CJA
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
This Article
Right arrow Abstract Freely available
Right arrow Résumé de cet Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Engen, D. A.
Right arrow Articles by Wang, L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Engen, D. A.
Right arrow Articles by Wang, L.
Canadian Journal of Anesthesia 52:18-25 (2005)
© Canadian Anesthesiologists' Society, 2005
General Anesthesia

A demand-based assessment of the Canadian anesthesia workforce – 2002 through 2007

[Évaluation des effectifs canadiens en anesthésie fondée sur la demande – de 2002 à 2007]

Dale A. Engen, MD, Gordon H. Morewood, MD FASE, Nancy J. Ghazar, MD, Ted Ashbury, MD FRCPC, Elizabeth G. VanDenKerkhof, DRPH and Louie Wang, MD FRCPC

From the Department of Anesthesiology, Queen’s University, Kingston, Ontario, Canada.

Address correspondence to: Dr. Gordon Morewood, Department of Anesthesiology, University of Pennsylvania Health System –Presbyterian Medical Center, 51 North 39th Street, Philadelphia, PA 19104, USA. E-mail: morewoog{at}uphs.upenn.edu


   Abstract
TOP
 Abstract
Introduction
 Methods
 Results
 Discussion
 APPENDIX Survey questionnaire
 References
 
Purpose: The number of anesthesia providers required by the Canadian health care system remains controversial. Questions persist regarding both the adequacy of the current supply and what the future demand will be. The purpose of this study was to quantify the number and adequacy of anesthesia providers in 2002, and predict the same for the year 2007.

Methods: All licensed health care facilities potentially employing anesthetic services were identified. On February 1st, 2002 a questionnaire was mailed to each institution. On April 1st, a second mailing was sent to non-responders. Those facilities that did not respond to either mailing were contacted by telephone.

Results: Responses were obtained from 831 of 891 (93%) health care facilities. Four hundred and twenty-six of the facilities employed anesthetic services. There were 1,610 operating rooms (ORs) in use daily, and 2,134 full-time equivalent (FTE) anesthesia providers were available to the institutions surveyed. Respondents identified an immediate need for 228 additional FTEs. Hospitals with less than five ORs or five FTEs reported higher vacancy rates than hospitals with greater than five ORs or five FTEs (P < 0.0001). Ontario (n = 85) and Quebec (n = 69) had the largest absolute deficits of FTEs and significantly greater odds of vacancies than western provinces (Ontario OR = 1.84, Quebec OR = 2.50). The projected need for 2007 was an additional 560 FTEs.

Conclusion: This is the first study to survey a national census of "consumers" of anesthetic services: Canadian health care facilities. The results indicate substantial current and worsening future shortages of anesthesia providers in Canada.


   Introduction
TOP
 Abstract
 Introduction
Methods
 Results
 Discussion
 APPENDIX Survey questionnaire
 References
 
LIMITED human resources will likely provide a major challenge to clinicians, hospital administrators and policymakers involved in Canada’s health-care system over the next several years.1,2 Recent surveys have revealed widespread public concern about access to medical specialists.3–5 Historically, Canadian physician resource planning has been based on simple head counts and physician-to-population ratios.1 In the past two decades, a number of reports based on these methodologies have predicted a potential physician surplus.1 For example, governmental responses to the Barer-Stoddart report resulted in an 11.3% reduction in Canadian medical school enrollments over three years in the early 1990’s.6 This was followed by a similar reduction in postgraduate positions in 1997.7 Simultaneously, re-entry positions for graduate medical training were reduced (historically a source of 40% of specialist anesthesiologists in Canada)6,7 and the Royal College of Physicians and Surgeons of Canada changed the assessment of training and specialty certification requirements for International Medical Graduates (IMGs) effectively limiting the supply of IMGs.8 In addition, as recently as 1998, academics were predicting that the aging of Canada’s population posed no threat of shortage to the Canadian physician supply in general, including most specialist groups.9 Analysis of their data shows that anesthesia was not included in this assessment and that they failed to appreciate the growing percentage of elderly that utilize most specialist surgical services.

