Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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A 20-Year Update on the Practice of Thoracic Surgery in Canada: A Survey of the Canadian Association of Thoracic Surgeons

  • Sami Aftab Abdul (Division of Thoracic Surgery, The Ottawa Hospital General Campus) ;
  • Frances Wright (Department of Surgery, Faculty of Medicine, University of Toronto) ;
  • Christian Finley (Department of Surgery, Faculty of Medicine, McMaster University) ;
  • Sebastien Gilbert (Division of Thoracic Surgery, The Ottawa Hospital General Campus) ;
  • Andrew J. E. Seely (Division of Thoracic Surgery, The Ottawa Hospital General Campus) ;
  • Sudhir Sundaresan (Division of Thoracic Surgery, The Ottawa Hospital General Campus) ;
  • Patrick J. Villeneuve (Division of Thoracic Surgery, The Ottawa Hospital General Campus) ;
  • Donna Elizabeth Maziak (Division of Thoracic Surgery, The Ottawa Hospital General Campus)
  • Received : 2023.07.25
  • Accepted : 2023.08.21
  • Published : 2023.11.05
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Abstract

Background: This study provides an update to a landmark 2004 report describing demographics, training, and trends in adherence to thoracic surgery practice standards in Canada. Methods: An updated questionnaire was administered to all members of the Canadian Association of Thoracic Surgeons via email (n=142, compared to n=68 in 2004). Our report incorporates internal data from Ontario Health and the Canadian Partnership Against Cancer. Results: Forty-eight surgeons completed the survey (male, 70.8%; mean±standard deviation age, 50.3±9.3 years). This represents a 33.8% response rate, compared to 64.7% in 2004. Most surgeons (69%) served a patient population of over 1 million per center; 32%-34% reported an on-call ratio of 1:4-1:5 days, and the average weekly hours worked was 56.4±11.9. Greater access to dedicated geographic units per center (73% in 2021 vs. 53% in 2004) has improved thoracic-associated services and house staff, notably endoscopy units (100% vs. 91%), with 73% of respondents having access to both endobronchial and endoscopic ultrasound. Access to thoracic radiology has also improved, particularly regarding positron emission tomography scanners per center (76.9% vs. 13%). Annual case volumes for lung (255 vs. 128), esophageal (41 vs. 19), and mediastinal resections (30 vs. 13), along with hiatal hernia repair (45 vs. 20), have increased substantially despite reports of operating room availability and radiology as rate-limiting steps. Conclusion: This survey characterizes compliance with current practice standards, addressing the needs of thoracic surgeons across Canada. Over 85% of respondents were aware of the 2004 compliance paper, and 35% had applied for resources and equipment in response.

Keywords

Acknowledgement

We extend our gratitude to the members of CATS for their participation in this survey. We also acknowledge Dr. Jennifer Artz, the Managing Director of CATS, for her administrative support in the digital distribution of the survey.

References

  1. Mulder DS, McKneally MF. The education of thoracic and cardiac surgeons: a Canadian initiative. Ann Thorac Surg 1995;60:236-8. https://doi.org/10.1016/0003-4975(95)00406-b 
  2. Deslauriers J, Pearson FG, Nelems B. Evolution of thoracic surgery in Canada. Can Respir J 2015;22:72. https://doi.org/10.1155/2015/318710 
  3. Darling GE, Maziak DE, Clifton JC, Finley RJ; Canadian Association of Thoracic Surgery. The practice of thoracic surgery in Canada. Can J Surg 2004;47:438-45. 
  4. Sundaresan S, Langer B, Oliver T, et al. Standards for thoracic surgical oncology in a single-payer healthcare system. Ann Thorac Surg 2007;84:693-701. https://doi.org/10.1016/j.athoracsur.2007.03.069 
  5. Prashad A, Mitchell M, Argent-Katwala M, Daly C, Earle CC, Finley C. Pan-Canadian standards for cancer surgery. Can J Surg 2019;62:S171-83. https://doi.org/10.1503/cjs.010419 
  6. Brenner DR, Poirier A, Woods RR, et al. Projected estimates of cancer in Canada in 2022. CMAJ 2022;194:E601-7. https://doi.org/10.1503/cmaj.212097 
  7. Moffatt-Bruce S, Crestanello J, Way DP, Williams TE Jr. Providing cardiothoracic services in 2035: signs of trouble ahead. J Thorac Cardiovasc Surg 2018;155:824-9. https://doi.org/10.1016/j.jtcvs.2017.09.135 
  8. Schieman C, Kelly E, Gelfand G, et al. Thoracic surgery training in Canada according to the residents: the thoracic surgery resident survey, of the Canadian thoracic manpower and education study (T-Med). J Surg Educ 2010;67:325-34. https://doi.org/10.1016/j.jsurg.2010.07.004 
  9. Schieman C, Seder CW, D'Amico TA, Grondin SC. General thoracic surgical training in North America: contrasting general thoracic surgery residencies in Canada and the United States. J Thorac Cardiovasc Surg 2018;156:2379-87. https://doi.org/10.1016/j.jtcvs.2018.07.016 
  10. Arnaout A, Prashad A, Dunk N, et al. National thoracic surgery standards implementation: barriers, enablers, and opportunities. Curr Oncol 2021;28:405-16. https://doi.org/10.3390/curroncol28010043 
  11. Ivanovic J, Maziak DE, Gilbert S, et al. Assessing the status of thoracic surgical research and quality improvement programs: a survey of the members of the Canadian Association of Thoracic Surgeons. J Surg Educ 2011;68:258-65. https://doi.org/10.1016/j.jsurg.2011.02.005 
  12. Ivanovic J, Anstee C, Ramsay T, et al. Using surgeon-specific outcome reports and positive deviance for continuous quality improvement. Ann Thorac Surg 2015;100:1188-95. https://doi.org/10.1016/j.athoracsur.2015.04.012 
  13. Edwards JP, Datta I, Hunt JD, et al. A novel approach for the accurate prediction of thoracic surgery workforce requirements in Canada. J Thorac Cardiovasc Surg 2014;148:7-12. https://doi.org/10.1016/j.jtcvs.2014.03.031 
  14. Grondin SC, Schieman C, Kelly E, et al. A look at the thoracic surgery workforce in Canada: how demographics and scope of practice may impact future workforce needs. Can J Surg 2013;56:E75-81. https://doi.org/10.1503/cjs.008412 
  15. Karas TZ, Accola KD. Reflections on 40 years of workforce surveys: how the times have changed. Ann Thorac Surg 2020;110:1090-1. https://doi.org/10.1016/j.athoracsur.2020.05.036 
  16. Edwards JP, Datta I, Hunt JD, et al. Forecasting the impact of stereotactic ablative radiotherapy for early-stage lung cancer on the thoracic surgery workforce. Eur J Cardiothorac Surg 2016;49:1599-606. https://doi.org/10.1093/ejcts/ezv421 
  17. Turner SR, Artz JD, Darling GE, et al. Diversity in national society leadership and podium speakers in cardiothoracic surgery. Ann Thorac Surg 2022;114:561-6. https://doi.org/10.1016/j.athoracsur.2022.01.044 
  18. Maziak DE, Darling GE, Inculet RI, et al. Positron emission tomography in staging early lung cancer: a randomized trial. Ann Intern Med 2009;151:221-8. https://doi.org/10.7326/0003-4819-151-4-200908180-00132 
  19. Canadian Cancer Statistics Advisory Committee in Collaboration with the Canadian Cancer Society, Statistics Canada and the Public Health Agency of Canada. Canadian cancer statistics 2021. Canadian Cancer Society; 2021.