Surgical Task-Sharing in the Western Canadian Arctic: A Networked Model Between Family Physicians with Enhanced Surgical Skills and Specialist Surgeons.

backgroundWith the loss of generalism in the surgical specialties, there has been a move in Canada to train family physicians in enhanced surgical skills (FP-ESS) to address the surgical needs of rural and remote populations. This research project sought to describe one network integrating FP-ESS and specialist surgeons, focusing on the role of FP-ESS and their relationship with specialist surgeons, in the surgical care of the Beaufort Delta Region of the Northwest Territories of Canada.

methodsUsing a participatory approach, semi-structured interviews were conducted with 22 stakeholders within the surgical system. Interviews were transcribed and reviewed, then imported into NVivo 12 for analysis. First-level coding was performed based on both deductive and inductive reasoning in an iterative fashion during interview collection to develop and refine the codebook. This was followed by second-level categorizing.

resultsThe FP-ESS physicians provide cesarean section services to maintain a local obstetrics program, to provide gastrointestinal endoscopy, and to provide emergency on-call support, as described by one stakeholder. FP-ESS work together with specialist surgeons through an informal network keeping surgical care as close to home as possible. FP-ESS within this health regions were seen as "a really big gain to the system."

conclusionsThis study deepens our understanding of rural surgical service delivery, in particular where FP-ESS and specialist surgeons function collaboratively. It also contributes to strengthening rural surgical systems in Canada and therefore to addressing the health gap between rural/remote/indigenous and urban populations.