Recognizing the impending shortage of anesthesia personnel, based primarily on the work of Donen et al.,7 the Association of Canadian University Departments of Anesthesia (ACUDA) commissioned a study designed specifically to address human resource planning within the specialty of anesthesia.10 This study culminated as the Ryten report which created a model based on "percapita" utilization of anesthetic services by age and gender. It demonstrated an increase in demand for anesthetic services in women of childbearing years (20–39 yr) and the elderly (> 60 yr).11 Projecting this model into the future, Byrick et al. demonstrated that by 2016 the demand for anesthesia services would increase by 31% despite an increase in the general population of only 18%, due to an increasing proportion of elderly.12 Craig et al. attempted to convert this future increased demand into specific numbers of physicians.13 According to their analysis, Canada was deficient 208 anesthesia providers in 1999, and a projected deficit of 656 would occur by 2016. However, they articulated a need for further study to validate their model and to update these conclusions.

Despite these studies, the number of anesthesia providers required by the Canadian health-care system remains controversial. Questions persist regarding both the adequacy of the current supply and what the future demand will be. Since the provision of anesthetic services remains primarily hospital based, it is one area of physician resource planning that is uniquely suited to questioning these "institutional consumers." As an alternative approach, the authors conceived a survey which would contact each health-care institution across Canada and obtain brief but fundamental information on anesthetic services. A single previous study, limited to specific centres within the province of Ontario, utilized a similar design in 1998.14 The purpose of this study was to characterize anesthesiology human resources for the whole of Canada. The main outcome was to quantify the number and adequacy of anesthesia providers in 2002, and predict the same for the year 2007.


   Methods
TOP
 Abstract
 Introduction
 Methods
Results
 Discussion
 APPENDIX Survey questionnaire
 References
 
After receiving approval from the Research Ethics Board of Queen’s University a questionnaire was sent to each health-care facility across Canada that might have employed anesthetic services.

The survey consisted of 13 multiple-choice or numerical-answer questions (Appendix). The questionnaire was printed on a single page with an English version on one side and French on the other. An addressed, stamped, return envelope and a brief bilingual cover letter explaining the objectives of the study were included.

The list of institutions to be surveyed was compiled from the registry of licensed health-care facilities maintained by each provincial government in combination with a proprietary database maintained by Southam Directories Incorporated. For each institution, the survey was addressed by name to (in decreasing order of preference) the Chair or Director of Anesthesia, the Chief Medical Officer, or the Chief Executive Officer. Each addressee was encouraged to delegate completion of the questionnaire to whichever individual within their institution they felt was best able to provide the information requested.

The survey was first mailed on February 1, 2002. Responding institutions were tracked by the use of unique identifying numbers on each questionnaire. On April 1, 2002 a second identical survey was mailed to all non-responding institutions. During June and July 2002, all remaining non-responding institutions were contacted directly by telephone.

All questions were closed-ended with categorical responses, therefore statistical analysis included frequencies and percentages on all variables. Variables included location and type of anesthetic services, and current (2002) and future (2007) full-time equivalent (FTE) needs. An FTE was defined as an anesthesiologist who was in hospital providing direct patient care 40 hr per week (Appendix). Cross-tabulations were performed on FTE deficit (i.e., proportion of unfilled positions) by; hospital size, number of operating rooms (ORs), number of available FTEs, population size, and province/region. Associations between vacancy rates and demographic characteristics were assessed using Chi-square for trend. Odds ratios and 95% confidence intervals (CI) were calculated to assess for the magnitude and the precision of the associations. Cross-tabulations were also calculated for response rates by province. Finally, net FTE deficits for this study were compared to studies in the literature. Analysis was performed using MS Excel and EpiInfo 2002.


   Results
TOP
 Abstract
 Introduction
 Methods
 Results
Discussion
 APPENDIX Survey questionnaire
 References
 
Eight hundred and ninety-one health-care facilities were identified for inclusion in the study. Eight hundred and thirty-one (93%) hospitals responded. After exclusion of redundant data due to hospital mergers and closures, the final data sheet consisted of 773 questionnaires.

Four hundred and twenty-six (55%) facilities employed anesthetic services. Twelve (2%) institutions that had no access to anesthetic services at the time of the survey identified a need for such services. Of the institutions that employed anesthesia services, there were approximately 1,610 ORs in use daily across the country. These institutions identified 2,134 FTE specialist anesthesiologists and family practice anesthesiologists, available to provide care nationally.

