UofA - Rural Family + Surgery

[Larrivee]

Hey guys,

 

Has anyone here done, or heard of someone who has done the U of A rural family med with +1 in general surgery? (http://www.familymed.med.ualberta.ca/Home/Education/Rural/)

What can you do as a family doc with a gen surg +1? Does it just make you a better surgical assist or can you actually do some procedures on your own?

 

Thanks.

[cdnmaple]

Apparently the idea is to be able to do some procedures on your own, not just as an assist.

 

There are GP's in rural AB and SK who do appendectomies, and of course there are GP's everywhere who do cesareans. I really don't know much beyond that, like if they're doing gallbladders or anything bigger. I'm sure if you asked the program they can probably tell you what they're trying to do.

[NLengr]

http://www.familymed.med.ualberta.ca/Home/Education/ThirdYear/surgery-obstetrics.cfm

[Larrivee]

http://www.familymed.med.ualberta.ca/Home/Education/ThirdYear/surgery-obstetrics.cfm

 

Thanks, I didn't see that. I probably misinterpreted, however I thought the link I posted was saying you could do a whole year in general surgery (as opposed to 6/12 and 6/12 obs).

 

I wonder how far out in the boonies you'd have to be to practice as a GP-surgeon. It definitely sounds like a good back-up to a surgical specialty application... but not if you have to be in the North West Territories to practice.

Has anyone gone this route? If so, how was it finding work?

[Lactic Folly]

The rest of the time you'd be practicing as a rural family physician (doing the full range of medicine), so you'd have to enjoy that in addition to the specialty of surgery, if used as a backup...

[NLengr]

Thanks, I didn't see that. I probably misinterpreted, however I thought the link I posted was saying you could do a whole year in general surgery (as opposed to 6/12 and 6/12 obs).

 

I wonder how far out in the boonies you'd have to be to practice as a GP-surgeon. It definitely sounds like a good back-up to a surgical specialty application... but not if you have to be in the North West Territories to practice.

Has anyone gone this route? If so, how was it finding work?

 

Reading the page I'm not even sure of the scope of surgery you'd be able to do. It says endoscopy and minor surgical procedures. The procedures makes me think thinks like I and D, minor skin stuff small hernias etc. I don't read that as lap appy's and gall bags. They're not very clear.

[BoyInTheBubble]

You also need to be comfortable living in the middle of nowhere. You won't get privileges at academic sites..... or any area within striking distance of a hospital with general surgeons.

 

It really only happens in the isolated spots of rural Alb, Sask and BC.

 

Rural family docs everywhere are getting ousted from deliveries let alone C-sections. Patients are getting sent to the Big City to centralized obstetrics clinics more and more.

[medicine man]

Hey guys,

 

Has anyone here done, or heard of someone who has done the U of A rural family med with +1 in general surgery? (http://www.familymed.med.ualberta.ca/Home/Education/Rural/)

What can you do as a family doc with a gen surg +1? Does it just make you a better surgical assist or can you actually do some procedures on your own?

 

Thanks.

 

I think whatever it is, it should be minor. Although these areas are in dire need of healthcare, I don't think we should jump the gun and expose them to subpar care.

 

"minor" procedures like appendectomies or hernias take surgical residents at least the end of a few years into their residency before they can comfortably do it. And we are talking about residents who live and breathe this stuff. Endoscopy alone takes GI residents at least 1 full year of focus to feel somewhat comfortable. I would be very weary of any fellowship claiming in 6 months of gen surgery + 6 months of obstetrics to offer this stuff and to even be passable.

 

Bedside I and Ds probably don't need a fellowship. You could probably do some cosmetic surgical stuff in 6 months but what would be the point of offering that in a rural fellowship. I'm not sure what this fellowship accomplishes. Perhaps surgeons/surgical residents can correct me where im wrong

[HycrestJIT]

I think whatever it is, it should be minor. Although these areas are in dire need of healthcare, I don't think we should jump the gun and expose them to subpar care.

 

"minor" procedures like appendectomies or hernias take surgical residents at least the end of a few years into their residency before they can comfortably do it. And we are talking about residents who live and breathe this stuff. Endoscopy alone takes GI residents at least 1 full year of focus to feel somewhat comfortable. I would be very weary of any fellowship claiming in 6 months of gen surgery + 6 months of obstetrics to offer this stuff and to even be passable.

