Evaluating the scope of rural general surgery in British Columbia

Rebecca M Afford ¹, Sara D Bolin ¹, Dunavan K Morris-Janzen ¹

⁰From the University of British Columbia, Faculty of Medicine, Vancouver, B.C.

Canadian Journal of Surgery. Journal Canadien De Chirurgie +

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March 7, 2024

View abstract on PubMed

Summary

Rural general surgeons in British Columbia perform diverse procedures, but the frequency of unconventional surgeries has decreased over the past decade, potentially due to new guidelines. This shift impacts patient access and training needs.

Area Of Science

Surgical Practice
Rural Health
Health Policy

Background

Rural general surgeons in British Columbia (BC) undertake procedures beyond the traditional scope of their specialty.
The Rural Practice Subsidiary Agreement (RSA) formally defines rurality in BC.
Understanding the evolving scope of practice for these surgeons is crucial.

Purpose Of The Study

To analyze the scope of practice for BC's rural general surgeons.
To determine if changing privileging guidelines have affected their practice over time.

Main Methods

Utilized Medical Services Plan (MSP) data from 2011-2021 for procedures billed by general surgeons in RSA-defined rural communities.
Categorized billed procedures by surgical specialty.
Analyzed procedural trends based on community characteristics and temporal changes.

Main Results

Over 222,000 procedures were performed in 23 rural BC communities between 2011 and 2021.
Colonoscopies, colorectal, and hernia procedures were most common; plastic surgery comprised the most frequent unconventional procedures.
A significant decrease in unconventional general surgery procedures was observed over the decade (p < 0.001).

Conclusions

Rural general surgeons' scope of practice is influenced by resources, community needs, and specialist availability.
Evolving privileging guidelines appear to have reduced the performance of unconventional procedures by rural general surgeons.
This trend necessitates understanding its impact on training and patient care in rural areas.