Anesthesia human resources in 2002 and 2007
The data regarding the availability of anesthesia providers is summarized in Table IGo. Sixty two percent of institutions that provide anesthetic services reported that they had an adequate supply of providers. Of note, however, 35% were understaffed and 228 FTE positions for anesthesia providers were reported as unfilled at the time of the survey. Furthermore, 46% of respondents anticipated expanding their need for anesthetic services by the year 2007. Overall, a need for 560 additional anesthesiologists by the year 2007 was identified.


View this table:
[in this window]
[in a new window]
  		TABLE I Current and future need for full-time equivalent (FTE) anesthesia providers
 
Geographic distribution
The largest absolute deficits of FTE anesthesiologists were found in Ontario (n = 85, 37%) and Quebec (n = 69, 30%; Figure 1Go).



View larger version (14K):
[in this window]
[in a new window]
  		FIGURE 1 Full-time equivalent anesthesiologist (FTE) deficit by province.

 
Demographic distribution (Table IIGo)
The proportion of vacancies (vacancy rate) was greater the smaller the hospital ({chi}2 for trend = 16.3) and least in hospitals with greater than 500 beds (OR = 0.49, 95% CI 0.31–0.77). Hospitals with five or more ORs reported proportionately fewer vacancies than hospitals with less than five ORs ({chi}2 = 28.6, P < 0.0001). Similarly, hospitals with five or more FTEs reported proportionately fewer vacancies than hospitals with less than five FTEs ({chi}2 = 43.2, P < 0.0001). Centres with a population of at least 250,000 had half the vacancy rate of centres with a population less than 50,000 (population 250,000–999,999 OR = 0.57, 95% CI 0.37–0.87; population 1,000,000 + OR = 0.56, 95% CI 0.37–0.86). Institutions in Ontario (OR = 1.84, 95% CI 1.26–2.69) and Quebec (OR = 2.50, 95% CI 1.68–3.72) had significantly greater odds of vacancies than those in western provinces.


View this table:
[in this window]
[in a new window]
  		TABLE II Health care institutional characteristics vs vacancy rate for anesthesia providers
 
Obstetrical services
A total of 369 respondent institutions from this survey reported an aggregate of 282,546 estimated annual births. By comparison, a total of 327,187 live births was reported by statistics Canada for July 1, 2001 to June 30, 2002.15 Only half of the institutions provided full-time epidural analgesia services, but these institutions encompassed 89% of all deliveries (Table IIIGo). Ninety-seven percent of all deliveries occurred in an institution where at least part-time epidural analgesia services were available.


View this table:
[in this window]
[in a new window]
  		TABLE III Characteristics of institutional epidural analgesia availability for labour and delivery
 
Non-OR activity
Anesthesiologists were also commonly active in many areas of the hospital outside the OR (Figure 2Go). In 318 (75%) of the respondent institutions that provided anesthetic services, anesthesiologists provided patient care in one or more locations other than the OR suite.



View larger version (13K):
[in this window]
[in a new window]
  		FIGURE 2 The provision of anesthesia services outside of the operating room. POC = preoperative clinic; ICU = intensive care unit; APM = acute/inpatient pain management service; CPM = chronic/outpatient pain management clinic; Rad = radiology suite; Cath = cardiac catheterization laboratory.

 

   Discussion
TOP
 Abstract
 Introduction
 Methods
 Results
 Discussion
APPENDIX Survey questionnaire
 References
 
This is the first study to survey a national census of "consumers" of anesthetic services: Canadian health care facilities. The results indicate substantial current and worsening future shortages of anesthesia providers across Canada. While these shortages affect the entire spectrum of health-care facilities across the country, they were greatest in smaller hospitals, smaller communities, and the provinces of Ontario and Quebec.

