Surgical care in small alberta communities.

A three-phase study was carried out in 1981 to determine the number of surgical procedures being done in Alberta communities with fewer than 10,000 inhabitants. Health insurance statistics grouped according to hospital and community size revealed that approximately 25% of physicians practicing in smaller communities did relatively uncomplicated major procedures, such as inguinal hernia repair. Those physicians who were surgically active tended to be versatile, carrying out procedures in several surgical disciplines. A questionnaire to individual hospitals revealed significant differences in procedural work between hospitals of similar size, serving similar populations. A second questionnaire showed that almost all rural hospitals, regardless of size, felt that the ability to monitor cardiac arrhythmias, provide physiotherapy and manage normal obstetrics was important and indicated that the importance of the ability to do surgical procedures varied according to the size of the hospital. The majority of physicians performing these procedures are not surgeons, and many of them will be retiring in the next ten years, so the training of their replacements becomes an important issue. While some consolidation of facilities will be inevitable, it should be combined with technological upgrading.