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Patterns of practice of general surgeons in non-metropolitan British Columbia Herdman, John 1975

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PATTERNS OF PRACTICE OF GENERAL SURGEONS IN NGN-METROPOLITAN BRITISH COLUMBIA by JOHN HERDMAN B . A . U n i v e r s i t y of Oxford, 1943 M . A . , B.M., B.Ch. Un i v e r s i t y of Oxford, 1945 A THESIS SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE in the Department of Health Care and Epidemiology We accept t h i s t h e s i s as conforming to the required standard THE UNIVERSITY 0? BRITISH COLUMBIA A p r i l , 1975 In presenting th is thes is in par t ia l fu l f i lment of the requirements for an advanced degree at the Univers i ty of B r i t i s h Columbia, I agree that the L ibrary sha l l make it f ree ly ava i lab le for reference and study. I fur ther agree that permission for extensive copying of th is thesis for scho la r ly purposes may be granted by the Head of my Department or by h is representa t ives . It is understood that copying or pub l i ca t ion of th is thes is fo r f inanc ia l gain sha l l not be allowed without my wri t ten permission. Department of The Univers i ty of B r i t i s h Columbia Vancouver 8, Canada Date 1 1 Abstract The problem of ensuring ef f ic ient use of human resources in the health care f i e ld has become of great importance with the complete coverage of the population by publ ic ly funded schemes that has occured in recent years. There have been numerous suggestions for the replacement of physicians by less sk i l l ed personnel, and attention has also been paid to the problem of whether physicians practising in a free-enterprise, fee-f or--service system make the most desirable use of their s k i l l s . This study examines the practices of two groups of Br i t i sh Columbia surgeons. It seeks to determine the size of their operative workloads, and considers factors which may influence the patterns of practice of these surgeons. The workloads are measured in Cali fornia Relative Value units , using the Br i t i sh Columbia Medical Association fee schedule and Medical Services Commission data as the basis of a computer analysis . I t was found that the workloads were at less than a desirable level as this has been defined in the l i tera ture , and that some of the general surgeons carry out a consid-erable amount of subspecialty surgery, and of general practice. The reasons for this are discussed with particular emphasis on the significance of these findings for medical manpower planning. Several possible areas of further research are described. It is believed that these i i i would p r o v i d e i n f o r m a t i o n which i s ne c e s s a r y f o r sound d e c i s i o n making i n the h e a l t h care f i e l d . iv Table of Contents Chapter Page Preface v i i i 1. Introduction . . . . 1 i) Health care and medical manpower . . . . 1 i i ) Operative workloads of general surgeons . 4 i i i ) The situation in Canada 8 Underutilization of s k i l l s 8 Influence of practice setting 8 Personal factors 9 Other factors 10 Study questions 10 2. Study Design 11 i) Study area 11 i i ) Hospital regions in the study area . . . 11 i i i ) Study population 12 iv) Study procedure 13 v) Study hypothesis . 14 3. Methodology 17 i) Measurement of operative workloads . . . 17 i i ) Indices 18 i i i ) Surgery income/total income rat io . . . . 20 iv) Analysis of personal factors 20 v) Data sources 21 vi) Computer programme 21 4. Results 23 i) The specific hypotheses 23 V Chapter Page i i ) The general hypotheses 31 5. Discussion 35 6. Implications for medical manpower planning . . . . 41 7. Summary and Conclusions 45 Bibliography 46 Appendices 49 A. L i s t of study regions with map 49 B. Method of allocated C a l i f o r n i a Relative Value units to B.C.M.A. fee schedule items . . . . . . 51 C. Method of c a l c u l a t i n g d o l l a r value of C a l i f o r n i a Relative value uni t 55 D. Output showing operative workloads and indexes for surgeons and groups of surgeons 56 E. Output;- showing operative workloads and complexity index for surgeons grouped according to place of graduation, length of r e g i s t r a t i o n in B.C. and age with s t a t i s t i c a l a n a l y s i s . . . . 80 F. Total income and proportion earned by operative surgery for study surgeons 13;5 v i L i s t o f Tables Table Page I . C h a r a c t e r i s t i c s of study surgeons 1 3 I I . P r o p o r t i o n o f income of study surgeons earned by o p e r a t i v e s u r g e r y t o t o t a l m e d i c a l income by 1 0 % p e r c e n t i l e s 2 5 I I I . P r o p o r t i o n o f income o f study surgeons earned by o p e r a t i v e s u r gery to t o t a l m e d i c a l income . . . . 2 5 IV. Annual s u b s p e c i a l t y workload o f Group A and Group B surgeons by i . P l a c e o f g r a d u a t i o n , i i . Year o f r e g i s t r a t i o n i n B.C., i i i . Age 2 7 V. Annual g e n e r a l s u r g i c a l workload o f Group A and Group B surgeons by i . P l a c e o f g r a d u a t i o n , i i . Year o f r e g i s t r a t i o n i n B.C., i i i . Age 2 8 V I . Mean complexity r a t i o o f Group A and Group B surgeons by i . P l a c e o f g r a d u a t i o n , i i . Year o f r e g i s t r a t i o n i n B.C., i i i . Age 2 9 V I I . T o t a l workload o f study surgeons by annual CRV u n i t s and mean weekly CRV u n i t s 3 2 V I I I . General s u r g i c a l workload o f study surgeons by annual CRV u n i t s and mean weekly CRV u n i t s . . . 3 3 IX. Comparison o f o p e r a t i v e workloads of surgeons i n U.S.A. p r e p a i d group p r a c t i c e , U.S.A. community p r a c t i c e , Canadian d i s t r i c t g e n e r a l h o s p i t a l p r a c t i c e (Group A), and Canadian community h o s p i t a l p r a c t i c e (Group B) 3 7 X. Table t o show frequency o f four most common minor s u r g i c a l procedures performed i n B r i t i s h Columbia by c e r t i f i e d g e n e r a l surgeons i n 1 9 7 3 5 4 v i i Acknowledgements I have been f o r t u n a t e t o have the a s s i s t a n c e of many people i n the p r e p a r a t i o n o f t h i s s t u d y . F i r s t and foremost I am g r a t e f u l to Dr. D.O. Anderson, P r o f e s s o r and Head o f the D i v i s i o n o f H e a l t h S e r v i c e s Research and Development a t the U n i v e r s i t y o f B r i t i s h Columbia, who suggested the g e n e r a l a r e a o f study, a s s i s t e d me throughout and made a v a i l a b l e t o me the e x t e n s i v e f a c i l i t i e s o f the D i v i s i o n . Dr. C . J . G . Mackenzie o f the U n i v e r s i t y o f B r i t i s h Columbia, and Mr. Bernard Bloom o f Harvard M e d i c a l School were members o f the t h e s i s committee and made v a l u a b l e s u g g e s t i o n s i n con-n e c t i o n w i t h the d e s i g n o f the study, as w e l l as f o r the format o f the r e p o r t . Mr. S h i l l i n g t o n a s s i s t e d me i n the s t a t i s t i c a l a n a l y s i s and Mrs. Margaret Wertz, whose knowledge of t e c h n i q u e s f o r a n a l y s i s o f B r i t i s h Columbia h e a l t h s t a t i s t i c s i s u n r i v a l l e d , was r e s p o n s i b l e f o r the computer program. To a l l o f these I would l i k e t o express my thanks. Preface Governments in Canada are attempting to ensure that the resources devoted to health care are e f f i c ient ly allocated and properly u t i l i z e d . One of the problems confronting them is the appropriate use of health profes-sionals and, in part icular , physicians. There is concern that the s k i l l s of some medical practitioners are not being used to the best advantage and that a substantial amount of their time is being devoted to tasks that could be performed by less sk i l l ed personnel. I t has been argued that in the United States, the s k i l l s of general surgeons are under-u t i l i z e d . It i s believed that a similar situation exists in Canada and this thesis w i l l attempt to demonstrate th i s . 1 CHAPTER 1 INTRODUCTION i ) Health Care and Medical Manpower In recent years i n most developed countries, the State has become increasingly involved in the pr o v i s i o n of health services. I t has become a matter of general agreement that the i n d i v i d u a l should no longer be c a l l e d upon to bear the cost of i l l n e s s ; that cost should be borne by the community as a whole. In consequence, payments for medical and ho s p i t a l services are not made d i r e c t l y by those who receive the services, but by an agency on behalf of the state using tax revenues. Under these circumstances, the ordinary con-s t r a i n t s of the market place do not apply. In economic terms, the p r i c e of the service drops and the demand accord-ingly r i s e s . The supply of services i s i n turn increased by the di v e r s i o n of an increased—and s t e a d i l y increasing amount of--.the nation's resources into health care. In monetary terms, there i s a rapid escalation i n the cost of these s e r v i c e s . In Canada, h o s p i t a l and medical services are financed j o i n t l y by the federal and p r o v i n c i a l governments under the terms of the Hospital Insurance and Diagnostic Services Act (1957) and the Medical Care Act (1967). Expenditures on these and a l l i e d services have been s t e a d i l y r i s i n g . From 1963 to 1971 the t o t a l expenditures i n Canada on health and 2 s o c i a l w e l f a r e rose from 3,899 m i l l i o n to 10,027 m i l l i o n d o l l a r s . A d j u s t e d f o r p o p u l a t i o n growth, t h i s r e p r e s e n t s an i n c r e a s e o f 124% per c a p i t a . (Canada Year Book, 1973). T h i s has become a matter o f g r e a t concern to bot h l e v e l s o f government. Numerous sugg e s t i o n s have been made f o r c o n t r o l -l i n g t h i s i n c r e a s e . Reduction i n the number o f a c t i v e treatment beds and the s u b s t i t u t i o n o f community c l i n i c s (Hastings 1972, Klarman 1969) and r e g i o n a l p l a n n i n g (Task Force Reports 1970) have been advocated. There has a l s o been c o n s i d e r a b l e d i s c u s s i o n , b o t h i n Canada and elswhere about the p r o v i s i o n o f c l i n i c a l s e r v i c e s . Who sho u l d p r o v i d e them? To what e x t e n t i s the p h y s i c i a n e s s e n t i a l i n the p r o v i s i o n o f what i s now regarded as me d i c a l c a r e ? Can some as p e c t s o f such c a r e be p r o v i d e d e q u a l l y e f f e c t i v e l y by l e s s h i g h l y t r a i n e d , and t h e r e f o r e l e s s e x p e n s i v e , p e r s o n n e l ? In the U.S.A., the debate was t r i g g e r e d by an a l l e g e d a c t u a l or p r o s p e c t i v e shortage o f p h y s i c i a n s (Peterson and P e n n e l l 1967, F e i n 1967). More r e c e n t l y , however, i t has been suggested by an A s s i s t a n t S e c r e t a r y o f the Department o f H e a l t h , E d u c a t i o n and Welfare t h a t there may even be a s u r p l u s o f p h y s i c i a n s i n the U.S. (Edwards 1974) . Economists have a l s o argued t h a t the debate on whether o r not there i s a shortage o f p h y s i c i a n s i s somewhat meaningless, s i n c e p h y s i c i a n s are i n a p o s i t i o n t o c r e a t e the demand f o r t h e i r s e r v i c e s , and the demand w i l l a c c o r d i n g l y i n c r e a s e as the supply of p h y s i c i a n s i n c r e a s e s (Ginsberg 1966, Evans 1972) . 