Strengths of this study included the excellent response rates from all regions of the country (Table IVGo); the direct querying of the "consumers" of anesthesia services; and the use of a standardized number of hours per week to define a FTE anesthesiologist. The 93% response rate allows confidence that the results are representative of the nation overall. The direct questioning of individuals in the institutions in which anesthetic services were utilized allowed us to obtain direct estimates of need rather than theoretical projections. The sensitivity of physician demand to number of hours worked per week as emphasized by Ryten11 prompted the decision to clearly define a FTE anesthesia provider. Forty hours spent per week providing direct patient care appears to be a reasonable number based on the results of a recent survey of anesthesiologists.16


View this table:
[in this window]
[in a new window]
  		TABLE IV Institutional response rate by province
 
A weakness of the present study is that the specific individual completing the questionnaire in each case was not identified. It is possible that clinicians and administrators might have interpreted anesthesia resource needs differently. However, the designation of a FTE based on hours of direct patient care was intended to allow any individual within the institution to objectively translate OR, intensive care unit, or clinic hours directly to FTE requirements. A second weakness is that we did not address how many additional FTE anesthesiologists would be required to enable researchers, educators, and physician leaders to pursue academic and administrative endeavours.

The deficit numbers reported in this study were somewhat greater than those of previous reports. One explanation for this discrepancy is the inclusion of both specialist anesthesiologists and family physician anesthesiologists nationwide in the current survey. Yang et al. studied ten urban institutions in Ontario and did not attempt to measure shortages in rural areas.14 Craig et al. extrapolated data from the Ryten report that was modelled on billing patterns for anesthesia services in Quebec. There are very few family practice anesthesiologists working within this province,11 thereby likely under-representing national shortages in this group.

Within anesthesia, physician resource planners now have two studies, utilizing distinctly different methodologies, which show that the current supply of anesthesiologists is inadequate and that the deficit will worsen over the next five years (Table VGo). The consistency of these findings provides support for the use of Ryten’s model in calculating future anesthesia resource needs. Ryten’s report recommended graduating 150 FTE anesthesiologists per year to correct our current deficit and the predicted additional demand by the year 2016.11 The Canadian post-graduate medical education system currently produces 80 to 90 specialist anesthesiologists,13 and fewer family physician anesthesiologists per year.17 In addition, not all specialist anesthesiologists are entering clinical practice11 and the average anesthesia career length of family physician anesthesiologists is only ten years.7 Making the shortages worse, Canadian physicians are training longer, are older as a group, and are retiring at an increasing rate.18


View this table:
[in this window]
[in a new window]
  		TABLE V Comparison of current and predicted national deficits of full-time equivalent (FTE) anesthesiologists between studies
 
The specialty of anesthesia is uniquely intertwined with most aspects of modern medicine. In the United Kingdom it is estimated that anesthesiologists are involved in the care of two thirds of all patients admitted to hospital.19 The recent Romanow report, Commission on the Future of Health Care in Canada, confirms that Canadians highly value their universal, accessible, single payer health-care system.20 However, as exemplified by news reports over the past few years, with the worsening shortage of anesthesiologists waiting lists will grow (a recent report states that waiting times have grown on average by 77% between 1993 and 2002),21 surgeries will be cancelled,22 ORs will be closed,23 and diagnostics tests will be delayed. This will accelerate the frustration felt by patients, family physicians and other specialists already struggling with an overtaxed system.

Finally, there is an urgent need to determine why all specialist anesthesiology graduates are not entering clinical practice and why family physician anesthesiologists make limited use of their anesthesia training.1,11 The barriers to IMGs and to the return of Canadian anesthesiologists trained or practicing abroad need to be investigated to ensure that we are not unnecessarily foregoing these valuable resources. Also, as recommended by recent government and academic reports, Canada needs to increase medical school, postgraduate, re-entry and IMG training positions and evaluate whether or not the current pedagogy is relevant for our health care system.1,2,11,24,25 Just as important, we need to consider rejuvenating the medical profession by decreasing the length of training or by reducing the time spent in pre-medicine years. New models of delivering health care, including the appropriate use of anesthesia assistants, need to be explored to increase clinical output and emphasize the role of physicians as diagnosticians.1,24 An inevitable result of inaction will be the withdrawal of anesthesiologists’ from participation in patient care other than in the OR. This would have a negative impact not only on patient care, but also on the development of the specialty itself. A national human resources plan that is specialty-specific is required.7,11,13 The Canadian Medical Forum Task Force Two and the possible creation of the Health Institute for Human Resources, as recommended by the Canadian Medical Association,26 appear to be positive initiatives. However, the Canadian Anesthesiologists’ Society should be proactive and lead the way on this issue in order to preserve the future of the profession.