 

Bedside I and Ds probably don't need a fellowship. You could probably do some cosmetic surgical stuff in 6 months but what would be the point of offering that in a rural fellowship. I'm not sure what this fellowship accomplishes. Perhaps surgeons/surgical residents can correct me where im wrong

 

See bold.

 

If you ask many rural residents, they would rather receive care in their own home community knowing that it would be provided by someone with less experience because it would allow them to stay near home with family and friends. That's actually really important to people.

 

Barring having a surgeon move and live in the styx full-time (good luck with that), other solutions need to be created in order to meet the gap in care.

 

Not to mention, asking people to drive 5+ hours on crappy northern canadian highways full of elk and moose is in some ways more risky and incurs a greater cost to the patient than it is to have someone who lives in the home community who can provide the service. When patients have to travel for medical care, they need to take time off work, find someone who can look after their families, spend money on travel, food and lodging away from home and assume the risk of travel. For a lot of patients this is both neither affordable nor safe. Not to mention, costs of emergency transport are huge.

 

It's hard to understand this if you didn't grow up in a place that's 5+ hours away from the nearest tertiary hospital. Asking Joe Farmer to drive 5 hours for a colonoscopy is a good way to ensure that he doesn't ever get one. Which sounds like such a better quality of care provision, no?

 

Finally, an obstetrics service in a rural community really does need someone who can provide operative obstetrical care (along with a provider who can provide the anesthesia for it) in order for it to survive. This is the biggest thing I think people overlook when they consider this topic; how the impact effects then entire provision of medical services for the whole community.

 

Medicine cannot be provided in an ideal manner to all people at all times. Rural communities should not need suffer further reductions in the quality of care that they can provide to their members because of ivory tower arguments on what should be considered ideal. The entire argument falls out the window when you try to provide services in the styx.

 

----

 

As an aside, Price Albert in Saskatchewan has a fully established 1 year surgical skills enhanced year training program for rural family physicians which is quite comprehensive and well-laid out with well-defined objectives. I'd recommend looking there.

[NLengr]

I think whatever it is, it should be minor. Although these areas are in dire need of healthcare, I don't think we should jump the gun and expose them to subpar care.

 

"minor" procedures like appendectomies or hernias take surgical residents at least the end of a few years into their residency before they can comfortably do it. And we are talking about residents who live and breathe this stuff. Endoscopy alone takes GI residents at least 1 full year of focus to feel somewhat comfortable. I would be very weary of any fellowship claiming in 6 months of gen surgery + 6 months of obstetrics to offer this stuff and to even be passable.

 

Bedside I and Ds probably don't need a fellowship. You could probably do some cosmetic surgical stuff in 6 months but what would be the point of offering that in a rural fellowship. I'm not sure what this fellowship accomplishes. Perhaps surgeons/surgical residents can correct me where im wrong

 

One of the reasons it takes surgical residents a couple years to get comfortable is because they have a lot of wasted time on off service and scut.

 

Inguinal hernias are easily within the realm of a GP. They are pretty straight forward once you have been taught. You just need to know what patients to avoid. Remember for years rural GPs did hernias routinely.

[A-Stark]

If I recall correctly, the hernia surgeons at the Shouldice hospital are GPs not FRCSC surgeons. I mean, I almost did an entire inguinal hernia repair as a med student.

 

Having said that, it strikes me that some of these rural areas are not really that remote (Prince Albert, really?) and should have at least a surgeon around. Somewhere like St Anthony on the Northern Peninsula of Newfoundland is arguably more remote than your average rural Prairie town yet manages to have numerous subspecialty services (and apparently a great experience for electives).

[HycrestJIT]

If I recall correctly, the hernia surgeons at the Shouldice hospital are GPs not FRCSC surgeons. I mean, I almost did an entire inguinal hernia repair as a med student.

 

Having said that, it strikes me that some of these rural areas are not really that remote (Prince Albert, really?) and should have at least a surgeon around. Somewhere like St Anthony on the Northern Peninsula of Newfoundland is arguably more remote than your average rural Prairie town yet manages to have numerous subspecialty services (and apparently a great experience for electives).

 

Prince Albert does have specialists. I was pointing out that it's really the only organized program for GPs to do an enhanced surgical skills year - the U of A one is poorly organized and in constant flux.

 

http://www.medicine.usask.ca/family/residency-program/enhanced-skills-division/index.html

[Jochi1543]

See bold.

 

If you ask many rural residents, they would rather receive care in their own home community knowing that it would be provided by someone with less experience because it would allow them to stay near home with family and friends. That's actually really important to people.

