Need for GP anesthetists

Canadian Medical Association Journal 1996; 154: 300

[Letters]

We feel that Dr. A. Wayne Barry's recommendation concerning funding of positions in anesthesia for general practitioners (GPs) ("Meeting the challenge: providing anesthesia services in rural hospitals," CMAJ 1995; 153: 1455- 1456 [full text / résumé]) needs to be tempered with the reality of rapidly changing health care delivery in some of the provinces surveyed by Drs. Patrick M. Chiasson and Peter D. Roy ("Role of the general practitioner in the delivery of surgical and anesthesia services in rural western Canada," CMAJ 1995; 153: 1447-1452 [abstract / résumé]). Since the formation of the Regional Health Authorities in Alberta, we have witnessed a major change in the distribution of surgical services. The demographic aspects of anesthetists' practices in Alberta have changed, and this is not reflected in the survey by Chiasson and Roy.

A GP trainee recently completed training with us only to find that the community hospital where she worked, which had been identified as "in need" at the outset of training, no longer provided surgical services. This has created great concern for us, since we are involved in recruiting and training GP anesthetists.

Barry states that there are ample positions available for all specialist anesthetists in large and medium-sized hospitals in Canada. This is patently untrue in central Alberta. Of seven recently certified specialists in anesthesia in the residency program at the University of Alberta, only three obtained permanent positions, and two of these positions were in another province. In light of the limited work opportunities for recent graduates, the assumption that rural centres should be staffed with GP anesthetists only should be reviewed.

Our committee in charge of the training program in GP anesthesia has reduced the number of positions, and our funding program takes into consideration human-resource needs within a Regional Health Authority when accepting an applicant for such a position. Our program has concurrently experienced an increase in applicants for GP-anesthesia training since a change in the path to specialty training through the Royal College of Physicians and Surgeons of Canada. Because it is now almost impossible for a GP with an interest in anesthesia to return for specialty training, many GP trainees who wish to maintain their interest and improve their marketability are seeking access to anesthesia via our training program. This is an unfortunate misalignment of specialty interest and job availability.

The 1988 CMA report to General Council on GP-anesthesia training made many recommendations concerning the provision of anesthesia services by nonspecialists. But the CMA's subsequent action has not been as timely as we had wished. We urge the CMA to work with the Canadian Anaesthetists Society and provincial licensing authorities to establish clearer definitions of training requirements, practice limitations, maintenance of competence and human-resource needs in order to identify the optimal role for GPs who provide anesthesia services.

Ramona A. Kearney, MD, FRCPC
Director
Anaesthesia Residency Program
University of Alberta
Dan P. Gray, MD, FRCPC
Rural Practice Coordinating Committee
University of Alberta
Edmonton, Alta.

| CMAJ February 1, 1996 (vol 154, no 3) |