   APPENDIX Survey questionnaire
TOP
 Abstract
 Introduction
 Methods
 Results
 Discussion
 APPENDIX Survey questionnaire
References
 
The questionnaire was printed as a single page with English on one side and French on the other. Answers to multiple choice questions were indicated by "check boxes."

  1. Name of Hospital(s):_____
  2. Province in which your institution is located:_____
  3. Local urban population: < 10,000; 10,000–49,999; 50,000–99,999; 100,000 – 249,999; 250,000 –999,999; > 1,000,000
  4. Surgical services routinely available at your institution include (check all that apply): None; General; Orthopedic; Neuro; Cardiac
  5. The number of acute care beds at your institution is: 0; 1 – 50; 51 – 100; 101 – 300; 301 – 500; > 500
  6. The approximate number of obstetrical deliveries annually is:_____
  7. Is care available from an anesthesiologist at your institution? yes, 24 hr per day, seven days per week; yes, 24 hr on some days, but less than seven days per week; yes, but only on a scheduled basis; no, but it is needed; no, it is not needed (skip remainder of questionnaire and return in enclosed envelope)
  8. Average number of operating rooms used daily at your institution:_____
  9. Are epidurals provided by an anesthesiologist for labour and delivery? not applicable (no obstetrical services provided); no, epidurals are not available to obstetrical patients; no, but the physician providing obstetrical care may also provide this service; yes, during the day if an anesthesiologist is available; yes, 24 hr per day
  10. Other locations where anesthesiologists provide scheduled care at your institution (check all that apply): intensive care unit; cardiac catheterization laboratory; radiology suite; pain service - (acute/inpatient, chronic/outpatient); preoperative assessment clinic; other (specify):_____
  11. For the purposes of the last three questions, anesthesiologists who work less than full-time should be defined on the basis of Full Time Equivalents (FTEs). One FTE anesthesiologist is expected to be in the hospital providing patient care roughly 40 hr per week. For example, an institution that has two anesthesiologists who each work 30 hr per week would have 1.5 FTE anesthesia providers available. ([30 + 30] 40 = 1.5)
  12. The total number of full-time and FTE anesthesia providers at your institution is:_____
  13. The number of full-time and FTE anesthesia providers currently available is: about right; too few (number of FTE anesthesia positions unfilled:_____); too many (excess number of FTE anesthesia providers:_____)
  14. As best as you can estimate, five years from now the number of full-time and FTE anesthesia providers needed by your institution will be: unchanged; fewer (estimate number of positions eliminated:_____); more (estimate number of positions added:_____)


   Acknowledgments
 
Michael Warner and Jennifer Bond for administrative assistance.


   Footnotes
 
Support: Material and financial support for this project was provided solely by the Department of Anesthesiology at Queen’s University.

Accepted for publication May 3, 2004. Revision accepted October 15, 2004.


   References
TOP
 Abstract
 Introduction
 Methods
 Results
 Discussion
 APPENDIX Survey questionnaire
 References
 
1 Canadian Medical Forum Task Force Two: A Physician Resource Strategy for Canada. Physician Workforce in Canada: Literature Review and Gap Analysis. January 2003.

2 Kirby M, Breton M. The Health of Canadians – The Federal Role – Final Report. The Standing Committee on Social Affairs, Science, and Technology. October 2002.

3 Canadian Medical Association. Ipsos-Reid. National Report Card 2001 Report, updated September 2001.

4 Blendon RJ, Schoen C, DesRoches C, Osborn R, Zapert K. Common concerns amid diverse systems: health care experiences in five countries. Health Aff (Millwood) 2003; 22: 106–21.[Abstract/Free Full Text]

5 The Canadian health care system: views and experiences of adults with health problems. The Commonwealth Fund 2002 international health policy survey. May 2003.

6 Barer ML, Stoddart GL. Toward integrated medical resource policies for Canada: 1. Background, process and perceived problems. CMAJ 1992; 146: 347–51.[Medline]

7 Donen N, King F, Reid D, Blackstock D. Canadian anesthesia physician resources: 1996 and beyond. Can J Anesth 1999; 46: 962–9.[Abstract/Free Full Text]

8 The Royal Physicians and Surgeons of Canada. Memoranda to Deans of Medicine, Associate Deans, Postgraduate Medical Education, Provincial Registrars. Subject: Foreign Medical Degrees and Foreign Training. October 17, 1996 and December 9, 1996. Ottawa, 1996.

