Developing practice guidelines for anesthesia services in rural Canada: the importance of the family physician perspecti
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CORRESPONDENCE
Developing practice guidelines for anesthesia services in rural Canada: the importance of the family physician perspective Vaibhav A. Kamble, MD
. Beverley A. Orser, MD, PhD . C. Ruth Wilson, MD
Received: 5 May 2020 / Accepted: 7 May 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, The goal of the Guidelines to the Practice of Anesthesia1 published annually by the Canadian Anesthesiologists’ Society (CAS) is to promote safe and timely anesthesia care for all Canadians. This goal can only be achieved if physicians with the right clinical skills are available to the right patients in the right environment. We have concerns about how the 2020 edition of the Guidelines portray the provision of anesthesia care for rural Canadians in stating that: ‘‘The Canadian Anesthesiologists’ Society (CAS) acknowledges the fact that remote communities often lack the population base to support a specialist anesthesiology practice. In these communities, appropriately trained family physicians may be required to provide anesthesia services. In communities with the clinical volume to support full-time anesthesiologists,
The authors of the article: Can J Anesth 2020; 67: 64-99, respectfully declined an invitation to submit a reply to the above letter. V. A. Kamble, MD (&) Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada e-mail: [email protected] B. A. Orser, MD, PhD Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada Department of Anesthesia, Sunnybrook Health Sciences Centre, Toronto, ON, Canada C. R. Wilson, MD Department of Family Medicine, Queen’s University, Kingston, ON, Canada
fellowship-certified anesthesiologists should provide these services.’’1. This statement suggests that clinical volumes determine the best anesthesia care provider, with specialists being the first choice and family practice anesthesia providers a second-in-line alternative. The first concern with these guidelines is feasibility—i.e., despite high clinical volumes across Canada, there simply are not enough specialists available to service urban and rural areas. For example, in 2019, the Yarmouth Regional Hospital in Nova Scotia, which serves 58,000 people, was left with one anesthesiologist trying to serve a hospital usually staffed with four.2 The second concern is that in the large and complex Canadian healthcare system, ‘‘best practices’’ for anesthesia services should be determined by a community’s overall medical needs. For example, in Nunavut, the government funds only a limited number of salaried physicians. As such, Iqaluit (as with certain other remote communities) needs family physicians who can provide anesthesia care, not full-time specialists who are unable to support obstetric, inpatient medical, emergency, and office-based care. Other jurisdictions, such as Yellowknife in the Northwest Territories, are currently well served by locum specialists supporting a core group of family practice anesthesia providers. For decades,
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