A SURVEY OF MANPOWER IN SPINAL SURGERY. ITS FINDINGS AND CONSEQUENCES FOR THE DELIVERY OF SPINAL DISORDERS SERVICES

Abstract

Introduction: In 1998 the British Scoliosis Society was asked by the Board of Affiliated Societies to the BOA to provide information concerning the activity, numbers and training implications for specialists in our field. We had no systematic data so with the valuable assistance of the BOA a survey of spinal surgery activity was undertaken amongst 187 Orthopaedic Surgeons who had declared spinal surgery as a main interest in a previous BOA survey. One hundred and fifty questionnaires were returned (80.2%). This data was collated and analysed by the Statistical Department of the British Orthopaedic Association.

As a result of the information obtained a template for the organisation of management of spinal disorders in UK and its manpower implications was developed. This template was then circulated to the Presidents of all the British Spine Societies for consideration at their AGMs in 1999. There was widespread support. It is understood that the BOA have also discussed these proposals along with those from other affiliated societies and it is perhaps time for further action.

Methods and results: The results from the postal questionnaires were analysed along with information from other sources. Fifty-five surgeons were identified as being Specialist Spinal Surgeons (greater than 70% of their time), 120 Surgeons were designated Surgeons With An Interest (greater than 30% of their time), 25 Surgeons spent less than 30% of their time on spines. Sixty-two per cent (93 Surgeons) considered their facilities for spinal work were adequate, 34.7% (52) considered that they were inadequate and 3.3% (5) said that they were unacceptable. Forty-nine per cent (73) of those responding employed a triage system with 58.5% using a physiotherapist and 16.2% using a nurse. Five point nine per cent used a clinical assistant and 19.1% of triage was done by the Spinal Surgeon.

Regarding outpatient waiting times, 31% of Surgeons had a waiting time of three to six weeks for urgent appointments with 20% longer than six weeks. Sixty per cent had a waiting time of over six months for non urgent consultations. For urgent but not emergency surgery 70% had a waiting time of over three weeks and half of those were over six weeks. For non urgent spinal surgery 70% were waiting more than six months with 50% waiting more than nine months.

Conclusion: Our limited manpower and resources must be used with maximum efficiency while we wait for the inevitably slow build up to international best practice which is likely to take at least ten years with a fair wind.

The Template: 20 Regional Spine Centres each with at least five Specialist Spinal Surgoens (SSS) including one or two Neurosurgeons, total 100 Surgeons.

Sixty-five District Spine Centres (at least three per Region) with at least two Surgeons With An Interest (SWI) (Orthopaedic or Neuro), total 130 Surgeons. At present we have 55 SSS of whom 18 will be retired by 2005. We have around 120 SWI of whom only nine will be retired in 2005 taking retirement age at 65. We therefore have a shortfall of 63 SSS and perhaps 10 SWI a number of whom may wish to upgrade to SSS. According to Okafor and Sullivan (1998) the average European country of our size would have 150 SSS compared with our 55.

1.There is an urgent need for more Orthopaedic Surgeons and in particular Spinal Surgeons.

2.Surgeons need adequate facilities and infrastructure to allow them to work efficiently. Finance is required.

3. Until the training base for future Specialists involved in the management of spinal disorders is steadily expanded from bottom to top, little progress can be expected.