Afford, Rebecca M., Bolin, Sara D., Morris-Janzen, Dunavan K., Mclellan, Alastair, Robbins, Nicole, Scott, Tracy M., and Karimuddin, Ahmer A.
Background: Rural general surgeons perform many procedures outside the conventional scope of the specialty. Unique to British Columbia, the Rural Practice Subsidiary Agreement (RSA) formally defines rurality in the province. Our goal is to understand the scope of practice for BC's rural general surgeons and whether it has been affected over time by changing privileging guidelines. Methods: Medical Services Plan (MSP) data were collected from 2011 to 2021 for procedures billed by general surgeons in communities defined by the RSA as rural. We categorized codes from the MSP based on surgical specialty. For each community, we calculated the totals for these categories considering what other surgical specialties were present as well as changes over time. Results: From 2011 to 2021, 222 905 procedures were performed in 23 rural communities in BC. Colonoscopies were the most frequently performed procedure (n = 80114, 35.9%), followed by colorectal (n = 23891, 10.7%) and hernia procedures (n = 20 911, 9.4%). The most common unconventional procedures were plastic surgeries (n = 8077, 3.6%). Classification within the RSA did not significantly influence the percentage of unconventional general surgery procedures performed (p = 0.4). When another surgical specialty was present, there was often a decrease in the number of that specialty's procedures performed by general surgeons. Over the past decade, rural general surgeons performed fewer unconventional general surgery procedures (p < 0.001). Conclusion: General surgeons working in rural communities perform a variety of procedures based on resources, community need, and access to other specialists. Over the last decade, this appears to have been influenced by new privileging guidelines. Understanding the scope of rural general surgery can inform training opportunities and, as there is a migration away from rural surgeons performing as many unconventional procedures, can elucidate the implications on patients and communities. Contexte : En r gion rurale, les chirurgiens g n ralistes effectuent beaucoup d'interventions sortant du cadre conventionnel de pratique de leur sp cialit . La Colombie-Britannique est actuellement la seule province avoir mis en place l'entente Rural Practice Subsidiary Agreement (RSA), qui d finit officiellement la ruralit dans la province. Notre objectif est de mieux d limiter le champ de pratique des chirurgiens g n ralistes exer ant en milieu rural en Colombie-Britannique et de d terminer s'il a t affect dans le temps par l' volution des directives concernant l'octroi de privil ges. M thodes : Des donn es du r gime d'assurance maladie de la province (Medical Services Plan, ou MSP) pour la p riode de 2011 2021 ont t recueillies pour les interventions factur es par des chirurgiens g n ralistes dans les communaut s d sign es rurales selon la RSA. Nous avons class les codes du MSP selon la sp cialit chirurgicale. Pour chaque collectivit , nous avons calcul les totaux pour ces cat gories, tout en tenant compte des autres sp cialit s chirurgicales pr sentes et des changements dans le temps. R sultats : De 2011 2021, 222 905 interventions ont t effectu es dans 23 collectivit s rurales en Colombie-Britannique. La colonoscopic tait l'intervention la plus courante (n = 80 114, 35,9%), suivie des chirurgies colorectales (n = 23 891, 10,7%) et des r parations de hernies (n = 20 911, 9,4%). Parmi les interventions non classiques, la chirurgie plastique occupait le premier rang (n = 8077, 3,6%). La classification selon la RSA n'a pas eu d'influence significative sur le pourcentage de chirurgies g n rales non classiques effectu es (p = 0,4). Lorsqu'un prestataire d'une autre sp cialit chirurgicale tait pr sent, on observait souvent une baisse du nombre d'interventions de cette sp cialit effectu es par les g n ralistes. Au cours de la derni re d cennie, les chirurgiens g n ralistes en milieu rural ont effectu moins d'interventions de chirurgie g n rale non classiques (p < 0,001). Conclusion : Dans les collectivit s rurales, les chirurgiens g n ralistes effectuent un ventail d'interventions qui varie selon les ressources, les besoins communautaires, et l'acc s d'autres sp cialistes. Durant la derni re d cennie, cette diversit semble avoir t influenc e par les nouvelles directives concernant l'octroi de privil ges. En connaissant le champ de pratique des chirurgiens g n ralistes en milieu rural, on peut guider les occasions de formation et, alors que les g n ralistes effectuent de moins en moins d'interventions non classiques, mieux comprendre ce que cela signifie pour la patient le et les collectivit s., For Canadians in rural, remote, and northern settings, access to specialty surgical care is more challenging than in urban communities. Although the Canada Health Act states that its primary objective [...]