3 Vayda's ( 1 9 7 3 ) findings that both the number of surgeons and the number of operations performed i s proportionately higher i n Canada than i n the U.K. are consistent with t h i s argument. In Canada concern has been directed more to the cost of using highly paid physicians to perform r e l a t i v e l y low-s k i l l e d procedures (Lees 1973a, 1973b) although t h i s has also been the concern of economists i n both countries (Evans 1972, Reinhardt 1972, 1973, Smith Galladay and M i l l e r 1972, Boaz 1972). In Canada, the emphasis has been on the extended use o f nurses with s p e c i a l t r a i n i n g i n c l i n i c a l s k i l l s (Lees 1973b, Spitzer et a l 1974). Similar programs have been described i n the U.S.A. (Gordon 1974) as well as the use of a new type of paraprofessional, the physician-a s s i s t a n t (Dauphnee 1972, Smith et a l 1972). R e l a t i v e l y l i t t l e a t t e n tion appears to have been paid to the problem of the inappropriate use of s k i l l s within the medical profession. Recently however, i n the U.S., there have been a number of a r t i c l e s suggesting that there i s an u n d e r u t i l i z a t i o n of the s k i l l s of many s u r g i c a l s p e c i a l i s t s (Hughes et a l 1972, Odom 1972, Schwartz 1974) and that too many surgeons are being trained (Beeson 1974). Another viewpoint i s that of Moore (1974) who sees the problem a s the performance of surgery by those that he regards a s unqualified i n t h i s regard. R i l e y , W i l l i e and Haggerty ' s ( 1 9 6 9 ) finding that i n the Rochester area of 4 New York state 20 per cent of urban general p r a c t i t i o n e r s and 65 per cent of r u r a l general p r a c t i t i o n e r s perform h o p s i t a l surgery i s consistent with t h i s view. A very comprehensive study of a l l facets of s u r g i c a l care including manpower studies i s being undertaken j o i n t l y by the American College of Surgeons and the American Surgical Association. This project (Longmire 1971) known as the Study on Surgical Services i n the United States has been described by one of i t s proponents as: "one of the most d e f i n i t i v e and broadly based self-examinations ever undertaken by a learned profession." ( M i l l e r 1974) However, i t appears that the study may be handicapped by the lack of a complete data base. I t s information w i l l pre-sumably be obtained from such diverse sources as the Bureau of S t a t i s t i c s , h o s p i t a l records and Blue Cross and Blue Sh i e l d figures rather than from a single u n i f i e d source. Such a source only e x i s t s i n areas where there i s a universal medical care system with a c e n t r a l computerized record keeping and b i l l i n g system of the kind found i n B r i t i s h Columbia and other Canadian provinces. i i ) Operative Workloads of General Surgeons I t i s generally accepted that i t i s a misuse of s k i l l s for any health p r a c t i t i o n e r to devote any substantial amount of time to areas that do not require the s p e c i f i c s k i l l s he has acquired, and that i t i s equally undesirable for him to carry out procedures for which he lacks s p e c i f i c t r a i n i n g and for which other p r a c t i t i o n e r s have received s p e c i a l t r a i n i n g . I t 5 f o l l o w s t h a t a g e n e r a l surgeon i s making the b e s t use o f h i s s p e c i a l s k i l l s when he devotes h i m s e l f e n t i r e l y t o the p r a c t i c e o f g e n e r a l s u r g e r y . The p r a c t i c e o f s u r g e r y i n v o l v e s much more than the performance of t e c h n i c a l p r o c e d u r e s (Chase 1972). Yet t h e r e appears t o be agreement i n the l i t e r a t u r e t h a t a surgeon must devote a s u b s t a n t i a l amount o f h i s time to such procedures i f he i s t o be regarded as f u l l y engaged i n h i s s p e c i a l t y , and i f he i s to m a i n t a i n h i s t e c h n i c a l s k i l l s . Hughes e t a l . (1972) have a n a l y z e d the p r a c t i c e o f surgeons i n a New York community and suggest t h a t a surgeon s h o u l d c a r r y out the e q u i v a l e n t o f t e n i n g u i n a l h e r n i a o p e r a t i o n s a week i f he i s to be c o n s i d e r e d to have a w e l l - b a l a n c e d p r o d u c t i v e work-load and t o be f u l l y employed as a surgeon. I n g u i n a l h e r n i a was s e l e c t e d as the s t a n d a r d because i t i s regarded as an o p e r a -t i o n o f average c o m p l e x i t y . Hughes and h i s co-workers have a l s o found t h a t the c h i e f r e s i d e n t o f a u n i v e r s i t y t r a i n i n g programme was p e r f o r m i n g an average of 8.2 h e r n i a e q u i v a l e n t a week, and b e l i e v e t h a t t h i s i s t y p i c a l o f most good u n i v e r s i t y programmes (Hughes e t a l 1973) a Owens (1970) i n a study o f New York c i t y surgeons found t h a t most o f them were c a r r y i n g out one to f o u r major procedures a week, and t h a t these surgeons f e l t t h a t they c o u l d do a t l e a s t f i v e more such o p e r a t i o n s a week w i t h o u t d i f f i c u l t y . P h i l i p s (1968) i n an a n a l y s i s o f h i s own r u r a l s u r g i c a l p r a c t i c e regarded a c a s e l o a d o f 1564 o p e r a t i o n s a year f o r t h r e e surgeons as about 6 the c o r r e c t l o a d . T h i s corresponds approximately t o Hughes' ten h e r n i a e q u i v a l e n t s a week. Maloney (1970) i n a study o f u n i v e r s i t y h o s p i t a l p r a c t i c e found t h a t s t r i c t l y f u l l - t i m e surgeons were p e r f o r m i n g o n l y an average o f 2.2 o p e r a t i o n s weekly (given the nature o f u n i v e r s i t y h o s p i t a l s u r g e r y , e q u i v a l e n t t o perhaps 4.4 t o 6.6 h e r n i a s ) and t h a t these surgeons b e l i e v e d t h a t t h i s was i n s u f f i c i e n t t o m a i n t a i n t h e i r s k i l l s . Bunker (1970) produces f i g u r e s t o suggest t h a t U.K. surgeons perform approximately twice as many o p e r a t i o n s as t h e i r American c o u n t e r p a r t s , w h i l e E c k e r d o f f (1969), an American a n a e s t h e t i s t , a t t r i b u t e s t h i s t o poor o r g a n i z a t i o n and n e e d l e s s waste o f time i n the o p e r a t i n g room. Spencer (1974), Chairman o f the Department o f Surgery a t New York U n i v e r s i t y , has s a i d o f a workload o f the e q u i v a -l e n t o f ten h e r n i a s a week, "I imagine many surgeons, i n c l u d i n g the author, would c o n s i d e r even t h i s workload t o o l i t t l e . " The a c t u a l workload o f surgeons i n a Canadian c o n t e x t has been s t u d i e d by McPhedran and Eckstand (1973). These authors reviewed the time spent i n o p e r a t i n g rooms by A l b e r t a surgeons i n 1970. They do not, however, d i s c u s s whether these surgeons are u n d e r - u t i l i z e d and appear to assume t h a t the time a c t u a l l y spent i n s u r g e r y i s a l s o the d e s i r a b l e amount o f time. With t h i s assumption, they p r o j e c t the number of surgeons t h a t w i l l be needed i n A l b e r t a t o p r o v i d e f o r p o p u l a t i o n i n c r e a s e s . LeRiche and S t i v e r (1959) have s t u d i e d the time spent i n a s e l e c t e d procedures by 7 O n t a r i o surgeons i n c l u d i n g g e n e r a l p r a c t i t i o n e r s . T h e i r study i s based on f i g u r e s from a s i n g l e i n surance p l a n (P.S.I.) and no c o n c l u s i o n s can be drawn about o v e r a l l workloads. In a f u r t h e r more r e c e n t study of a p r e p a i d group p r a c t i c e , which employed seven g e n e r a l surgeons, Hughes and h i s c o l l e a g u e s found a median weekly work-load o f 9.9 h e r n i a e q u i v a l e n t s , and a mean work-load o f 9.2 (Hughes e t a l 1974) . The surgeons were s a l a r i e d , and t h e i r s a l a r i e s were not r e l a t e d to the amount o f surgery they performed. The economic i n c e n t i v e s t o the group management under these circumstances would be to employ the l e a s t number o f surgeons who c o u l d c a r r y out the c l i n i c work-load i n an e f f i c i e n t manner, or to put i t d i f f e r e n t l y t o arrange f o r a work-load f o r each surgeon which made the most e f f i c i -ent use o f h i s s k i l l s . The f a c t t h a t the median work-load so c l o s e l y approximates 10 h e r n i a e q u i v a l e n t s i s an i n d i c a -t i o n o f the v a l i d i t y o f Hughes' o r i g i n a l o b s e r v a t i o n s . I t appears then t h a t a surgeon who i s p e r f o r m i n g approximately t e n o p e r a t i o n s of average c o m p l e x i t y (e.g. an a d u l t i n g u i n a l h e r n i a r e p a i r ) i s working a t an a p p r o p r i a t e and d e s i r a b l e l e v e l . Such a l e v e l , the l i t e r a t u r e suggests, w i l l p e r mit him to m a i n t a i n h i s t e c h n i c a l s k i l l s , y e t g i v e him time f o r other f a c e t s of s u r g i c a l c a r e and f o r l e i s u r e . The l i t e r a t u r e c i t e d above suggests t h a t such a l e v e l i s not reached by a l a r g e number of surgeons i n the U.S .A . i n the words of Hughes e t a l , "Might there n o t be widespread u n d e r - u t i l i z a t i o n o f g e n e r a l surgeons." 8 i i i ) The Situation in Canada a) Underutilization of s k i l l s It is suggested that such under-util ization extends to Canada. Surgeons trained in university a f f i l i a t ed programmes in either Canada or the U.S .A 0 are generally e l ig ib le to take the specialty examinations, and i f successful to practice, in either country and i t i s probable that any marked differences in supply in the two countries would be adjusted by movement of surgeons in or out of Canada. There appear, however, to have been no recent studies made on the question of the under-u t i l i z a t ion of surgical s k i l l s in Canada. b) Influence of practice setting It is suggested that the patterns of practice of surgeons w i l l be related to the types of hospital in which they pract ice. The pattern of practice in a metropolitan area, where many of the surgeons are engaged in ter t iary care, have the assistance of sk i l l ed resident staff , and may have teaching and research responsibi l i t ies w i l l be different from that in a non-metropolitan area where usually the only concern of the surgeon is patient care at the secondary (and possibly primary) l e v e l . Moreover i t seems l ike ly that there w i l l be differences in practice patterns even within the secondary care regions. The hospitals con-cerned w i l l vary considerably in physical f a c i l i t i e s , and the complexity o f their treatment f a c i l i t i e s , and in the ava i l ab i l i ty o f specialised medical and other health profes-sionals . Those with the better resources are l i k e l y to 9 provide a more attractive professional environment to the physician. They are also more l i k e l y to be situated in centres which provide cul tura l and educational f a c i l i t i e s which appeal to the physician and his family. But for these very reasons the areas w i l l tend to have a greater concentra-tion of physicians, and in particular w i l l be more l i k e l y to have those subspecialists who are dependent on specialised f a c i l i t i e s . It might be anticipated then that the general surgeon in working in a more sophisticated hospital w i l l find i t more d i f f i c u l t to establish a surgical practice because of competition from the existing staff ; because of the existence of subspecialists there w i l l be less opportunity to supplement his general surgical practice by subspecialty surgery; and he may find i t necessary to engage in general practice, at least in the early days of his career. However, once he is well established he may do a larger volume and more complicated surgery than his colleagues working in less sophisticated settings. Surgeons in hospitals with fewer resources might expect to encounter less d i f f i c u l t y in establishing their practices; subspeci-a l i s t s may not be available in their community, and they may under these circumstances be faced with community and peer pressure to engage in subspecialty surgery, c) Personal factors It i s suggested that factors peculiar to the individual , such as place of graduation, age and length of practice in Br i t i sh Columbia w i l l influence the type of pract ice . Such 10 f a c t o r s have been found to i n f l u e n c e p a t t e r n s o f p r a c t i c e elsewhere (Anderson and C r i c h t o n 1972). However i t i s l i k e l y t h a t these w i l l be o f i n s i g n i f i c a n t importance as compared to the type of h o s p i t a l i n which the surgeon p r a c t i c e s . d) Other f a c t o r s Other f a c t o r s such as the involvement o f p h y s i c i a n s i n h o s p i t a l or m e d i c a l a s s o c i a t i o n a f f a i r s , and t h e i r i n t e r -e s t s o u t s i d e medicine might p o s s i b l y a f f e c t t h e i r p a t t e r n o f p r a c t i c e . However i t i s d i f f i c u l t t o o b t a i n r e l i a b l e d a t a on such a c t i v i t i e s , and the methodology used i n t h i s t h e s i s i s not s u i t a b l e f o r s t u d y i n g t h i s q u e s t i o n . For these reasons i t w i l l not be c o n s i d e r e d f u r t h e r . e) Study q u e s t i o n s T h i s t h e s i s w i l l t h e r e f o r e study i n one a r e a o f Canada, non-metropolitan B r i t i s h Columbia, t h r e e d i f f e r e n t b u t r e l a t e d q u e s t i o n s . They a r e : i ) The u t i l i z a t i o n o f s u r g i c a l s k i l l s o f g e n e r a l surgeons. i i ) The i n f l u e n c e o f the type o f h o s p i t a l i n which a surgeon p r a c t i c e s on h i s p a t t e r n o f p r a c t i c e . i i i ) The i n f l u e n c e o f f a c t o r s p e c u l i a r t o an i n d i v i d u a l surgeon on h i s p a t t e r n o f p r a c t i c e . 