population/physician ratios as indicators of physician supply.

There appear to be sizeable shortages of anesthetists in most Canadian provinces at this time. Unfortunately, there is no way to rapidly increase the output of Canadian anesthesia training programmes. Canada’s medical schools are not graduating enough doctors to feed larger numbers into the Post-M.D. training system and it will be quite a while before the size of the graduating class increases sufficiently to expand the numbers qualifying as anesthetists. This means that Canada will be importing anesthetists from abroad for some time to come. Successful recruitment from abroad should not substitute for the need to concurrently deal with the fundamental problem, which is insufficient output from Canada’s own educational programmes.

The special contribution made by family physicians in the provision of anesthesia services needs to be documented in a systematic fashion. In particular, it is necessary to compute the share of services delivered by family physicians in each province. Is there a way to reach agreements about the share of anesthesia services that will be delivered by family physicians? Should training opportunities be provided in a more formal manner? At present, family physicians can have a few months of tailor-made training. There are no statistical records of the numbers taking advantage of such training opportunities. Because as much as 20% of a province’s anesthesia services may be delivered by family physicians, there is a real risk that growing shortages of family physicians will impact on the ability or willingness of family physicians to deliver anesthesia services. If family physicians reduce their level of activity in anesthesia, this will have to be made up by increasing the numbers of specialist anesthetists.

The methods proposed for studying the demand and supply of anesthesia services can be an example to other specialties of how they can examine the factors specific to changes in requirements for the particular set of health care services delivered by each specialty.

Ryten Report Main

© ACUDA 2007