Plastic Surgery

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Research Paper Outline Plastic Surgery Section - Specialties Recruiting and Retention Fund November 6, 2012 Attn: Mr. Eric J. Harris, Q.C. From: Stan Valnicek, MD, Section Head – Plastic Surgery Dear Mr. Harris Thank you for taking the time to review our submission for the SRRF. We have tried to organize it into logical sections representing the issues that we face as a Section. Our argument is based on data from the following sources: 1. Canadian Institute for Health Information http://www.cihi.ca 2. Medical Services Plan (MSP) BC Payment Information 2010/11 report (Latest) 3. Survey of our section membership – October 2012 (83% response rate)

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I have included the raw data in the appendix to this submission. We have tried to use the latest available data sets from sources independent to our section in order be fair and accurate in our claims. I am happy to provide all additional documentation and supporting evidence for items in this submission as required. The goal of this submission is to protect the provision of public hospital based plastic surgery services in the province of BC. Recent media attention in the Vancouver Sun has brought light to the long waits our patients face in the public system: http://www.vancouversun.com/health/Operation+Delayed/7494235/story.html Part of the public issue relates to limited hospital resources in the BC public health care system. Barriers to recruitment are primarily driven by availability of OR time and the willingness of Health Authorities to provide the necessary resources for new surgeons. Low remuneration does affect recruitment in areas of the province that are chronically underserviced since competitive rural opportunities exist across Canada even when major urban areas are well staffed. Our main issue as a section is retention of surgeons within the public system and this is primarily driven by significant intra and inter-provincial income discrepancies that put us near the bottom of all surgical specialties.

Research Paper Outline 0. Definition of Plastic Surgery Plastic surgery is a misunderstood specialty and it is surprising to us how pervasive the misconceptions are among not just the public but also our colleagues in the medical profession. Media portrayals of cosmetic surgery have led to unfortunate distortions and harmful attitudes, which over the years have had significant negative impact on our profession and particularly on remuneration for public work. Plastic surgery as a specialty grew out of the need to address the management of complex wound healing issues in patients with severe burns, spinal cord injuries, major trauma or defects caused by the extirpation of cancers. This is still the core of our profession today. One hundred years ago skin grafting did not exist and even moderate burns were fatal or led to severe contractures and lifelong disability. Patients who had breasts or parts of their face removed spent their remaining lives disfigured and often shunned. Spinal cord injured patients lived with massive bedsores severely restricting their mobility and independence. Children born with congenital anomalies such as facial clefts were ostracized or worse. Those of us who carry out missions to the third world see the effects on patients and families in regions where plastic surgical care is not readily available. Plastic surgeons have also been pioneers in tissue transplantation, wound healing, nerve regeneration and tissue engineering. Rebuilding form and function has led to the development of entirely new areas such as hand and wrist surgery, facial trauma surgery, craniofacial surgery, microsurgery and skin cancer management. In the province of BC our plastic surgery section provides the majority of care in the following areas: - Disease and injury to hand and wrist - Disease and injury to the face - Burns - Congenital defects of the upper extremity or face - Reconstruction for defects from cancer ablation - Pressure sores in spinal cord...
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