11 CHAPTER 2 STUDY DESIGN i) The study area The study area consists of the province of Br i t i sh Columbia outside the metropolitan areas of Vancouver and Vic to r i a . These areas w i l l be excluded because i t is believed that the conditions of practice are different in such areas from the rest of the province. There is easy access to tert iary care f a c i l i t i e s , surgeons may have the assistance of sk i l l ed resident staff , and may have teaching, and research respons ib i l i t ie s . The objectives of the study w i l l best be obtained by excluding these areas, together with the adjoining regions which are believed to receive a substantial amount of care in the metropolitan areas. i i ) Hospital regional d i s t r i c t s Br i t i sh Columbia is divided for hospital planning and insurance purposes into twenty-nine regional hospital d i s t r i c t s . Five are excluded from the study as metropoli-tan regions. The remaining hospital d i s t r i c t s can be divided into two groups based on the type of hospital in the d i s t r i c t . 1 ) Regions which contain at least one acute care hospital with sixteen or more special i s ts .^ Such a hospital w i l l be referred to as a d i s t r i c t general hospita l . xIt is assumed that a l l special ists l i s ted in the B.C. Medical Directory as resident in a c i ty or town in which there is an acute care hospital , other than public health o f f i c i a l s , are members o f the hospital staff in that community. 12 2) Regions in which the largest acute care hospital has seven or less specia l i s t s . Such a hospital w i l l be designated as a community hospi ta l . There are no hospitals located in c i t i e s or towns where there are eight to fifteen spec ia l i s t s . The hospital regional d i s t r i c t s in the two groups, together with those excluded from the study, are shown in Appendix A. While the cr i ter ion used for categorising these regional hospital d i s t r i c t s is number of special i s ts , the d i s t r i c t general hospitals are also found generally to have special ists in the more common subspecia l t ies such as urology, orthopaedic .surgery, otorhinolaryngoloy and opthal-mology. They generally have one or more full-time cer t i f ied radiologists and pathologists. The community hospitals usually do not have subspecialty surgeons and only a small number of them have a radiologist or pathologist, i i i ) Study population The study population w i l l consist of a l l cer t i f ied general surgeons in the study area who b i l l e d the Medical Services Commission of Br i t i sh Columbia for $20,000 a year or more in f i sca l 1973"1- and who belong to one of the follow-ing groups: Group A. Surgeons practising in d i s t r i c t general hospitals . xSurgeons b i l l i n g less than $20,000. are regarded as being semi-retired, or in part-time practice, or as having entered or le f t practice during the year. They represent 18% of a l l general surgeons licensed to practice in Br i t i sh Columbia, but are responsible for only 2.1% of the b i l l i n g s . 13 Group B. Surgeons p r a c t i s i n g i n community h o s p i t a l s i n r e g i o n s which do not have a d i s t r i c t g e n e r a l h o s p i t a l . There are f o r t y surgeons i n Group A and t h i r t y - e i g h t i n Group B. TABLE I C h a r a c t e r i s t i c s o f Study Surgeons Pl a c e o f g r a d u a t i o n Canada U.K. Other Year o f R e g i s t r a t i o n i n B.C. Before 1950 1950-1963 A f t e r 1963 Age 55 and over 45-54 Under 45 TOTAL Group A 26 10 4 6 15 19 8 15 17 40 Group B 27 5 6 9 13 16 9 11 18 38 T o t a l 53 15 10 15 28 35 17 26 35 78 i v ) Study procedures For the purpose of t h i s study the f i e l d o f g e n e r a l surgery w i l l be assumed to encompass those o p e r a t i v e p r o -cedures l i s t e d i n the B r i t i s h Columbia Me d i c a l A s s o c i a t i o n 14 (B.C.M.A.) fee schedule (1972) under the heading General surgery (pages 57-62). For h i s t o r i c a l reasons t h i s s e c t i o n i n c l u d e s c a r d i o t h o r a c i c procedures, but s i n c e the performance of these procedures i s c o n f i n e d almost e n t i r e l y t o the m e t r o p o l i t a n areas excluded from the study, t h i s w i l l not a f f e c t the r e s u l t s . S u b s p e c i a l t y surgery w i l l be c o n s i d e r e d to be those o p e r a t i v e procedures l i s t e d i n the B.C.M.A. fee schedule under the headings o r t h o p a e d i c s u r g e r y , o t o r h i n -o l a r y n g o l o g y , neurosurgery, opthalmology, p l a s t i c s u r g e r y , o b s t e t r i c s and gynaecology, and u r o l o g y . The term t o t a l  o p e r a t i v e procedures (or t o t a l CRV u n i t s ) w i l l be used t o denote the combined g e n e r a l and s u b s p e c i a l t y s u r g e r y . The d e s i r a b l e workload w i l l be taken as the e q u i v a l e n t o f ten a d u l t i n g u i n a l h e r n i a o p e r a t i o n s a week. In t h i s study the workload w i l l be measured i n C a l i f o r n i a R e l a t i v e Value u n i t s , u s i n g the 1969 s c a l e ( C a l i f o r n i a R e l a t i v e Value Study 1969); the e q u i v a l e n t o f ten h e r n i a s a week i s 4140 CRV u n i t s a year (90 CRV u n i t s p e r week). T h i s i s d i s c u s s e d i n more d e t a i l i n a subsequent s e c t i o n , v) Study hypotheses Three g e n e r a l hypotheses w i l l be c o n s i d e r e d . 1. That the g e n e r a l surgeons p r a c t i s i n g i n non-m e t r o p o l i t a n B r i t i s h Columbia are u n d e r - u t i l i z i n g t h e i r o p e r a t i v e s u r g i c a l s k i l l s . 2. That the p r a c t i c e p a t t e r n s o f surgeons i n h o s p i t a l r e g i o n s w i t h d i s t r i c t g e n e r a l h o s p i t a l s are d i f f e r -ent from those i n h o s p i t a l r e g i o n s w i t h o n l y community 15 hospitals. The variables that w i l l be examined are the tota l number of operations performed, the amount of general surgery, the amount of subspecialty surgery, the complexity of the operative procedures and the proportion of income obtained from surgery. 3. That any differences in patterns of practice that are found w i l l not be related to place of graduation, age, or length of practice in Br i t i sh Columbia. In order to answer the questions raised in these general hypotheses, these specific nu l l hypotheses w i l l be tested: 1. That the mean total surgical workload of surgeons practicing in Group A and Group B regions w i l l not be s ignif icantly different from the desirable workload of 4140 CRV units . 2. That the mean tota l surgical workload of d i s t r i c t general hospital (Group A) surgeons w i l l not be s igni f icant ly different from the mean total surgical workload of community hospital (Group B) surgeons. 3. That the mean general surgical workload of Group A surgeons w i l l not be s igni f icant ly different from that of Group B surgeons. 4. That the mean subspecialty surgical workload of Group A surgeons w i l l not be s igni f icant ly different from that of Group B surgeons. 5. The proportion of income derived from operative surgery to total income received from the M.S.C. w i l l not be s ignif icant ly greater for Group A surgeons than for Group B surgeons. 16 6. The complexity rat io of the general surgery performed by the Group A surgeons w i l l not be s ignif icant ly greater than the complexity rat io of the general surgery performed by the Group B surgeons. 7. Any differences in the mean amount of general surgery, mean amount of subspecialty surgery, and complexity rat io of the two groups are not related to place of gradua-t ion , age, or length of practice in B.C. Although not direct ly related to the general study hypotheses, the question of whether there was any correlation between total income and proportion of income earned by operative surgery was thought to be of interest, and the following additional nu l l hypothesis was tested. 8. There is no correlation between proportion of income earned by operative surgery and total income received from M.S.C. 17 CHAPTER 3 METHODOLOGY i ) Measurement o f o p e r a t i v e workloads In order t o measure the volume o f o p e r a t i v e work c a r r i e d out by a surgeon, i t i s ne c e s s a r y t o use a s c a l e which measures the o p e r a t i v e procedures i n terms o f r e l a t i v e c o m p l e x i t y . T h i s s t y l e o f problem i s common i n economics where i t i s u s u a l l y s o l v e d by u s i n g a system o f p r i c e w e i g h t s . A s i m i l a r s o l u t i o n has been adopted by the C a l i f o r n i a M e d i c a l A s s o c i a t i o n which has developed a system o f R e l a t i v e Value U n i t s c a l e s f o r m e d i c a l and s u r g i c a l s e r v i c e s . The s c a l e s are based on the average fees charged i n C a l i f o r n i a f o r these s e r v i c e s . The s u r g i c a l procedure s c a l e has been shown by Hughes e t a l (1972) t o c o r r e l a t e w e l l w i t h a c t u a l time spent by the p a t i e n t i n the o p e r a t i n g room. An a d u l t h e r n i a r e p a i r i s v a l u e d a t n i n e C a l i f o r n i a R e l a t i v e Value u n i t s . The accepted l e v e l o f t e n h e r n i a e q u i v a l e n t s per week, d i s c u s s e d above, t h e r e f o r e corresponds t o 90 C a l i f o r n i a R.V. u n i t s , and t h i s v a l u e w i l l be used i n the study as the d e s i r a b l e s u r g i c a l o p e r a t i v e workload. Hughes (1972) assumes a work year o f 48 weeks. This appears h i g h . As w e l l as t a k i n g v a c a t i o n s , surgeons u s u a l l y a t t e n d one or more conven-t i o n s a year, and a work year o f 46 weeks appears more r e a l i s t i c . T h i s f i g u r e w i l l be used i n t h i s study g i v i n g an annual d e s i r a b l e workload o f 4140 CRV u n i t s . The d a t a on o p e r a t i v e workloads has been o b t a i n e d from the computer tapes of the M e d i c a l S e r v i c e s Commission (M.S.C.) of B r i t i s h Columbia. 1 These show a l l procedures b i l l e d to the Commission by the p h y s i c i a n s of B r i t i s h Columbia, and r e p r e s e n t the e n t i r e p r a c t i c e o f p h y s i c i a n s w i t h the e x c e p t i o n o f Worker's Compensation cases and o u t -o f - p r o v i n c e v i s i t o r s . The study year i s f i s c a l 1973 ( A p r i l 1972 t o March 1973) which because of the time taken t o p r o c e s s c l a i m s corresponds approximately to c a l e n d a r 1972. The procedures are r e c o r d e d by t h e i r number i n the B r i t i s h Columbia M e d i c a l A s s o c i a t i o n fee schedule (1972) and each p r o c e d u r a l item i n the s e c t i o n s o f g e n e r a l s u r g e r y , o t o r h i n -o l a r y i n g o l o g y , orthodpaedic s u r g e r y , gynaecology, p l a s t i c s u r g e r y , neurosurgery and u r o l o g y has been a l l o c a t e d a C a l i f o r n i a R e l a t i v e u n i t value based on comparable p r o -cedures i n the C a l i f o r n i a s c h e d u l e . The method o f doing t h i s i s d i s c u s s e d i n d e t a i l i n Appendix B. i i ) I n d i c e s Two i n d i c e s were used i n t h i s s t u d y . They a r e a s p e c i a l t y index, and a complexity index. (The l a t t e r o f these i s a m o d i f i c a t i o n of Hughes' mean H.E. per o p e r a t i o n . ) The s p e c i a l t y index i s designed as an i n d i c a t i o n o f the p r o p o r t i o n o f a g e n e r a l surgeon's time t h a t i s spent i n g e n e r a l p r a c t i c e . I t i s c a l c u l a t e d by d i v i d i n g the number o f g e n e r a l s u r g i c a l C.R.V. p r o c e d u r a l u n i t s performed by Used by p e r m i s s i o n o f the B.C. M e d i c a l A s s o c i a t i o n and the M e d i c a l S e r v i c e s Commission. 