9 Roos NP, Bradley JE, Fransoo R, Shanahan M. How many physicians does Canada need to care for our aging population. CMAJ 1998; 158: 1275–84.[Abstract]

10 Seal R, Reid D. Submission to the Romanow Commission from CAS/ACUDA. October 31, 2001.

11 Ryten E. A physician workforce planning model for the specialty of anesthesia: theoretical and practical considerations. Association of Canadian University Departments of Anesthesia. Available from URL: http://www.anesthesia.org/acuda/en/ryten.html - last accessed October 24, 2003.

12 Byrick RJ, Craig D, Carli F. A physician workforce planning model applied to Canadian anesthesiology: assessment of needs. Can J Anesth 2002; 49: 663–70.[Abstract/Free Full Text]

13 Craig D, Byrick R, Carli F. A physician workforce planning model applied to Canadian anesthesiology: planning the future supply of anesthesiologists. Can J Anesth 2002; 49: 671–7.[Abstract/Free Full Text]

14 Yang H, Byrick R, Donen N. Analysis of anesthesia physician resources: projected Ontario deficit in 2005. Can J Anesth 2000; 47: 179–84.[Abstract/Free Full Text]

15 Statistics Canada. CANSIM II, table 051-0004. Last modified June 27, 2003.

16 Ghazar N, Morewood GH, Engen D, Ashbury T, VanDenKerkhof EG, Wang L. Gender differences in the Canadian anesthesia workforce. Can J Anesth 2003; 50: A109 (abstract).[Free Full Text]

17 Society of Rural Physicians of Canada Group. Joint position paper on training for rural family physicians in anesthesia. November, 2001.

18 Chan BT. Canadian institute for health information report. From perceived surplus to perceived shortage: what happened to Canada’s physician workforce in the 1990’s? June 2002.

19 Audit Commission. Anesthesia under examination. The efficiency and effectiveness of anaesthesia and pain relief services in England and Wales. London: Audit Commision, 1997.

20 Romanow RJ. Commission on the future of health care in Canada. Building on values. The future of health care in Canada. Final report, November 28, 2002.

21 Hawaleshka D. Cut the wait times, Macleans, October 27, 2003.

22 Orwen P. Surgery crisis looming. Toronto Sunday Star. December 1, 2002.

23 Haley L. Vancouver ORs forced to close due to shortage of physicians. The Medical Post. November 19, 2002; vol 38: iss 42.

24 McKendry R. Physicians for Ontario – Too Many? Too Few? For 2000 and Beyond. Report of the fact finder on physician resources in Ontario. December 1999.

25 The Association of Canadian Medical Colleges. Strategic planning for a sustainable system of health care in Canada. Brief to the Commission on the future of health care in Canada. October 31, 2001.

26 Wharry S, Sullivan P. CMA calls for "more hands on deck." CMA Interface 2003; vol 4: no 10.




This article has been cited by other articles:


Home page
 Canadian J. AnesthesiaHome page
P. K. Morley-Forster
Tomorrow and tomorrow and tomorrow: wait times for multidisciplinary pain clinics in Canada/Demain, et demain, et demain : les temps d'attente dans les cliniques de la douleur pluridisciplinaires au Canada
Can J Anesth, December 1, 2007; 54(12): 963 - 968.
[Full Text] [PDF]

Home page
 Canadian J. AnesthesiaHome page
D. R. Bevan
The future of academic anesthesia departments in Canada/L'avenir des departements universitaires d'anesthesie au Canada.
Can J Anesth, June 1, 2006; 53(6): 533 - 539.
[Full Text] [PDF]

Home page
 Canadian J. AnesthesiaHome page
N. Donen and J.-F. Hardy
Anesthesia physician resources - time to change the focus/Les ressources medicales en anesthesie - il est temps d'ajuster l'objectif
Can J Anesth, January 1, 2005; 52(1): 1 - 7.
[Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Résumé de cet Article
Right arrow Full Text (PDF)
Right arrow Submit a scholarly reply
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Engen, D. A.
Right arrow Articles by Wang, L.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Engen, D. A.
Right arrow Articles by Wang, L.

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS