Letter to the editor: response to “Surgeon unemployment: Would practice sharing be a viable solution?”

We read with great interest the article by Wakeam and Feinberg¹ regarding a shared practice model whereby a surgeon who is winding down practice partners with a young surgeon.

Does this type of practice model need only apply to a transition into and out of practice? Are there other forms of sharing a practice where efficient use of resources and mentoring can occur? Our shared practice model may represent an alternative.

Although our clinic, endoscopy and operative resources have not increased proportionally as we hire surgeons to our colorectal group, complete clinical integration has afforded us a work environment that is efficient, fun and, most importantly, provides great patient care. There is a 1-line system to “The Ottawa Colorectal Group,” whereby 1 surgeon in our group may provide the initial consultation and obtain consent for an operative procedure, which may be performed by any of the 3 surgeons (soon to be 4); our offices and administrative support are all in 1 area. At times, all 3 of us are in clinic together, but invariably there are extra operative days, endoscopy time, academic activities or vacation that usually lead to 2 surgeons working together in clinic. Consequently, a surgeon in our group may meet a patient for the first time on the day of an operation and therefore must rely on a partner to establish a therapeutic relationship. With an automatic second opinion available at the time of consult, or when we run the list of patients with their management plans (at the end of clinic with the entire team, including our administrative staff), patients are happy to know that multiple surgeons are involved in their care. This also extends to the operating room, where we are consistently in each other’s rooms. There is also “round the clock” coverage of patients in all clinical settings (i.e., clinic to operating room), as the schedule is set up to ensure that at least 1 surgeon is always available. Hence, resources are not wasted, and inpatients receive consistent care through a rotating weekly coverage schedule (which is really nice from a lifestyle perspective). As eluded to, we are able to capture extra resources that become available, and now, as we expand to a fourth surgeon, we are extending beyond the academic centre to work with a large community hospital where, as a group, we will have privileges and regular operative time. This new partnership will not only foster mentorship within our group but also provide a means to mentor community-based surgeons wishing to learn new techniques in colorectal surgery, thereby enhancing patient care throughout our region. The right people are crucial for this model to work, as it is built on trust — personalities, technical skills, judgment and core value systems need to be aligned. We also need to communicate regularly and frequently — a good electronic medical record would facilitate improvement.

As general surgeons, we see this concept in action on the acute care service, which is replacing the traditional emergency surgery model; our shared practice represents a similar evolution within the elective setting.