19 the number of office ca l l s b i l l e d . (B.C.M.A. fee schedule items ending in 01 - 07). Obviously a l l general surgeons see patients in their offices in the course of their specialty pract ice . Many of these v i s i t s however are consultations which are b i l l e d under a separate code, or are post-operative v i s i t s which are not b i l l e d at a l l , and a large number of office ca l l s would indicate that a general surgeon was not confining his practice to his specialty. An indication of the degree to which a general surgeon is engaging in general practice w i l l be given by the specialty index. The indication w i l l be relat ive to other surgeons in the specialty, and w i l l not be an absolute measure of the amount of general practice carried on by any indiv idual . The complexity index i s a measure of level of d i f f i -culty (or complexity) of a surgeon's pract ice. I t is obtained by dividing the number of C.R.V. units performed by the number of operations performed. At one end of the scale a cardiac surgeon w i l l obviously have a very high complexity ra t io , the surgeon in a small community w i l l probably have a low one. The rat io w i l l depend on the f a c i l i t i e s available to the surgeon, as well as on his training and a b i l i t y . Since this study is of general surgery, only those procedures l i s ted in the B.C.M.A. fee schedule under the heading General Surgery (pages 57-62) w i l l be used in calculating the index. 20 i i i ) Operative income/total income r a t i o The s p e c i a l t y r a t i o was subsequently found to be unsatisfactory for the purpose for which i t was designed because of the very large variance i n the figures obtained which made parametric s t a t i s t i c a l analysis unsatisfactory. An alternative method o f estimating the proportion of practice devoted to general practice and to surgery was developed (Appendix C). The value of a CRV unit i n d o l l a r terms was obtained by div i d i n g the d o l l a r value of selected B.C.M.A. fee schedule items by the number of CRV units allocated to them (Appendix C). This value was found to be $12.02 and by multiplying each surgeon's annual CRV units by t h i s figure, the approximate amount of his income attributable to operations was obtained. The figure was expressed as a percentage of the t o t a l income received by him from the M.S.C., and t h i s figure was taken as a measure of the amount of his practice which was devoted to surgery as opposed to general p r a c t i c e . iv) Analysis of personal factors To determine the possible e f f e c t of other factors on the practice patterns found, the e f f e c t of three sets of three independent variables were studied. 1. Place of undergraduate t r a i n i n g : Canadian U.K. Other. 2. Age: 44 and under; 45 to 54; 55 and over. 3. Date of r e g i s t r a t i o n i n B r i t i s h Columbia: Before 1950; 1950-63; After 1963. 21 The dependent v a r i a b l e s examined were: 1. Number o f g e n e r a l s u r g i c a l CRV u n i t s performed. 2. Number o f s p e c i a l t y CRV u n i t s performed. 3. Complexity r a t i o , v) Data Sources The data c o n c e r n i n g the study surgeons has been o b t a i n e d from the computer f i l e s o f the H e a l t h Manpower Research U n i t o f the P r o v i n c e o f B r i t i s h Columbia. These (code name "PHYSFILE") c o n t a i n i n f o r m a t i o n on income, r e s i d e n c e , p l a c e of t r a i n i n g and date of r e g i s t r a t i o n f o r a l l B r i t i s h Columbia p h y s i c i a n s , and can be l i n k e d to the M.S.C. data through the p h y s i c i a n ' s b i l l i n g number,if a p p r o p r i a t e p e r m i s s i o n i s o b t a i n e d , v i ) Computer programme A f i l e was e s t a b l i s h e d i n which a l l r e l e v a n t B.C.M.A. fee schedule numbers were g i v e n CRV u n i t v a l u e s . A second f i l e was then prepared from PHYSFILE i d e n t i f y i n g by M.S.C. number those surgeons who f e l l i n t o the two study groups, D i s t r i c t General H o s p i t a l (Group A), or Community H o s p i t a l (Group B ) . The t h i r d f i l e used was the e x i s t i n g M.S.C. f i l e f o r f i s c a l 1973 which c o n t a i n e d a r e c o r d of a l l payments made t o B.C. p h y s i c i a n s i n f i s c a l 1973. A programme was then w r i t t e n t o p r o v i d e the b a s i c data r e q u i r e d . T h i s gave the number of o p e r a t i v e procedures and CRV u n i t s f o r each surgeon broken down i n t o t o t a l , g e n e r a l s u b s p e c i a l t y , and each i n d i v i d u a l s u b s p e c i a l t y , t ogether w i t h the s p e c i a l t y index and c o m p l e x i t y index. The surgeons were a l s o grouped by r e g i o n and group. T h i s t a b l e i s shown i n Appendix D. A second t a b l e was prepared which gave the same i n f o r m a t i o n (except f o r the breakdown o f s u b s p e c i a l t y work-load) f o r the surgeons d i v i d e d i n t o t h r e e s e t s of three groups based on age, l e n g t h o f p r a c t i c e i n B.C., and p l a c e o f t r a i n i n g . In order t o pre s e r v e the c o n f i d e n t i a l i t y o f t h e i r M.S.C. f i l e s , the surgeon's M.S.C. number was not pr i n t e d . S t a t i s t i c a l a n a l y s i s o f the data was c a r r i e d o ut us i n g a standard package, the S t a t i s t i c a l Package f o r the S o c i a l Sciences (SPSSH) v e r s i o n 5.01. The r e s u l t s were regarded as s i g n i f i c a n t i f p <0.05. 23 CHAPTER 4 RESULTS In t h i s s e c t i o n the e i g h t s p e c i f i c n u l l hypotheses s t a t e d i n the p r e c e d i n g c h a p t e r w i l l f i r s t be examined u s i n g s t a n d a r d s t a t i s t i c a l t echniques where a p p l i c a b l e , and the th r e e g e n e r a l hypotheses w i l l then be d i s c u s s e d , i ) The s p e c i f i c hypotheses Hypothesis 1. The mean t o t a l s u r g i c a l workload o f surgeons p r a c t i c i n g i n Group A and Group B h o s p i t a l s w i l l n o t be s i g n i f i c a n t l y d i f f e r e n t from the d e s i r a b l e workload o f 4140 CRV u n i t s . The annual workload o f Group A surgeons was 2729 CRV u n i t s (S.E. 228) and the 95% c o n f i d e n c e i n t e r v a l was 2266 - 3191. The annual workload o f the Group B surgeons was 2558 CRV u n i t s (S.E. 212) and the 95% c o n f i d e n c e i n t e r v a l was 2128 - 2987. The d e s i r a b l e workload o f 4140 CRV u n i t s was s i g n i f i c a n t l y d i f f e r e n t and the h y p o t h e s i s i s r e j e c t e d f o r both groups. Hypothesis 2. The mean t o t a l s u r g i c a l workload o f d i s t r i c t g e n e r a l h o s p i t a l surgeons (Group A) w i l l not be s i g n i f i c a n t l y d i f f e r e n t from the mean t o t a l s u r g i c a l work-lo a d o f community h o s p i t a l (Group B) surgeons. The annual workload of Group A surgeons was 2729 CRV u n i t s (S.E. 228) and o f the Group B surgeons 2558 CRV u n i t s (S.E„ 2 1 2 ) . Students t t e s t shows no s i g n i f i c a n t d i f f e r e n c e between these f i g u r e s (tyg = 0.54) and the h y p o t h e s i s cannot be r e j e c t e d * 24 Hypothesis 3. The mean g e n e r a l s u r g i c a l workload o f Group A surgeons w i l l not be s i g n i f i c a n t l y d i f f e r e n t from t h a t o f the Group B surgeons. The annual workload o f the Group A surgeons was 2016 CRV u n i t s (S.Eo 218) and o f Group B surgeons 1477 CRV u n i t s (S.E. 130). The v a r i a n c e o f the two groups i s s i g n i f i c a n t l y d i f f e r e n t ( F ( 3 9 ) ( 3 7 ) = 2.98). The h y p o t h e s i s t h e r e f o r e cannot be t e s t e d i n the form s t a t e d by Students t t e s t , b u t the two groups come from d i f f e r e n t u n i v e r s e s . 1 Hypothesis 4. The mean s u b s p e c i a l t y workloads o f Group A surgeons w i l l not be s i g n i f i c a n t l y d i f f e r e n t from t h a t o f the Group B surgeons. The annual workload o f the Group A surgeons was 713 CRV u n i t s (S.E. 113) and o f Group B surgeons 1080 CRV u n i t s (S.E. 104). Students t t e s t shows a s i g n i f i c a n t d i f f e r e n c e (t-,c = 2.38) and the h y p o t h e s i s i s r e j e c t e d . Hypothesis 5. The p r o p o r t i o n o f income d e r i v e d from o p e r a t i v e s u r g e r y t o t o t a l income r e c e i v e d from M.S.C. w i l l not be s i g n i f i c a n t l y g r e a t e r f o r Group A surgeons than f o r Group B surgeons. The o p e r a t i v e income to t o t a l income p r o p o r t i o n i s summarised i n Table I I and I I I , and g i v e n i n d e t a i l i n Appendix F. The X? t e s t on the data i n Table I I I shows no s i g n i f i c a n t d i f f e r e n c e between Group A and Group B ( x | = 0.89) and the h y p o t h e s i s cannot be r e j e c t e d . x B e h r e n s - F i s h e r ' s t - t e s t shows a s i g n i f i c a n t d i f f e r e n c e ( t 7 6 =2.09 9 = 59.1). 25 TABLE I I P r o p o r t i o n o f income earned by o p e r a t i v e s u r g e r y t o t o t a l m e d i c a l  income o f study surgeons. B y l O % . p e r c e n t i l e s P r o p o r t i o n o f Income Earned by Op e r a t i v e Surgery No. Group A o f Surgeons Group B T o t a l % 80 - 89 6 12 18 70 - 79 14 3 17 60 - 69 9 8 17 50 - 59 2 5 7 40 - 49 3 2 5 30 - 39 2 5 7 20 - 29 1 1 2 10 - 19 3 0 3 0 - 9 _P_ 2 2 T o t a l 40 38 78 Mean 63.0 61.7 62.4 Median 70.8 TABLE I I I 65.8 69.1 P r o p o r t i o n o f income earned by o p e r a t i v e s u rgery t o t o t a l income o f study surgeons P r o p o r t i o n o f Income Earned by O p e r a t i v e Surgery Group A Group B T o t a l 70 - 90% 20 15 35 50 - 69% 11 13 24 under 50% 9 10 19 Mean 63.0 61.7 62.4 Median 70.8 65.8 69.1 There i s no s i g n i f i c a n t d i f f e r e n c e between Group A and Group B (x. 2 = .89). 26 Hypothesis 6. The c o m p l e x i t y index o f the g e n e r a l surgery performed by the Group A surgeons w i l l n ot be s i g n i f i c a n t l y g r e a t e r than the c o m p l e x i t y index of the g e n e r a l s urgery performed by the Group B surgeons. The mean co m p l e x i t y index o f Group A was 9.946 (S.D. 1.515) and o f Group B 9.568 (S.D. 1.66). Students t t e s t ( o n e - t a i l e d ) shows no s i g n i f i c a n t d i f f e r e n t (t-^g = 1.06) and the h y p o t h e s i s cannot be r e j e c t e d . Hypothesis 7. Any d i f f e r e n c e s i n the mean amount of g e n e r a l s u r g e r y , mean amount of s u b s p e c i a l t y s u r g e r y and complexity r a t i o o f the two groups are not r e l a t e d t o p l a c e o f g r a d u a t i o n , age and l e n g t h o f p r a c t i c e i n B.C. The r e l a t i o n s h i p s between the independent and dependent v a r i a b l e s examined are shown i n T a b l e s IV, V and V I . These were as expected i n t h a t the r e l a t i o n s h i p s between the subgroups are s i m i l a r t o those between Group A and B as a whole w i t h these e x c e p t i o n s : Table IV) 1) The s u b s p e c i a l t y workload f o r o t h e r p l a c e o f g r a d u a t i o n f o r Group A was p r o p o r t i o n a t e l y h i g h e r than expected. 2) The s u b s p e c i a l t y workload f o r y e a r o f r e g i s t r a t i o n a f t e r 1963 f o r Group A was p r o p o r t i o n a t e l y h i g h e r than expected or b e f o r e 1950 i s lower. 3) The s u b s p e c i a l t y workload f o r age group 55 and over f o r Group A was p r o p o r t i o n a t e l y h i g h e r than expected. 