What is ESS?

Enhanced Surgical Skills describe a set of defined competencies of rural family physicians, which generally include one or both of appendectomy and Caesarean section.

As a general rule, with many individual exceptions, the ESS workforce is divided between two distinct skill sets. The first, which we sometimes refer to as ESS Surgery, represents a broad skill set, including operative delivery, which are acquired either overseas or through one of the twelve month R3 programs at the U of A or U of S.

The second, which is sometimes referred to as ESS Operative Delivery (OD), represents a focused skill related to perinatal surgical services. This skill set can be acquired formally (three months or more in a regional hospital or teaching centre) or informally (local mentoring). This second group has a larger number of ESS physicians than the ESS Surgery group.

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In 2000 there were 151 ESS rural family physicians sustaining local surgical programs in rural communities in western and northern Canada. Although the number of these programs has shrunk significantly – 80 in 1995; 55 in 2011 – the number of ESS has remained stable at 140 (2011). There is some evidence that several of these smaller programs grew larger in volume, absorbing a workforce displaced from programs which closed.

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Although there has been a sizable attrition between 1995 (80 communities) and 2011 (55 communities), these are distributed across all of the western provinces – 11 in BC, 27 in Alberta, 8 in Saskatchewan, 5 in Manitoba, as well as 3 in Northern Ontario and 1 in NWT. These small volume rural surgical programs can generally be found:

  • in communities of 5,000‐15,000 where ESS physicians provide most or all of the local surgical care; and,
  • in communities of 15,000‐25,000 where there is usually a significant local specialist presence that is supported by ESS physicians, especially for on-call relief (a “mixed” model).

Sources

  1. Iglesias S, et al. Advanced skills by Canada’s rural physicians, Can J Rural Med, 1999, 4(4); 227-233
  2. Iglesias S, Jones L. Rural surgery programs in western Canada. Can J Rural Med, 2002, 7(2)
  3. Iglesias S. Unpublished data