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RE: Transformational change in surgery

  • Randall W. Friesen, General Surgeon, Victoria Hospital
25 June 2020

Kudos to Drs. Urbach and Martin for their courage to speak to fundamental issues affecting delivery of surgical services in Canada. Our regional hospital's General Surgery division began a pooled referral process several years ago. The results: balancing of workload, less variation in practice, a more cohesive team, shorter waits overall and fewer wasted resources.
As the senior surgeon in the group at the time of transition, I shared concerns about patient willingness to see junior colleagues. However (to my reluctant satisfaction), only 10-20% of patients or referring physicians expressed a preference for a surgeon if it might result in a longer wait for consultation and/or surgery.
I believe it is also important to bring remuneration into the discussion; fear of loss of income drives much (or most) of the reluctance to change. Thus alternate payment models, especially in an era of reduced efficiency/turnover/volume, hold some promise (and some challenges).

Competing Interests: None declared.
References 
David R. Urbach, Danielle Martin. Confronting the COVID-19 surgery crisis: time for transformational change. CMAJ 2020;192:E585-E586.
See article »

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Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

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