27 TABLE IV Annual subspecialty operative workload of Group A and B surgeons  by 1. Place of graduation, 2. Year of registration in B.C.,  and 3. Age. GROUP A (District General Hospital) GROUP B (Community Hospital) Mean Annual Workload in Mean Annual Workload in No. CRV Units S.D. No. CRV Units S.D. 1. Place of graduation Canada 26 574 398 27 1089 638 U.K. 10 877 1161 5 1013 484 Other 4 1201 854 6 1097 859 2. Year of registration in B.C. Before 1950 6 457 449 9 769 604 1950-63 15 700 368 13 1523 722 After 1963 19 803 959 16 895 373 3. Age 55 and over 8 704 786 9 769 604 45 - 54 15 873 970 11 1255 729 under 45 17 575 334 18 1129 581 TOTAL 40 713 716 38 1080 642 28 TABLE V Annual general surgical operative workload and 1. Place of  Graduation, 2. Year of Registration in B.C. f and 3, Age. GROUP A GROUP B Mean Annual Mean Annual No. in Workload in No. in Workload in Group CRV Units S.D. Group CRV Units S.D. 1. Place of graduation Canada 26 2095 1447 27 1486 808 U.K. 10 1876 1332 5 1464 474 Other 4 1857 1404 6 1446 1085 2. Year of Registration Before 1950 6 1202 699 9 862 1022 1950-63 15 2910 1567 13 1818 449 After 1963 19 1567 1003 16 1545 731 3. Age 55 and over 8 886 768 9 862 1022 45 - 54 15 2522 1621 11 1620 499 Under 45 17 2102 1108 18 1698 705 TOTAL 40 2016 1384 38 1477 802 TABLE VI Mean Complexity Ratio and 1. Place of graduat ion, 2. Year of Registration ; and 3. Age. GROUP A GROUP B No. Complexity Ratio S.D. No. Complexity Ratio S.D. 1. Place of graduation Canada 26 9.98 1.43 27 9.53 1.90 U.K. 10 9.34 1.73 5 9.75 0.58 Other 4 11.17 0.75 6 9.53 1.14 2. Year of registration in B.C. Before 1950 6 9.24 1.75 9 8.36 2.75 1950 - 63 15 10.22 1.32 13 9.98 0.82 After 1963 19 9.94 1.59 16 9.91 1.04 3. Age 55 and over 8 9.12 1.60 9 8.36 2.75 45 - 54 15 10.01 1.89 11 9.95 0.70 Under 45 17 10.26 0.93 18 9.93 1.07 TOTAL 40 9.94* 1.51 38 9.56* 1.66 *Mean of individual surgeon's complexity ratios. 30 Opposite changes are found i n Table V as might be a n t i c i p a t e d . Table V. 1) The g e n e r a l s u r g i c a l workload f o r o t h e r p l a c e o f g r a d u a t i o n f o r Group A was p r o p o r t i o n a t e l y lower than expected. 2) The g e n e r a l s u r g i c a l workload f o r year o f r e g i s t r a t i o n a f t e r 1963 f o r Group A was p r o p o r t i o n -a t e l y lower than e x p e c t e d . 3) The g e n e r a l s u r g i c a l workload f o r age group 55 and over f o r Group A was p r o p o r t i o n a t e l y lower than expectedo I t appears then t h a t the r e l a t i o n s h i p between sub-s p e c i a l t y and g e n e r a l workloads was d i f f e r e n t i n t h r e e sub-g r o u p s — o t h e r p l a c e of g r a d u a t i o n , 55 and over, and r e g i s t r a -t i o n a f t e r 1 9 6 3 — f r o m t h a t found i n main Groups A and B. However r e f e r e n c e to the d e t a i l e d computer a n a l y s i s of p r a c t i c e p a t t e r n s i n Appendix E shows these d i s c r e p a n c i e s can be e x p l a i n e d by the d e v i a n t p r a c t i c e s o f two surgeons i n Group A. These i n d i v i d u a l s , w h i l e i n c l u d e d i n the study as c e r t i f i c a t e d g e n e r a l surgeons, are i n f a c t p r a c t i c i n g as s u b s p e c i a l i s t s , i n one case as an u r o l o g i s t , i n the other as an o r t h o p a e d i c surgeon. They have very l a r g e sub-s p e c i a l t y workloads (4089 and 2409 CRV u n i t s ) and low g e n e r a l s u r g i c a l workloads (283 and 281 CRV u n i t s ) . They were bot h r e g i s t e r e d i n B.C. a f t e r 1963, one i s i n the 55 and over sub-group, and one i n other p l a c e of g r a d u a t i o n sub-group. T h e i r presence accounts f o r the d i f f e r e n c e s found i n these 31 sub-groups. V7ith t h i s e x p l a n a t i o n , the h y p o t h e s i s can be a c c e p t e d . Hypothesis 8. There was no c o r r e l a t i o n between the p r o p o r t i o n of income earned by o p e r a t i v e s u r g e r y and t o t a l income r e c e i v e d from M.S.C. The data i s g i v e n i n Appendix F. The c o r r e l a t i o n c o e f f i c i e n t f o r Group A was 0.188 (n = 40) and f o r Group B i t was 0 o166 (n = 38). N e i t h e r o f these f i g u r e s i s s i g n i f i c a n t l y d i f f e r e n t from zero and the h y p o t h e s i s c a n n e d be r e j e c t e d , i i ) The g e n e r a l hypotheses The three o r i g i n a l g e n e r a l hypotheses can now be examined. 1. That the g e n e r a l surgeons p r a c t i s i n g i n non-m e t r o p o l i t a n B r i t i s h Columbia are u n d e r - u t i l i z i n g t h e i r o p e r a t i v e s u r g i c a l s k i l l s . I f the f i g u r e of 4140 CRV u n i t s as a d e s i r a b l e work-load i s accepted, t h i s h y p o t h e s i s can be regarded as proven. The mean t o t a l workload o f both Group A and Group B (2727 and 2557 ) i s s i g n i f i c a n t l y d i f f e r e n t from t h i s f i g u r e , and i n f a c t o n l y 13 o f the 78 surgeons i n the study perform 4140 u n i t s or more per year, w h i l e 39, or h a l f o f the study group perform l e s s than 2300 u n i t s a year (Table V I I ) . I f the g e n e r a l surgery workload o n l y i s c o n s i d e r e d , the under-u t i l i z a t i o n i s c o n s i d e r a b l y g r e a t e r . Only t h r e e surgeons, a l l i n Group A reach the d e s i r a b l e workload o f 4140 CRV u n i t s w h ile 62 (79%) perform l e s s than 2300 CRV u n i t s a year (Tabic VIII) . TABLE VII Total surgical workload of study surgeons by annual CRV units and mean weekly CRV units Annual Total CRV Units (Mean weekly CRV Units) v 5160 ( 110) 4141 - 5160 (90.1 - 110) 3221 - 4140 (70.1 - 90) 2301 - 3220 (50.1 - 70) 1381 - 2300 (30.1 - 50) 461 - 1380 (10.1 - 30) s 46.1 ' ( 10.1) Total Median Mean No. of Surgeons Group A 3 4 8 6 12 4 3 40 2649 (57.6) 2727 (59.3) Group B 1 5 5 7 12 6 2 38 2562 (55.7) 2557 (55.6) Total 4 9 13 13 24 10 5 78 2608 (56.7) 2645 (57.5) TABLE VIII General surgical workload of study surgeons by annual CRV units and mean weekly CRV units Annual Total CRV Units (Mean weekly CRV Units) 5160 ( 110) 4141 - 5160 (90.1 - 110) 3221 - 4140 (70.1 - 90) 2301 - 3220 (50.1 - 70) 1381 -2300 (30.1 - 50) 461 - 1380 (10.1 - 30) ,461 ' ( 10.1) Group A 2 No. of Surgeons Group B 6 3 14 8 6 1 3 18 12 4 Total 2 1 6 32 20 10 Total Median Mean 40 1775 (38.6) 2014 (43.8) 38 1453 (31.6) 1476 (32.1) 78 1495 (32.5) 1752 (38.1) 34 2 . That the p r a c t i c e p a t t e r n s of surgeons i n h o s p i t a l r e g i o n s w i t h d i s t r i c t g e n e r a l h o s p i t a l s d i f f e r from those i n h o s p i t a l r e g i o n s w i t h o n l y community h o s p i t a l s . T h i s hypotheses i s a l s o p r o v e n . While no d i f f e r e n c e has been demonstrated i n the t o t a l o p e r a t i v e workload, the degree o f c o m p l e x i t y of the o p e r a t i v e procedures or the p r o p o r t i o n o f income earned by o p e r a t i v e s u r g e r y i n the two groups there i s a d i f f e r e n c e i n t h e s u b - s p e c i a l t y and the g e n e r a l s u r g i c a l workloads. 3. That any d i f f e r e n c e s i n p a t t e r n s o f p r a c t i c e t h a t are found w i l l n o t be r e l a t e d t o p l a c e o f g r a d u a t i o n , age or l e n g t h o f p r a c t i c e i n B r i t i s h Columbia. A f t e r adjustment f o r s e v e r a l a t y p i c a l surgeons no evidence has been found t h a t the d i f f e r e n c e s shown i n g e n e r a l and s u b s p e c i a l t y workloads are r e l a t e d t o any o f the above f a c t o r s , and t h i s h y p o t h e s i s can be a c c e p t e d . 35 CHAPTER 5 DISCUSSION It has already been stated that a general surgeon makes the best use of his s k i l l s when he devotes himself entirely to the practice of general surgery, and when he performs not less than 4140 CRV units a year. It is clear that very few of the surgeons studied are making optimal use of their s k i l l s as so defined. The majority performed less than the desir-able amount o f operations, performed a substantial amount of subspecialty surgery, or carried on a general practice in addition to their surgical pract ice. The total number of operations performed was the same in the two groups but a much greater proportion was made up of subspecialty surgery in Group B (42%) than in Group A (26%), with a corresponding but opposite difference in the amount of general surgery. This was not unexpected, because of the presence of sub-special ists in the larger hospitals . A large amount of the subspecialty surgery in the Group B hospitals was gyna-ecology (Appendix C) . Few of these hospitals have gynaecol-ogists on their staff . A l l the Group A hospitals do (Medical Directory of B . C . 1973-74)0 Although there was no difference demonstrated between the two groups in the proportion of income earned by opera-tive surgery, there were wide differences within the groups. Nineteen o f the surgeons (25%) earned less than hal f their income from surgery. These individuals appeared to be 36 actively engaged in general practice. Seventeen of the surgeons earned over 8 0 % of their income from surgery and appeared to confine their practice to surgery since the remaining income—less than 20%—can be reasonably a t t r i -buted to such ac t iv i t i e s as surgical consultations and medical reports (Table IV). It is instructive to compare the workloads found in this study with those found in Hughes' studies of a prepaid group practice (Hughes et al 1974) and of a community hospital practice (Hughes et a l 1972). The surgeons in the Hughes1 studies appear not to have engaged in subspecialty surgery as defined in this paper, probably because both his studies involve metropolitan areas where surgeons are more l i k e l y to confine themselves to their specialty. Table IX compares the general and the tota l surgical work-load found in this study with those workloads found by Hughes and his colleagues. The general surgical workload, which represents the surgical procedures for which the surgeons are primarily trained, is approximately the same in this study, and in Hughes' community hospital study, and less than half that of the prepaid plan. The mean total workload of the B.C. surgeons was however substanti-a l l y greater than that of the Hughes' community surgeons, though s t i l l less than that of the prepaid grant practice surgeons, because of the considerable amount of sub-specialty surgery performed by the B.C. surgeons. There is therefore a ful ler u t i l i za t ion of surgical s k i l l s in the TABLE IX Comparison of operative workloads of surgeons in U.S.A. prepaid group practice,  U.S.A. Community Practice, Canadian D.G.H. Practice (Group A), and Canadian C.H. Practice (Group B) Annual CRV units/general surgeon Practice setting Range Median Mean S.D. No. of Surgeons U.S.A. prepaid group 2980-4564 4274 3973 604 7 U.S.A. community 388-5616 1338 1857 1443 19 Canadian Group A (total units) 290-6113 2652 2729 1447 40 (general surgeon units) 96-5345 1782 2016 1384 Canadian Group B (total units) 16-5355 2562 2558 1310 38 (general surgeon units) 7-3410 1462 1477 802 Figures for U.S.A. surgeons converted from H.E. per day to CRV units per year by conversion factor of 432 (9 x 48). 38 prepaid practice than in the other groups. The reasons for this cannot be determined from the available evidence. It is possible however that in a prepaid practice where the size of the cl ientele is known and the demand for surgical services can be estimated with reasonable accuracy, the number of surgeons can be effectively l imited to the number required by the work-load in a way that is not possible in a setting where fee for service applies and the number of surgeons is determined by other considerations. The B . C . Group A contained a number of small group practices and, while i t is beyond the scope of this study, i t would be interesting to compare the u t i l i z a t ion of surgical s k i l l s within these groups with that of independent practit ioners in the same regions. The finding that no difference could be demonstrated in the complexity of the surgery performed in the two hospital groups was unexpected. The explanation may be in the amount of operations done by general practitioners in the two groups. If, as might be expected, the general practitioners were more restr icted in the larger hospitals as to the complexity of the procedures they may do, then the general surgeons might be carrying out low-complexity procedures in these hospitals which would be performed by general practitioners in the community hospitals . This would tend to reduce the complexity rat io of Group A hospitals, and might mask the fact that more complex pro-cedures are in fact performed in the Group A hospitals . x 39 The data does not permit any c o n c l u s i o n on t h i s p o i n t . A study o f the i n d i v i d u a l complexity r a t i o s o f the surgeons o f the two groups, and t h e i r v a r i a n c e s ; or a study o f g e n e r a l p r a c t i t i o n e r s u r g e r y i n the two groups would be necessary to decide t h i s . No d i f f e r e n c e was demonstrated i n the p r o p o r t i o n o f income d e r i v e d from o p e r a t i v e s u r g e r y i n the two groups. I t had been thought t h a t surgeons i n the l a r g e r c e n t e r s might be f o r c e d t o do more g e n e r a l p r a c t i c e i n o r d e r to o b t a i n a s a t i s f a c t o r y income, but t h i s d i d not appear to be the c a s e . I t was a l s o found t h a t there was no c o r r e l a t i o n between t o t a l income and the p r o p o r t i o n o f income d e r i v e d from non-operative p r a c t i c e . T h i s i s s u r p r i s i n g s i n c e i t might be surmised t h a t those surgeons who were engaged e n t i r e l y i n s u r g i c a l p r a c t i c e would be found to have a h i g h e r income than those who were g e n e r a l - p r a c t i t i o n e r surgeons; surgery i s g e n e r a l l y b e l i e v e d to be the form o f medical p r a c t i c e which p r o v i d e s the h i g h e s t remuneration. P o s s i b l y the reason i s t h a t none o f the surgeons i n the study who were engaged i n s u r g i c a l p r a c t i c e o n l y , were working a t maximum c a p a c i t y , w h i l e some o f the g e n e r a l p r a c t i t i o n e r surgeons were. Two of the l a t t e r , f o r example, b i l l e d for i n excess of 5,000 o f f i c e v i s i t s i n the y e a r , a f i g u r e which at the r a t e o f four v i s i t s an hour would mean t h a t they were spending a p p r o x i m a t e l y 25 hours a week i n o f f i c e g e n e r a l p r a c t i c e a l o n e . I t may w e l l be t h a t a study of p r a c t i c e p a t t e r n s i n m e t r o p o l i t a n areas 40 which would include surgeons undertaking t e r t i a r y care would show d i f f e r e n t r e s u l t s . The r e s u l t s showed that there was a wide range i n the amount of general practice c a r r i e d out by surgeons, and suggest that t h i s was not related to the type of community i n which they p r a c t i c e . The question of whether the surgeon who confines himself to the p r a c t i c e of surgery provides better q u a l i t y of care than the surgeon who does not i s a con t r o v e r s i a l one. One approach to t h i s problem might be to carry out a study of the p r a c t i c e s of the two types of surgeons, matched for other variables such as h o s p i t a l category, using standard medical audit procedures to measure q u a l i t y of care. 41 CHAPTER 6 IMPLICATIONS FOR MEDICAL MANPOWER PLANNING I t i s important to look a t the f i n d i n g s above i n the c o n t e x t of the environmental f a c t o r s t h a t are i n v o l v e d . B r i t i s h Columbia o u t s i d e the m e t r o p o l i t a n areas i s s p a r s e l y p o p u l a t e d , t r a n s p o r t a t i o n o f s i c k people i s handicapped by geographic and c l i m a t i c c o n d i t i o n s , and q u i t e d i f f e r e n t c o n s i d e r a t i o n s must ap p l y from those i n , f o r example, the areas d i s c u s s e d by Hughes. These are d e n s e l y p o p u l a t e d and every k i n d o f h e a l t h resource—human and p h y s i c a l — i s immediately a v a i l a b l e . The presence of a surgeon i n an i s o l a t e d community may be e c o n o m i c a l l y and s o c i a l l y j u s t i -f i e d even i f there i s i n one sense, an u n d e r - u t i l i z a t i o n o f h i s s k i l l s . M e d i c a l p e r s o n n e l , i n remote a r e a s , have a v a l u a b l e stand-by f u n c t i o n . In the p a s t , the q u e s t i o n o f what m e d i c a l s e r v i c e s were p r o v i d e d t o an a r e a was dependent on the d e c i s i o n s o f i n d i v i d u a l p h y s i c i a n s on where t o l o c a t e ; and these i n t u r n were made on the b a s i s o f the r e t u r n s t h a t the p h y s i c i a n might e x p e c t — o f which money was o n l y one, i f o f t e n the main, c o n s i d e r a t i o n ( F e i n , 1967) Q Today, as the S t a t e assumes the r e s p o n s i b i l i t y o f p r o v i d i n g medical care f o r a l l i t s members, and f o r p a y i n g the p r o v i d e r s of t h a t c a r e , the c o n s i d e r a t i o n s o f the market p l a c e become l e s s and l e s s important. "He who pays the p i p e r c a l l s the tune", and 42 the S t a t e w i l l i n e v i t a b l y become i n c r e a s i n g l y i n v o l v e d i n the p l a n n i n g o f h e a l t h care, i n c l u d i n g the p l a n n i n g o f d i s t r i b u t i o n and l o c a t i o n o f p h y s i c i a n s . In a democracy the d e c i s i o n s made w i l l o f course be fundamentally p o l i t i c a l , b u t economic, s o c i o l o g i c a l and medic a l c o n s i d e r a t i o n s w i l l have to be taken i n t o a c c o u n t . The type o f i n f o r m a t i o n t h a t i s o b t a i n e d i n t h i s study, and the g r e a t mass o f a d d i t i o n a l d a t a t h a t t h i s methodology c o u l d p r o v i d e i n other areas o f medical p r a c t i c e c o u l d be of g r e a t importance i n decision-making p r o v i d e d t h a t i t s l i m i t a t i o n s are a p p r e c i a t e d . As has been s a i d e a r l i e r , t h i s study cannot assess the stand-by f u n c t i o n o f the surgeon; and i t must be r e a l i z e d t h a t the study i s o f the s i t u a t i o n a t one " t i m e - s l i c e " . Changes, t r e n d s , i n c r e a s e s or decreases i n the v a r i a b l e s d i s c u s s e d are not measured except i n d i r e c t l y . But w i t h these l i m i t a t i o n s , t h i s study r a i s e s a number o f p o i n t s t h a t should be of i n t e r e s t t o those r e s p o n s i b l e f o r h e a l t h p l a n n i n g . The low s u r g i c a l workload o f many o f the surgeons s h o u l d be o f concern, p a r t i c u l a r l y i n the l a r g e r c e n t e r s which have s u f f i c i e n t surgeons t o make the stand-by f u n c t i o n r e l a t i v e l y unimportant. There i s f o r example one are a i n the p r o v i n c e which has th r e e a d j o i n i n g Group A h o s p i t a l r e g i o n s w i t h 18 g e n e r a l surgeons, none of whom rea c h the suggested workload o f 4140 CRV u n i t s a year (90 CRV u n i t s per week). T h i s r a i s e s the q u e s t i o n o f whether a c t i o n might be d e s i r a b l e t o di s c o u r a g e f u r t h e r s e t t l e m e n t by g e n e r a l surgeons i n t h i s a r e a . 43 The amount o f s u b s p e c i a l t y s u r g e r y performed by g e n e r a l surgeons i s another matter which should i n t e r e s t the p l a n n e r . In the community h o s p i t a l s t h i s accounts f o r 40% of a l l o p e r a t i o n s , and i n the d i s t r i c t g e n e r a l h o s p i t a l s 26%. Some o f t h i s w i l l be emergency s u r g e r y i n p a t i e n t s who are not f i t to t r a n s f e r t o c e n t e r s w i t h s u b s p e c i a l t y f a c i l -i t i e s , and some may be r e l a t i v e l y minor o p e r a t i o n s such as t o n s i l l e c t o m y . But i t appears p o s s i b l e t h a t much o f i t i s surgery t h a t would be b e t t e r performed by the a p p r o p r i a t e s u b s p e c i a l i s t s i n l a r g e r c e n t e r s — o r perhaps i n the case o f the d i s t r i c t g e n e r a l h o s p i t a l s , by s u b s p e c i a l i s t s i n the same h o s p i t a l . T h i s i s p a r t i c u l a r l y t r u e o f g y n a e c o l -o g i c a l s u r g e r y which i s u s u a l l y o f an e l e c t i v e n a t u r e . F u r t h e r s t u d i e s u s i n g the methodology developed i n t h i s paper c o u l d p r o v i d e more d e t a i l e d i n f o r m a t i o n on t h i s p o i n t . The p a t t e r n s of p r a c t i c e o f the surgeons s t u d i e d v a r i e s g r e a t l y . Some appear t o c o n f i n e t h e i r p r a c t i c e to g e n e r a l surgery, w h i l e o t h e r s have a l a r g e s u b s p e c i a l t y or g e n e r a l p r a c t i c e . Manpower s t u d i e s i n v o l v i n g p r o j e c t i o n o f f u t u r e needs tend to r e g a r d the g e n e r a l surgeon as a s i n g l e e n t i t y , and assume t h a t when a c e r t i f i e d g e n e r a l surgeon r e t i r e s the a p p r o p r i a t e replacement i s another g e n e r a l surgeon—who would presumably be a r e c e n t graduate. General surgery i s however an e v o l v i n g s p e c i a l t y j u s t as much as the more e x o t i c s u b s p e c i a l t i e s , and the t r a i n i n g o f the r e c e n t graduate may w e l l be much narrower, i f more thorough, than t h a t o f h i s p r e d e c e s s o r of 30 years ago. 44 He i s much l e s s l i k e l y f o r example t o have e x p e r i e n c e i n s u b s p e c i a l t i e s such as gynaecology, and may l a c k both the necessary s k i l l s and the i n c l i n a t i o n f o r the type o f p r a c t i c e of the surgeon he i s to r e p l a c e . Indeed o f t e n the a p p r o p r i a t e replacement f o r a r e t i r i n g g e n e r a l surgeon i n a growing community might w e l l be a s u b s p e c i a l i s t or a g e n e r a l p r a c t i t i o n e r . T h i s study a l s o suggests t h a t the p r o d u c t i v i t y of a surgeon decreases w i t h age. The workloads o f the surgeons over 55 as a group are much l e s s than those of the under 55's. Unless s t u d i e s which attempt to p r o j e c t f u t u r e manpowers pay a t t e n t i o n t o the types o f p r a c t i c e s o f surgeons, and t h e i r age d i s t r i b u t i o n as w e l l as t o the numbers, they may w e l l be m i s l e a d i n g . I t would however be p o s s i b l e by r e f i n i n g the methodology used i n t h i s study and combining i t w i t h the e x i s t i n g data on m e d i c a l manpower t o o b t a i n a more a c c u r a t e f o r e c a s t of the f u t u r e needs f o r s u r g i c a l manpower i n the v a r i o u s areas of B r i t i s h Columbia than e x i s t s a t p r e s e n t . S h i l l i n g t o n (1974) f o r example has p r e p a r e d a computer s i m u l a t i o n model which p r o j e c t s the number o f p h y s i c i a n s t h a t w i l l be needed t o m a i n t a i n the e x i s t i n g p h y s i c i a n -p o p u l a t i o n r a t i o i n B r i t i s h Columbia. T h i s c o u l d be expanded to p r o j e c t the number o f CRV u n i t s by s p e c i a l t y t h a t w i l l be needed, and the mix o f p h y s i c i a n s t h a t c o u l d most e f f e c t i v e l y meet t h a t need, t a k i n g i n t o account the f a c t o r s d i s c u s s e d above. 45 CHAPTER 7 SUMMARY AND CONCLUSIONS T h i s study has examined the p r a c t i c e s of two groups o f surgeons i n B r i t i s h Columbia to determine whether t h e r e i s an u n d e r - u t i l i z a t i o n o f t h e i r s k i l l s and t o see what f a c t o r s i n f l u e n c e t h e i r p a t t e r n s o f p r a c t i c e . There does appear t o be an u n d e r - u t i l i z a t i o n o f s k i l l s , and the d a t a suggests t h a t the type o f h o s p i t a l i n which a surgeon works a f f e c t s h i s p r a c t i c e p a t t e r n , and t h a t h i s volume o f work decreases w i t h age and l e n g t h o f p r a c t i c e i n B r i t i s h . Columbia. However more important than the a c t u a l r e s u l t s has been the development of a methodology which p e r m i t s the measurement and a n a l y s i s o f s u r g i c a l p r a c t i c e s u s i n g a w i d e l y r e c o g n i s e d s c a l e — C a l i f o r n i a R e l a t i v e Value u n i t s . T h i s methodology can be extended to p r o v i d e d e t a i l e d i n f o r m a t i o n about many f a c e t s o f m e d i c a l p r a c t i c e , and the i n f o r m a t i o n w i l l be i n a form which enables meaningful comparisons to be made between p h y s i c i a n s i n d i f f e r e n t s e t t i n g s u s i n g such groupings as p r o v i n c e , h o s p i t a l r e g i o n s , type o f h o s p i t a l , type o f p r a c t i c e — g r o u p , s o l o or community h e a l t h c e n t e r . I f d e c i s i o n s i n the f u t u r e o f m e d i c a l care i n t h i s p r o v i n c e are to be soundly based, i n f o r m a t i o n of t h i s k i n d w i l l be e s s e n t i a l 0 46 BIBLIOGRAPHY Anderson, D.O. and C h r i c h t o n , A.O.J. (1973). What p r i c e group p r a c t i c e ? O f f i c e o f the C o o r d i n a t o r H e a l t h S c i e n c e s . U.B.C., Vancouver. Beeson, P.B. (1974). Some good f e a t u r e s of the B r i t i s h N a t i o n a l H e a l t h S e r v i c e . J . Med. Educ. 49. 43. Boaz, R.F. (1972). Manpower u t i l i z a t i o n by s u b s i d i s e d f a m i l y p l a n n i n g c l i n i c s . J o u r n a l o f Human Resources 7, 191. B r i t i s h Columbia M e d i c a l A s s o c i a t i o n Schedule o f Minimum Fees (1973). B r i t i s h Columbia M e d i c a l A s s o c i a t i o n . Vancouver. Bunker, J.P. (1970). 