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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).