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**Issues and Barriers to Maternity Anesthesia Care in Hospitals with Low Obstetric Volumes -- the Ontario experience PPPPaaaammmmeeeellllaaaa AAAAnnnngggglllleeee MMMMDDDD FFFFRRRRCCCCPPPPCCCC MMMMSSSScccc CChhrriissttiinnee KKuurrttzzLLaannddyyRRNN MMSSccNNPPhhDD YYaammiinniiMMuurrtthhyy MMBBBBSS PPeetteerr CCiinnooMMDD CCCCFFPP SSuunnnnyybbrrooookk HHSSCC,, WWoommeenn''ss CCoolllleeggee HHoossppiittaall,, UUnniivveerrssiittyy ooff TToorroonnttoo,, MMccMMaasstteerr UUnniivveerrssiittyy,, HHaammiillttoonn,, OONN HHeeaaddwwaatteerrss HHeeaalltthh CCaarree CCeenntteerr,, OOrraannggeevviillllee,, OONN,, CCaannaaddaa DDiisscclloossuurree (cid:1)(cid:1) NNoo DDiisscclloossuurreess (cid:1)(cid:1) NNoo CCoommmmeerrcciiaall IInntteerreessttss (cid:1)(cid:1) NNoo CCoonnfflliicctt ooff IInntteerreessttss OObbjjeeccttiivveess (cid:1)(cid:1) PPrreesseenntt rreesseeaarrcchh rreellaatteedd ttoo tthhee OOnnttaarriioo MMaatteerrnniittyy AAnneesstthheessiiaa EExxppeerriieennccee (cid:1)(cid:1) LLooww vvoolluummee ((<<22000000 ddeelliivveerriieess)) OOBB cceenntteerrss (cid:1)(cid:1)(cid:1)(cid:1) LLLLaaaarrrrggggeeeerrrr cccceeeennnntttteeeerrrrssss////ggggrrrreeeeaaaatttteeeerrrr ssssyyyysssstttteeeemmmmssss iiiissssssssuuuueeee (cid:1)(cid:1) OOuurr rreeccoommmmeennddaattiioonnss (cid:1)(cid:1) UUppddaattee//EExxppeerriieenncceess ssiinnccee tthhee ssttuuddyy BBaacckkggrroouunndd (cid:1)(cid:1) SSuummmmeerr 22000044,, iinnvviittaattiioonn bbyy OOMMCCEEPP (cid:1)(cid:1) FFuullll RReeppoorrtt ttoo MMiinniissttrryy ooff HHeeaalltthh && LLoonngg--tteerrmm ccaarree,, NNoovveemmbbeerr 22000055.. (cid:1)(cid:1) hhhhttttttttpppp::::////////wwwwwwwwwwww....wwwwoooommmmeeeennnnssssrrrreeeesssseeeeaaaarrrrcccchhhh....ccccaaaa////PPPPDDDDFFFF////pppprrrrooooggggrrrraaaammmmssss////MMMMaaaatttteeeerrrrnnnniiii ttyy%%2200AAnneesstthheessiiaa%%2200RReeppoorrtt__..ppddff (cid:1)(cid:1) OOMMCCEEPP rreeppoorrtt,, AAppppeennddiixx DD (cid:1)(cid:1) PPuubblliiccaattiioonn:: sseeccoonnddaarryy aannaallyyssiiss// hhoossppiittaallss wwiitthh llooww vvoolluummee ddeelliivveerriieess ((<<22000000)) (cid:1)(cid:1) CCaannaaddiiaann JJ ooff AAnneesstthheessiiaa 22000099 MMaatteerrnniittyy SSeerrvviicceess iinn OOnnttaarriioo (cid:1)(cid:1) CChhiillddbbiirrtthh:: AA lleeaaddiinngg ccaauussee ooff hhoossppiittaall aaddmmiissssiioonn (cid:1) Trends: Increasing Urbanization of Low risk Care: (PPPESO 2005) (cid:1) Level 2 & 3 hospitals: > 50% Low risk (PPPESO 2006) (cid:1) Level l Maternity Services Closures smaller communities (cid:1) Maternal choice (PPPESO) (cid:1) Similar issues in BC (CJRM, 2010) MMaatteerrnniittyy SSeerrvviicceess iinn OOnnttaarriioo (cid:1) Supply of Low Risk Maternity Care providers (cid:1) MCP2, OMCEP, Babies Can’t Wait (cid:1) Anesthesia?? (cid:1)(cid:1) SSyysstteemm CCaappaacciittyy:: ffuuttuurree ggrroowwtthh (cid:1) 25 year Ontario Ministry of Finance mid-range forecast >32% increase in population (cid:1) 30% increase in the birth rate NNaattuurree ooff AAnneesstthheessiiaa SSeerrvviicceess (cid:1)(cid:1) MMeeddiicciinnee,, PPhhaarrmmaaccoollooggyy,, MMaatteerrnniittyy AAnneesstthheessiiaa CCaarree PPhhyyssiioollooggyy,, PPaatthhoopphhyyssiioollooggyy (cid:1)(cid:1) OOppeerraattiinngg RRoooomm (cid:1)(cid:1) BBrreeaaddtthh aanndd ssppaann ooff lliiffee:: (cid:1)(cid:1) NNeeoonnaattaall ttoo GGeerriiaattrriicc CCaarree (cid:1)(cid:1) IInnssttrruummeennttaall//CCeessaarreeaann DDeelliivveerryy//EEmmeerrggeennccyy (cid:1)(cid:1) TTrraauummaa TTeeaamm lleeaaddeerr HHyysstteerreeccttoommyy//RReettaaiinneedd (cid:1)(cid:1)(cid:1)(cid:1) CCCCaaaarrrrddddiiiiaaaacccc AAAArrrrrrrreeeesssstttt TTTTeeeeaaaammmm////TTTTeeeeaaaammmm lllleeeeaaaaddddeeeerrrr PPllaacceennttaa (cid:1)(cid:1) OOppeerraattiinngg RRoooomm (cid:1)(cid:1) MMaatteerrnnaall RReessuusscciittaattiioonn (cid:1)(cid:1) IInntteennssiivvee CCaarree (cid:1)(cid:1) RRaaddiioollooggyy ssuuiittee (cid:1)(cid:1) NNeeoonnaattaall RReessuusscciittaattiioonn (cid:1)(cid:1) EEmmeerrggeennccyy WWaarrdd (cid:1)(cid:1) CCrriittiiccaall CCaarree (cid:1)(cid:1) AAccuuttee PPaaiinn (cid:1)(cid:1) CCoonnssuullttaattiioonn (cid:1)(cid:1) CChhrroonniicc PPaaiinn (cid:1)(cid:1) CCoonnssuullttaattiioonn (cid:1)(cid:1) LLaabboorr PPaaiinn RReelliieeff LLaabboorr && DDeelliivveerryy CCoonnttrriibbuuttiioonn bbyy MMaatteerrnniittyy PPrroovviiddeerr TTyyppee AAnneesstthheessiioollooggyy//FFPP PPrriimmaarryy MMaatteerrnniittyy CCaarree AAnneesstthheessiiaa PPrroovviiddeerrss (cid:1)(cid:1) PPPPPPEESSOO 22000066 ((OOnnttaarriioo)) (cid:1)(cid:1) OObbsstteettrriiccss 8866%% ((22000066)) (cid:1)(cid:1) >>3322..66 %% EEsssseennttiiaall sseerrvviicceess ((2288%% CC--sseeccttiioonn;; 44..66%% FFoorrcceeppss)) (cid:1)(cid:1) 5599%% vvaaggiinnaall bbiirrtthhss hhaadd aann (cid:1)(cid:1) FFPP 99%% eeppiidduurraall (cid:1)(cid:1) MMiiddwwiivveess 44%% (cid:1)(cid:1) CCoommbbiinneedd:: MMaatteerrnniittyy AAnneesstthheessiiaa CCaarree >> 6600%% ooff WWoommeenn (cid:1)(cid:1) DDooeessnn’’tt iinncclluuddee ootthheerr aanneesstthheessiiaa sseerrvviicceess AAnneesstthheessiiaa SSeerrvviicceess PPrroovviissiioonn (cid:1) Human Resources Shortage (cid:1) Specialist Anesthesiologists (Byrick, Craig, Ryten) (cid:1) Family Physician Anesthetists (cid:1) 2%(Quebec) -20%(Saskatchewan) Anesthesia Care (cid:1)(cid:1) 8800 FFTTEE AAnneesstthheessiioollooggiissttss ((AACCUUDDAA,, RRyytteenn)) (cid:1)(cid:1) SSuurrvveeyy FFPPAA,, BBrroowwnn 22000055 ((nn==119955,, 8822%% RReessppoonnssee)) (cid:1)(cid:1) 5599%% ooff 112288 OOnnttaarriioo hhoossppiittaallss hhaadd >>11 FFPPAA (cid:1)(cid:1) FFPPAA aarree SSoollee pprroovviiddeerrss iinn 3399%% ooff hhoossppiittaallss (cid:1)(cid:1) SSmmaallll,, rruurraall,, rruurraall rreemmoottee hhoossppiittaallss FFaammiillyy PPhhyyssiicciiaann AAnneesstthheessiiaa HHRR SShhoorrttaaggee (cid:1)(cid:1) CCrraaiigg CCJJAA 22000022 (cid:1)(cid:1) 11998866--11999966:: 3322..66%% FFPPAAnneesstthheettiissttss (cid:1)(cid:1) 11999955--22000000:: 2222%% FFPPAAnneesstthheettiissttss (cid:1)(cid:1)(cid:1)(cid:1) CCCCuuuuttttssss ttttoooo mmmmeeeeddddiiiiccccaaaallll sssscccchhhhoooooooollll eeeennnnrrrroooollllllllmmmmeeeennnntttt 1111999988885555 (cid:1)(cid:1) LLoossss ooff rree--eennttrryy ppoossiittiioonnss ffoorr ttrraaiinniinngg iinn AAnneesstthheessiiaa 11999911 (cid:1)(cid:1) AAvveerraaggee bbuurrnnoouutt ~~ 55 yyeeaarrss ppoosstt ttrraaiinniinngg ((SSeeaall,, CCJJRRMM 22000011 PPhhyyssiicciiaannss))

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there's a new breed of locum physician out there, who's cherry-picking their opportunities. And there's a lot of places [hospitals] …that seem to be able to up the ante a bit … so it's very difficult to find people that want to come…. We as anesthetists with an APP … basically have no suppo
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there's a new breed of locum physician out there, who's cherry-picking their opportunities. And there's a lot of places [hospitals] …that seem to be able to up the ante a bit … so it's very difficult to find people that want to come…. We as anesthetists with an APP … basically have no suppo

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