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Spencer, F.C. (1974) i n M i l l e r , Saxbe e t a l . , l o c . c i t . S p i t z e r , W.O., S a c k e t t , D.L. e t a l . (1974). The B u r l i n g t o n randomised t r i a l o f the n u r s e - p r a c t i t i o n e r . N. Eng. J . Med. 290, 251. Task Force r e p o r t (1970). Cost o f H e a l t h S e r v i c e s i n Canada. Queen's P r i n t e r . Ottawa. Vayda, E. (1973). A comparison o f s u r g i c a l r a t e s i n Canada and i n England and Wales. N. Eng. J . Med. 289, 1224. 49 APPENDIX A Study Regions GROUP A: B r i t i s h Columbia Regional Hospital D i s t r i c t s With D i s t r i c t General Hospitals 2a. Kootenay Boundary 3. Okanagan-Similkameen 5. North Okanagan 6. Central Okanagan 7. Thompson-Nichola 20. Fraser-Ft. George 25. Nanaimo GROUP B; B r i t i s h Columbia Regional Hospital D i s t r i c t s Without a D i s t r i c t General Hospital 1. East Kootenay 2. Central Kootenay 4. Columbia-Shuswap 8. Cariboo 9. Squamish-Li11ooet 14. Sunshine Coast 15. Powell River 16. Mount Waddington 16a. Ocean F a l l s 17. Skeena A. 18. Kitimat-Stikine 19. Bulkley-Nechako 21. Peace River-Laird 22. Stikine 24. Cowichan Valley 26. Alberni-Clayoquot 27. Comox Strathcona B r i t i s h Columbia Regional Hospital D i s t r i c t s Excluded From Study: 10„ Fraser-Cheam 11. Central Fraser Valley 12. Dewdney-Alouette 13. Greater Vancouver 23. Ca p i t a l Each Group A regional h o s p i t a l d i s t r i c t contains a single d i s t r i c t general h o s p i t a l , and may contain community h o s p i t a l s . With one exception, these community hospitals do not have a general surgeon. The Group B regional h o s p i t a l d i s t r i c t s have one or more community ho s p i t a l s , but no d i s t r i c t general h o s p i t a l s . o i n R e g i o n a l H o s p i t a l 1 E a s t K o o t e n a y 2 C e n t r a l K o o t e n a y 2a Kootenay B o u n d a r y 3 Ok a n a g a n - S i m i l k a m e e n 4 Columbia-Shusv:ap 5 N o r t h Okanagan 6 C e n t r a l Okanagan 7 T h o m p s o n - N i c o l a 8 C a r i b o o 9 S q u a m i s h - L i l l o o e t 10 ' F r a s e r - C h e a m 11 C e n t r a l F r a s e r Valley 12 D e w d n e y - A l o u e t t e 13 G r e a t e r V a n c o u v e r 14 S u n s h i n e C o a s t 15 P o w e l l R i v e r 16 Mount Wa d d i n g t o n 16a Ocean F a l l s 17 Skeena-Queen C h a r l o t t e 18 K i t i m a t - S t i k i n e 19 B u l k l e y - N e c h a k o 20 F r a s e r - F o r t George 21 Peace R i v e r - L i a r d 22 S t i k i n e 23 C a p i t a l 24 Cowich a n V a l l e y 25 Nanaimo 26 • Alberni-Clayoquot 27 Comox-Strathcona REGIONAL HOSPITAL D I S T R I C T B O U N D A R I E S B R I T I S H C O L U M B I A APPENDIX B Method of A l l o c a t i n g C a l i f o r n i a R e l a t i v e Value U n i t s t o the B.C.M.A. Fee Schedule Where the B.C.M.A. procedure has a s i n g l e C a l i f o r n i a s i m i l a r procedure, the C a l i f o r n i a u n i t v a l u e w i l l be g i v e n ; e.g. B.C.M.A. Simple mastectomy 7490 C a l i f o r n i a 19180 simple mastectomy complete, u n i l a t e r a l 8.0 u n i t s Where the B.C.M.A. procedure appears t o corr e s p o n d t o more than one C a l i f o r n i a procedure, an average f i g u r e w i l l be s e l e c t e d , weighted as appears a p p r o p r i a t e ; e.g. B.C.M.A. 7444 E n t e r o s t o n y o r caecostomy C a l i f o r n i a 44300 Tube enterostomy or caecostomy (independent procedure) 8.5 u n i t s C a l i f o r n i a 44320 Colostomy or s k i n l e v e l caecostomy 12.0 u n i t s U n i t s a l l o c a t e d 9.0 (A s k i n l e v e l caecostomy i s c o n s i d e r e d t o be a v e r y much l e s s common procedure than a tube enterostomy or caecostomy). Where th e r e appears to be no C a l i f o r n i a procedure c o r r e s p o n d -in g t o a B.C.M.A. procedure, a procedure c o n s i d e r e d to be o f equal c o m p l e x i t y w i l l be s e l e c t e d and a t the u n i t v a l u e o f t h a t procedure a s s i g n e d t o the B.C.M.A. pr o c e d u r e . e.g. B.C.M.A. 77693 Drainage o f l i v e r abscess i s equated w i t h C.R.V. 49020 Drainage o f p e r i t o n e a l a b s c e s s , a l o c a l -i z e d p e r i t o n i t i s and a l l o c a t e d 11 u n i t s . 52 4. The B 0 C.M.A. fee schedule provides for procedures which do not f i t into the usual categories to be paid for on an individual basis. This class of procedure is ident i -fied in the fee schedule by the last three digits 999. They represent approximately 5 per cent of a l l procedures. Many such procedures w i l l represent complex opera-tions which, because of their r a r i ty , are not l i s t e d . Others may be re lat ively simple operations. But i t appears that the overall mean complexity w i l l be high. A value of 12 Cali fornia R.V 0 units has therefore been assigned to this group. 5. The methods of classi fying skin grafting procedures in both the Cal i fornia system and the B.C.M.A. fee schedules involves three variables: type of graft, size of graft and site of graft, while the class i f icat ions of type of graft are compatible, those of size at site are not, and i t proved impossible to relate d irect ly to the B.C.M.A. fee schedule to the Cali fornia system. Instead, the B.C.M.A. items have been allocated a R.V. value judged to be appropriate to the complexity of each item without reference to any corresponding Cal i fornia procedure. It w i l l be noted that consultation fees and assistants fees are regarded as beyond the scope of this study, and are not included. 53 Those procedures w i t h a C.R.V. value o f l e s s than 1.0 w i l l be o mitted from the study. These are minor procedures which are regarded as not r e q u i r i n g the s k i l l s o f a g e n e r a l surgeon. They do not appear t o account f o r a s i g n i f i c a n t p a r t o f the s u r g i c a l workload i n terms o f CRV u n i t s and t h e i r i n c l u s i o n or e x c l u s i o n would not a f f e c t the a n a l y s i s o f workload. (Table X) The procedures are however s u f f i c i e n t numerous to have a p o s s i b l e e f f e c t on the s u r g i c a l c o m p l e x i t y index i f they were i n c l u d e d . TABLE X TABLE TO SHOW FREQUENCY OF FOUR MOST COMMON MINOR SURGICAL PROCEDURES PERFORMED IN BRITISH COLUMBIA BY CERTIFIED GENERAL SURGEONS IN 1973 Mean CRV Value B.C.M.A. C.R.V. No. of No. of Per Surgeon Code Procedure Value Procedures Surgeons Per Year 7026 Superficial abscess 0.4 761 175 1.74 7035 Excision of benign tumor of skin 0.4 3665 223 6.57 7034 Additional benign tumor of skin 0o2 1225 166 1.48 7030 Minor laceration 0.4 1972 190 4.15 A minor surgical procedure is defined as having a C.R0V. value of less than 1.0. Source: 1973 M.S.C. data. 55 APPENDIX C C a l c u l a t i o n o f D o l l a r Value of CRV S u r g i c a l U n i t The B.C.M.Ao fee schedule (1973) numbers were o b t a i n e d f o r a l l o p e r a t i v e procedures t h a t has been performed by g e n e r a l surgeons i n B r i t i s h Columbia. 1. on more than 500 o c c a s i o n s ; 2. on from 300-499 o c c a s i o n s i n 1973. The source of t h i s data was a s p e c i a l study c a r r i e d out by the D i v i s i o n o f H e a l t h S e r v i c e s f o r another purpose. There were 18 procedures i n each group. The B.C.M.A. fee and CRV u n i t s were found f o r each procedure, and t o t a l s o b t a i n e d . By d i v i d i n g the f i g u r e o b t a i n e d from the sum o f the B.C.M.A. fees by t h a t o b t a i n e d by the a d d i t i o n o f the CRV u n i t s , a d o l l a r value f o r a CRV u n i t was o b t a i n e d . Since the M.S.Co pays onl y 90% o f the B.C.M.A. schedule, t h i s d o l l a r v alue was m u l t i p l i e d by 0.9 t o o b t a i n the f i g u r e used i n the study. The c a l c u l a t i o n s are as f o l l o w s : Group I (N = 18) Group I I (N = 18) T o t a l (N = 36) BCMA Fee T o t a l 2565 2065 463 0 CRV T o t a l 191.9 154.6 346.5 D o l l a r Value $ 13.37 $ 13.36 $ 13.36 Amount P a i d by MRC (90%) $ 12.02 56 APPENDIX D Workload o f surgeons i n d i v i d u a l l y and grouped by r e g i o n a l h o s p i t a l d i s t r i c t and r e g i o n a l h o s p i t a l d i s t r i c t Groups A and B. Workload i s shown by number o f procedures (P) and by number o f CRV u n i t s (V) and i s broken down i n t o : T o t a l Workload ( T o t a l ) G e n e r a l S u r g i c a l (Gen. Surg.) S u b s p e c i a l t y (Sub. spec.) Opthalmology (1) O t o r h i n o l o r y g o l g y (2) Neurosurgery (3) Gynaecology (4) Orthopaedics (5) P l a s t i c Surgery (6) Urology (7) A l s o shown i n the number o f o f f i c e c a l l s (O.C.), the s p e c i a l t y index (S„ 1), and the co m p l e x i t y index (C. 1) 0 The names o f the Regional H o s p i t a l D i s t r i c t s have been erased t o preserve the c o n f i d e n t i a l i t y o f the M.S.C. f i l e s . J SURGERY TABIJE I TOTAL GEN. SURG SUB.SPEC 1, 2 3 • ROUP A , IEGIGN: O . G . S . I . C . 1 P -V 372 4 3 7 2 . 9 0 55 28 3 . 2 0 317 4089 .70 ~ t ~ C 0 .0 1 5 .70 14 328. OC 0 0 .0 297 3714 .00 e > 42.OC 0 0 . 0 664 . 0 . 4 3 lb 2 P V 172 1572 .10 13 8 1396 .70 34 175.40 0 0 .0 15 65 . 10 0 • 0. 0 0 0 .0 c 2 1 . 7 0 9 54 .00 5 3 4 . 6 0 279 5 . C I I C . 12 3 P 121 113 8 0 3 1 / 1 ' 0 1 0 . 3 127 10 .71 12 .C3 V 1395.70 1359 .80 35 .90 0.0 17.10 2 .CC 0 .0 1.20 0 .0 15 .60 rr^C"*l |- Q 11 AC 4 p V 488 5579 .20 412 5 1 4 6 . 6 0 76 432 .60 1 1.60 41 181.80 8 4 4 . 8 0 4 4 8 . 0 0 6 2 6 . 4 0 8 50 .00 8 80 .00 2 59 7 1 • 7 o 16*1 ' 2 . 2 3 11.4C TCTAL P 1153 718 , 435 V 12919.69 9166 .30 4733 .59 I 60 23 4 309 22 16 3667 "T7613 269 .70 374 .80 4T5T0TJ 3763 .30 146. U/U T3U77TJ CEAN P V 2 8 8 . 2 5 179 .50 108.75 0 .25 15.00 3229 .97 2 0 4 6 . 5 8 1183.40 0 .40 67 .42 5.75 l . C O 7 7 . 2 5 5 .5C 93 .70 12.00 940 .82 36.50 4 . 0 0 916 .75 32 .55 2 . 2 3 11.AC " O T SURGERY TABLE I TOTAL GEN.SURG SUB.SPEC 1 2 3 4 5 6 7 O . C . S . I . C . .ROUP A \ .EGION: 1 P V 127 934 .90 47 4 5 1 . 7 0 80 4 8 3 . 2 0 0 0 .0 13 5 4 . 4 0 C 0 .0 23 188.40 36 209 .20 4 18.00 4 13.20 5031 0 . 0 9 . 9 .61 2 P V 299 2613 .90 157 1470 .70 1 4 2 ' 1143 .20 0 0 .0 22 92 .90 0 o.o 73 712 .40 40 292.70 2 24 .00 5 21 .20 3918 0 . 3 8 9 . 3 7 3 P 479 239 240 0 21 - 4 69 82 47 17 238 8 . 1 4 8 .10 V 3571 .30 1936 .50 1634 .80 0 .0 " 9 1 . 6 0 5 1 . 0 0 s. 646'.30 561.70 213 .CC 71 .20 ~ I 0 T 3 T 4 P V 327 J 1 6 3 . 5 0 186 1928 .60 141 1234.90 0 0 .0 i 24 9 6 . 0 0 0 • 0 .0 81 890 .30 3 T 232 .60 1 8 .00 1 8 .00 2283 """""~0T8~4~~~ 5 P V 353 3758 .90 216 2 4 6 0 . 4 0 137 1298.50 0 0 .0 20 105 .00 0 0 .0 65 932 .90 16 9 1 . 6 0 1C 67 .00 26 1C2.00 50 49 .21 11.39 *********************************************************************^ X T AL P 1583 1 4 5 74 0 0 ICO 4 311 208 64 5 3 115 20 C . 7 2 9 .76 V 14042.50 8247 .90 5794.60 0 .0 4 3 9 . 9 0 51 .00 3370.30 1387.80 330 .00 215 .60 MEAN P 317 .00 169.00 148.00 0 .0 20 .CO 0 .8C 62 .20 4 1 . 6 0 12.80 10.60 2304 .00 0.7,2 9 .76 — \ T 2 8 0 8 . 5 0 1649.58 n 5 B T 9 2 DTD 57 .98 —ITJ72C 674.U6 277 .56 SZ.CO 43 .12 ~ _ . **********************************************************************************^ : : . '. : :—: : — o i -00 I g— SURGERY TABLE I •ROUP A TOTAL GEN.SURG SUB.SPEC 1 2 3 4 5 6 7 O . C . S . I . . C . EGION: I P . V 182 1611.80 91/ , 851 .7C 91 7 6 0 . 1 0 0 0 . 0 0 0 . 0 0 0 .0 6 36 .00 80 701 .30 I 4 .00 4 18.30 301 7 0 .28 <J.36 2 P V 17C 1882.70 123 1419 .00 47 463 .70 ' 0 0 . 0 1 5 . 7 0 -i 12 .00 2 28 .00 36 375 .40 3 15.00 4 27 .60 471 3 .01 11.54 3 P 133 69 64 1 2 2 5 44 9 1 1455 0 . 3 7 7 . 8 9 V 1057.10 544 .50 512 .60 1.00 8 .00 2 4 . 0 0 70 .00 325 .60 76.OC 8 .00 • A P V 352 3 3 4 7 . 6 0 26 9 2 7 2 9 . 2 0 83 6 1 8 . 4 0 s 0 0 .0 0 0 . 0 3 34 .00 6 68 .00 58 399 .20 69 .00 8" 48 .20 4¥5~ "5T87"" 10.15" 5 P V 61 4 5 9 . 2 0 26 232 .40 35 2 2 6 . 8 0 0 0 .0 1 12 .00 0 0 .0 13 102.30 6 2 1 . 7 0 8 53 .00 7 37 .80 137C 0 . 1 7 8 .94 6 P 63 19 44 0 15 0 10 16 0 3 3672 0 .04 7 . 7 7 V 38C .7G 147 .70 233 .00 0 .0 6 0 . 8 0 0 .0 79 .60 82 .40 0 . 0 , 10 .20 21 .49 7 P V 139 1444.10 112 1 2 2 4 . 8 0 27 2 1 9 . 3 0 0 0 .0 0 0 . 0 C 0 .0 2 24 .00 21 175.30 3 12.00 1 8 .00 57" ' CT AL P 1100 709 391 1 19 6 44 261 32 28 10507 0 . 6 8 l o . c ' e V 10183.19 714 9 . 2 9 3033.90 1.00 86 .50 70 .00 407 .90 2080 .9C 229.00 158.60 KE AN P V 157 .14 1454.74 10 1.29 1021 .33 55 .86 433 .41 0 .14 0 .14 2 .71 12 .36 0. 