 

That's true. However bizarre I might consider this, I have seen patients who would rather wait 6 months for a procedure to be done 30 mins away than drive 1.5 hours to the big city and get it done within a few weeks.

[Jochi1543]

One of the reasons it takes surgical residents a couple years to get comfortable is because they have a lot of wasted time on off service and scut.

 

Truth, same for really all Royal College specialties, IMO - except, I suppose, things like peds or IM.

Inguinal hernias are easily within the realm of a GP. They are pretty straight forward once you have been taught. You just need to know what patients to avoid. Remember for years rural GPs did hernias routinely.

 

Were they lap, though? Seems like laparoscopic skills alone would take like 6 months to learn, regardless of the surgery.

[rmorelan]

Truth, same for really all Royal College specialties, IMO - except, I suppose, things like peds or IM.

 

 

Were they lap, though? Seems like laparoscopic skills alone would take like 6 months to learn, regardless of the surgery.

 

Yeah that isn't easy.

 

I was always curious about EM in terms of timelines. I mean they have 16ish shifts a week it seems as a resident - mostly because the times are all over the place. Seems like there should be a way to condense that if they wanted. Probably just that they don't

[NLengr]

Truth, same for really all Royal College specialties, IMO - except, I suppose, things like peds or IM.

 

 

Were they lap, though? Seems like laparoscopic skills alone would take like 6 months to learn, regardless of the surgery.

 

Laparoscopic inguinal hernia repair is the exception rather than the rule.

 

Most are still repaired open. Lap is overkill.

[ploughboy]

If I recall correctly, the hernia surgeons at the Shouldice hospital are GPs not FRCSC surgeons. I mean, I almost did an entire inguinal hernia repair as a med student.

 

And if I recall correctly they're all FRCSCs, but I'll be darned if I can find I staff list on their website to support my unreliable memory. I swear I've seen a staff list, though.

 

I'd think it would be a pretty sweet surgical gig - specializing in a relatively simple procedure in volume, with a very low complication rate and next-to zero call.

[NLengr]

And if I recall correctly they're all FRCSCs, but I'll be darned if I can find I staff list on their website to support my unreliable memory. I swear I've seen a staff list, though.

 

I'd think it would be a pretty sweet surgical gig - specializing in a relatively simple procedure in volume, with a very low complication rate and next-to zero call.

 

I think its a mix of RC and CCFP docs.

 

As a surgeon I think it would be mind numbing.

[aaronjw]

I think its a mix of RC and CCFP docs.

 

As a surgeon I think it would be mind numbing.

 

Agree. Can't imagine it's all that enjoyable or challenging especially since their patients are hand-picked.

[ploughboy]

I think its a mix of RC and CCFP docs.

 

As a surgeon I think it would be mind numbing.

 

No disagreement there. As an emerg doc and icu-wannabe I also think it would be pretty dull, but I bet there are surgeons out there who have reached a point in their career where opting for "routine, predictable, home for dinner at 6 and sleep in my own bed at night" seems pretty darn appealing. Doubt that Shouldice has trouble recruiting.

[NLengr]

No disagreement there. As an emerg doc and icu-wannabe I also think it would be pretty dull, but I bet there are surgeons out there who have reached a point in their career where opting for "routine, predictable, home for dinner at 6 and sleep in my own bed at night" seems pretty darn appealing. Doubt that Shouldice has trouble recruiting.

 

To their credit, their failure rate for the repair is very very low.

[BoyInTheBubble]

If I recall correctly, the hernia surgeons at the Shouldice hospital are GPs not FRCSC surgeons. I mean, I almost did an entire inguinal hernia repair as a med student.

 

Having said that, it strikes me that some of these rural areas are not really that remote (Prince Albert, really?) and should have at least a surgeon around. Somewhere like St Anthony on the Northern Peninsula of Newfoundland is arguably more remote than your average rural Prairie town yet manages to have numerous subspecialty services (and apparently a great experience for electives).

 

St Anthony is a great experience for electives!

 

The region benefitted from the well-established Grenfell Mission. It was endorsed/supported by some relatively famous surgeons and politicians throughout the years. I think it's a bit of an obscurity, but a real gem.

 

A few years back, they had two permanent general surgeons with support from various rotating locums. The surgeons, at least one of them (he's doesn't need to be named, but he's fairly famous!) was planning his retirement. And hopefully they found a replacement (or two!) to fill a big void.