86 10 .00 6 .29 58.27 3 7 . 2 9 297 .27 4 .57 32.71 4 . 0 0 22 .66 1501 .00 0 . 6 8 10. C8 en SURGERV TA OLE I V TOTAL GEN.SURG SUB.SPEC O . C . S . I . C . I 2090 :30 1687 .00 403 .30 2 .00 17.10 2 .00 204 .00 24.CO 6 7 . 0 6 ^ 87 .20 5 P 3 5 C ' ' ~ ' 30 5 ' • 45 0 9 3 1 6 - -u « Q 0 , 3 0 - 237 .90 0 .0 4 9 . 2 0 2 6 . C 0 12.00 4 9 . 5 0 14 .PC 87 .20 V 3538 .20 .3300.30 237 .90 _ _ 2 3 3 1 7 4 B - 9 - T — - T ~ ~ - — r n 3- 1"? 1* — o r - r z r w . * . . u . 3 23 93 35 .49 1C.82 7«; 0 8 0 2 9 8 48 105 3 1 . C C 9 .83 3 5 6 7 . 6 0 3 2 5 5 . 0 0 31^769 0 7 0 " 3 5 7 3 ^ ^ 24 .00 40 .90 25 .00 1 8 / . 4 0 " ~ _ _ _ _ - j - 5 7 jap ~ 12 "*~ 0 ~2~ 0 0 5 3 <: » 1952 .60 1890.20 62 .40 0 .0 8 . 00 0..0 0 .0 16 .40 14.00 24.00 124E ~ l T 5 r ~ T C . 3 T " 5 P V 220 1708.80 167 1448 .60 53 260 .20 0 0 .0 3 21 .60 0 0. 0 6 84 .00 39 126.60 28 .00 C 0 .0 44 32 .92 8 .67 6 P 35 3 244 1 C 9 X 0 12 5 3 12 19 58 — — n n 376 6 .11 9 .42 V 2817 .80 2298 .40 5,19.40 0 .0 58 . 10 59V8C. 36 .00 S i .3U 232.2U t^^^t************************ **********************W******^^ CTAL P V 1756 15675.29 1403 13879 .49 353 1795.80 1 2 .00 27 189 .30 9 8 7 . 8 0 29 360 .00 74 308 .70 53 230 .00 15C 618 .00 1999 6 .94 9 .89 — — , *—>™ *T— m — r—C7! a—tTC~ He AN P V 2 9 2 . 6 7 2612 .55 233 .83 2 3 1 3 . 2 5 58 .83 299 .30 0 .17 0 .33 6 . 17 3 1 . 5 5 1. EC 14 .63 4 .83 60 .00 12.33 51 .45 C • C J 38 .33 to. uu 1C3.00 7 • I ' ' ***************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ^ » * » ^ o JROUP A TOTAL GEN.SURG SUB.SPEC 1 2 3 4 5 6 7 O . C . S . I . C ! IEGION: I P V 5C8 4 7 C 6 . 9 0 345 3 5 9 9 . 9 0 163 1107.00 0 0 .0 33 149.30 3 16. OC « z 448 .00 54 . 364 .50 1 I .00 30 128.20 2411 1.49 10 .43 2 P V 412 4601 .20 33 2 4 0 2 4 . 1 0 80 577 .10 0 0 .0 2 10 .70 3 36 .00 2 24 .00 59 398.60 11 93.OC 3 14.60 83 48 .48 12.12 3 P - 286 16 9 117 . 0 14 4 1 5.8 9 31 479 3 .24 9 . 2 C V 2253 .80 1554 .00 699 .80 0 .0 6 4 . 6 0 38. ec 14.00 410 .60 50 .00 121.80 4 P V 322 2602 .80 190 1 8 7 7 . 3 0 132 725 .50 1 2 .00 12 5 1 . 5 C 1 12.00 . 0 0 .0 58 413 .40 26 92.OC 34 154.60 333 " 5 .64 —Tr.TW 5 P V 326 2952 .50 193 2 0 8 4 . 4 0 133 868 .10 0 0 . 0 41 209 .20 0 0. 0 2 24 .00 86 621 .90 3 10.00 1 3 . 0 0 568 3 .67 l c . ec 6 P 300 13 0 170 0 38 2 0 67 11 52 341 3 .55 9 .31 V 2 2 5 5 . 1 0 1209 .90 1045.20 0 .0 170 .90 14 .00 0 .0 542.30 73 . OC 245 .00 7 P V 232 1901.80 123 113 1.20 1C9 7 7 0 . 6 0 0 0 .0 16 6 8 . 5 0 5 85 .00 26 216.00 3b 248. 90 2 18.00 25 134.20 ~ T . T 1 " 9T2C~ 8 P V 328 • 2784 .80 22 2 2 1 5 0 . 6 0 1C6 634 .20 1 1.00 6 3 2 . 6 0 4 48 .00 2 24 .00 66 403 .40 14 53.OC 13 72 .20 367 5 .6 6 9 .69 9 P. 327 196 131 0 24 1 0 66 35 5 64 34 .55 11.26 V 3084 .30 2 2 1 0 . 9 0 8 7 3 . 4 0 0 .0 134 .00 24 .00 0 .0 527.60 159.00 28 .30 ——— r— — * * * * * * 4 * * 4 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * < t * * * * * * * ] ) OTAL P 3041 1900 1141 2 186 23 75 549 112 194 556C 3 . 5 6 10.44 V 27143.18 19642 .29 7300 .89 3 .00 891 .30 273 .80 750.00 3931 .40 549.00 9C2 .40 / SURGERY TABLE I ROUP A • V EG ION: £ * TOTAL GEN.SURG SUB.SPEC 1 V 2 3 4 5 6 7 O . C . S . I . C . I 1 P V 599 6113 .59 50 7 '5345 .00 92 768 .60 0 0 . 0 6 33 .30 9 122.AC 14 • 159 .00 27 228 .90 5 23 .00 31 201 .60 427 T2".~57~ 10.54 2 P V 138 1236.GO 94 100 2 .30 44 233 .70 1 1.60 12 4 7 . 6 0 0 0 .0 6 4 8 . 0 0 9 6 2 . 10 0 0 .0 16 74 .40 2794 0 .36 1C.66 3 P 54 1 473 68 0 5 5 2 30 8 ie 224 2 2 . 3 8 1C.60 V 5621 .39 5 0 1 2 . 5 0 6C8 .90 0 .0 2 8 . 8 0 94 .00 24 .00 231 .60 25 .00 205.50 2377 4 P V 51 290 .80 16 V. 9 6 . 1 0 35 194.70 0 0 .0 3 12 .00 0 0 .0 14 112.80 14 58 .30 1 2 .00 3 9 . 6 0 0 . 04 6 . CI 5 P V 177 1755.10 110 1338 .80 / 67 416 .30 0 0 .0 25 119.80 0 0. 0 21 196.80 12 4 5 . 5 0 2 10.00 7 44 .20 2286 0 .59 12 .17 . - ' • ********** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * I * * * * * * * * * * * * * * * * * * * * * * * * ™ CTAL P V 15C6 15016.68 1200 12794 .69 306 2222 .20 1 1.60 51 241 .50 14 216 .80 5 7 540 .60 92 626 .40 16 60 .00 75 535.30 81118 1 .St) 1U . c _ CEAN P 3 0 1 . 2 0 2 4 0 . 0 0 61 .20 0 .20 10.20 2 .8C 11.40 18 .40 3.20 15.CO 1621.60 1 .5 8 10 .66 V 3003 .38 2 5 5 8 . 9 4 4 4 4 . 4 4 0 .32 4 8 . 3 0 4 3 . 3 6 108.12 125.28 12.00 1-7.06 *********************************************************************************** . _ '. to TOTAL GEN.SURG SUB.SPEC 1 GROUP A SURGERY TABLE"' I ~ ~~ • ~ > _ 5 6 7 O.C. S.I. C. REGION : T - p - 3 8 6 308 78- 0 " 13 T ; T 5~ ~T3 43 446 ~ 6.74 • V 3447.00 3006.70 440.30 0.0 63.30 12.00 36.00 33.00 55.00 241.00 . 2 P V 4 16 4270.60 345 3778.00 71 492.60 1 1.00 6 31.00 - 3 28.OC 2 24.00 15 79.CO 21 1C3.00 23 226.60 72 52.47 1C.T 3 P 259 26 233 0 1 0 3 0 1 228 149 1.89 10.E V 2690.50 231 .00 2409 .50 O.O 5.70 0.0 28.00 O.C 3 .Oil 2311. 80 ~ . I'D L V P . - G l I T — T 4 P V 379 3799.40 337 3498.30 42 301 .10 0 0.0 5 24.40 2 14.00 4 56.00 13 . 54.50 7 75.OC 11 77.20 LOO l o . c i I t . J ***************************************** TOTAL P 1440 1016 424 1 25 6 12 3 3 42 3C5 853 12.38 1C.4 V 14207.50 10564.00 3643.50 1.00 124.40 54.00 ' 144.00 166.50 236.00 291(.6U MEAN P V 36C.O0 3551 . 88 254.00 2641.00 106.00 910 . 88 0.25 0.25 6.25 31. 10 1.50 13. 50 3.00 36.00 8.25 41.63 10.50 59.00 76.25 729.40 213.25 12.38 10.4 • . ••-J.^-J-J-J-J-J-J-J. J L - J , J, ************************************************* -*'***************** ************************************ "•'"••'•'•'•'•'""'•'•'•'•'•^•'^^^ ~ 40-SURGERY TABLE I TOTAL GEN.SURG SUB.SPEC 1 2 3 4 5 6 7 C.C. S.I 3ROUP A ***********************^******* GP.TOT P 11581 7791 3790 7 478 e5 532 1526 341 821 42234 1.91 10.25 V 109188.38 80663.88 28524'.48 10.20 2242.60 1128.20 5620 .80 12264 .99 1780.00 5477.70 K E A N p 289.52 194.77 94773 OTTT 1X795 27T3 13730 387T5" 8T52 20 .52 1055.85 1.9 1 10.35 V 2729.71 2016.60 < 713.11 0.25 56.06 28.20 140.52 306.62 44.5C 136.94 »»»•»»••»••*»«»»»**»*•»»»****»******»************************»***» -Or 0 SURGERY TABLE I OUP B TOTAL GEN.SURG SUB.SPEC 1 2 3 4 5 6 7 O.C. S.I. C.I. GION: f 1 P V 3 88 4223.90 190 2108.60 198 2115.30 1 ' 1 .60 1 5.70 5 45.00 84 . 12 73.60 57 • 4 76.6 0 7 27.00 43 2 75.80 305 6.91 11.10 2 P V 303 3159.10 173 1905.00 130 1254.10 0 0.0 0 0.0 1 ". 4.80 3 0 403.20 80 686.50 8 51. 00 11 108.60 149 12.79 11.01 3 P 287 120 167 0 0 2 20 55 14 76 89 13.72 10.18 V 2933.50 1221.30 1712.20 0.0 0.0 56.00 313. 80 392.30 73. 00 877.10 • 4 P V 186 1628.30 86 788.90 100 839.40 0 0.0 2 7. 80 0 0.0 48 523. 80 24 191.20 0 0.0 16 116.60 1413 0.56 9. 17 5 P V 159 1345.50 64 609.90 95 735.60 . 1 2.00 19 79. 20 1 4. 80 43 469.10 22 136.70 1 4.00 8 39 .80 222 2. 75 9. 53 ;********************************************************************************* ITAL P V 1323 13290.29 633 6632.70 690 6656.59 2 2 .60 22 92.70 9 110.60 225 2983.50 248 1882.30 30 165.00 154 1417.90 2178 3.05 10.48 1EAN P V 264.60 26 58.06 126.60 1326.74 138.00 1331.32 0.40 0.72 4.40 18.54 1.80 22.12 45.00 596.70 49.60 376.66 6. 00 32.00 30.80 283.58 435.60 3.05 10.48 I * * * * * * * * * * * * * * * * * * * * * * * * * * * *********************************************************************************** ST VO !********************* *»*»»*»»*»********»******************»*»*»**»**** *»***^ 85*6 95*1 2.9*Z.£TT 08VEZ A9*SZ ££'L9 ££*6 £5*909 00*59 £1 *08 00 */. £C*Z<7 ££*Z EI *<7 03 *I 0*0 0*0 06*8£0I, ££*0TI £**5iJLT ££*S8T ££*<7T8Z I9*S6Z A d NV3k 00 *Z0Z 0i.*6T8I OZ'ZVZ OO'ZZT 0<7*ZT 0*0 0I*9Tt£ 0£*9ZES 00*£^8 A 85*6 95*1 £I^£ LL 8Z 56T TZ Z. £ 0 I££ 955 Z88 d "IV11 c** ******:***** ************************************** 09*95 00*8TT 01*688 00*9£ 00*0*7 0 *0 0 *0 OL*6£TT 02. *V£*I A' 16*8 8£*0 Z£8I /. LI LS £ 0 0 9ZI 191 2.8Z d £ ££*6 *?9'l 9ZTT OV T i l 00* ZA 6 05*Z.V£ 9V 00*Z9 S 00 *6£ z 0* *T T Z 0*0 0 0£*£OZ. as OZ '8V8T 861 0SM5SZ 98Z A d Z 0VS8V OO'ZI 0I*£85 OZ'^M 00*8^ 00 *T 0*0 0L'£LZ\ OVEVOZ 0T*2.U£ A L £ *OT b*7m*7 5Sfr __2J? ? _...?_!» ...JLl ? 1 _P- 6 T :N0I9; 8 dflO >!«3 •o«0 I 9 5 *7 e Z I D3dS*9nS 0'dnS*N30 "1V101 i g i t i f f i A < j j 9 d i s SLRGERY TABLE I OUP B TOTAL GEN.SURG SUB.SPEC 1 2 3 4 5 6 7 O.C. S . I . C . I , GION: . 1 p V 7 16.70 3 7.30 4 9. 40 0 0.0 0 0. 0 0 0.0 0 0.0 4 9.40 0 0.0 0 0.0 3272 0.00 2.43 2 P V 276 2628.90 141 1507.20 135 1121.70 0 0.0 16 72. 80 0 0.0 64 631.20 33 333.90 5 15.00 17 68. 80 2072 0.73 10.69 3 P • 133 90 43 0 1 2 15 24 1 0 1 1067.40 11.86 V 1620.10 1067.40 552.70 0.0 5.70 24.00 200.00 318.00 5.00 0. 0 ,*************************************************** ITAL P 416 234 182 0 17 2 79 61 6 17 5345 C.48 11.03 V 4265.70 2581.90 1683.80 0.0 78. 50 24.00 831.20 661.30 20.00 68.80 IEAN P V 138.67 1421.90 78.00 860.63 60.67 561.27 0.0 0.0 5.67 26. 17 0.67 8.00 26.33 277.07 20.3? 220.43 2.00 6.67 5.67 22 .93 1781.67 0.48 11.03 -, * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * « * * * * ^ SURGERY TABLE I TOTAL GEN.SURG SUB.SPEC 1 2 3 4 5 6 7 O . C . S . I . C . I . OUP B _ _ _ _ _ _„... . _ _ _ . . : . . . 1 P 620 251 369 2 66 5 205 51 , 8 32 739 2 .93 8 .63 V 4819 .50 2167 .00 2652 .50 •2.60 274 .70 39 .00 1911.20 255 .80 4 9 . 0 0 120.20 2 P 445 173 272 2 61 4 130 47 13 15 . 1121 1.44 9 . 3 4 V 3724 .10 1615 .80 2108 .30 3 .20 20 5 .00 3 0 . 0 0 1339.40 3 8 5 . 7 0 73. 00 72 .00 ; 3 P 316 148 168 2 38 0 i 63 25 3 37 2581 0 .52 8 .98 V 2 211.30 1329.30 .882.00 3 .20 152.70 0 .0 434.00 130 .50 8. 00 153 .60 .4 p 581 204 377 0 64 0 185 88 3 37 5938 0 .33 9. 53 - V 4621 .20 1945.10 2676 .10 0 . 0 265 .20 0 .0 1645.10 570 . 2 0 15 .00 180.60 **************************************** TAL P 1962 776 1186 6 229 9 583 211 27 121 10379 0.68 9 . 0 9 V 15376 .09 7 0 5 7 . 2 0 8318.89 9 . 0 0 897 .60 69 .00 5329.70 1242.20 145.00 526.40 EAN P 490 .50 194 .00 296 .50 1.50 57. 25 2 . 2 5 145.75 52.75 6 .75 30 . 25 2594 .75 0 .68 9 . 0 9 V 3844 .02 1764 .30 2079.72 2 .25 224 .40 17.25 1332.42 335 .55 36 .25 131.60 * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ***************************************************************< oo SLRGERY TABLE I TOTAL GENi SURG SUB.SPEC 1 2 3 4 5 6 . 7 O . C . OUP. B G I C N : • . • . . _ _ . _ _ _ _ _ _ - 33 15 0 15 2420 [ 0.12 7.66 V 709..70 283 .30 426 .40 0 . 0 61 . 60 0 .0 257 .00 50 .00 0 * 0 57 .80 ********************************************************************************** ****^ ^^^ TAL P 115 37 78 0 15 0 33 16 0 15 2420 0.12 7 .66 V 7C9 .70 283 .30 426 .40 0 . 0 61 .60 0 .0 257.00. 50 .00 0 . 0 57 .80 EAN P 115 .00 3 7 . 0 0 78 .00 0 . 0 15.CO 0.0 3 3 . 0 0 15 .00 0 . 0 15.00 2420 .00 0 .12 7 .66 V 7C9 .70 283 .30 426.40 0 . 0 61 .60 0 .0 257.00 50 .00 0 . 0 57 .80 ************* SLRGERY TABLE I OUP B TOTAL GEN.SURG SUB.SPEC 1 __ — 4 5 6 7 O . C . S. I . C . I . GION: 1 p V 272 2891 .60 196 2140 .00 76 751 .60 0 0 . 0 • 6 0 29 .90 0 .0 31 454. 50 22 156 .00 5 18 .00 12 93 .20 618 l.<rb J.U. v_ ft*************************** ********************** **************** *************************************************** TAL P V 272 2891 .60 196 2140 .00 76 751 .60 0 .0 .0 6 0 29 .90 0 .0 31 454 .50 22 156 .00 5 18.00 12 93 .20 ' 618 3.46 10.92 FAN P 2 7 2 . 0 0 196.00 76 .00 0 .0 6 .00 0 .0 31 .00 22 .00 5 .00 12 .00 618 .00 3.46 10.92 V 2 8 9 1 . 6 0 2140. 00 751 .60 0 . 0 29 .90 0 .0 454 .50 156.00 18 .00 92. 20 ****************** *********************************************************************************************** SURGERY TABLE I JP B TOTAL GEN.SURG SUB.SPEC 1 2 3 4 5 6 7 O . C . S . I . C . I . ION: 1 P V 315 2 6 5 7 . 8 0 163 1489.60 152 1168.20 0 0 . 0 24 102.50 1 12 .00 16 139.60 86 73 7 .10 10 6 0 . 0 0 15 117.00 556 2.68 9 . 14 2 P V 426 3 7 1 7 . 7 0 204 2148 .00 222 1569.70 1 1.20 3 0 121.20 1 12.00 37 411 .90 45 371 .40 26 180.00 82 472 .00 513 4 .19 10. 53 3 P 166 89 77 0 4 1 13 31 . 11 17 731 1.21 9. 90 V 1375 .90 88 1.50 494 .40 0 . 0 17. 60 4 .80 113.80 196,00 4 7 . 0 0 115.20 ************************* AL P 907 456 451 1 58 3 66 162 47 114 1800 2.51 9 .91 V 7751 . 4 0 4519 .10 3232 .30 . 1.20 . 241 .30 28 .80 665.30 1304.50 287.00 704.20 AN P V 302 .33 2583 .80 152.00 1506 .37 150.33 1077.43 0 .3 3 0 . 4 0 . 1 9 . 3 3 80 .43 1.00 9 .60 22. 00 221.77 54 .00 4 3 4 . 8 3 15 .67 9 5 . 6 7 38 .00 234.73 600 .00 2.51 9 .91 ****»»»****»*************************»********^ SLRGERY TABLE I ^OUP B TOTAL GEN.SURG SUO.SPEC 1 2 3 4 5 6 7 O . C . S . I . ; C . I EG ION : V . -; 1 P V 223 1789.30 126 1175.60 97 613 .70 0 . 0 .0 22 91 .20 1 12 .00 9 39 .50 32 220 .80 6 66 .00 27 124.20 2 P 161 1306 .70 67 605. 80 94 700 .90 0 0 . 0 18 6 8 . 80 0 0 . 0 42 451 .40 24 136.70 3 20 .00 7 24 .00 2568 0.24 9 .04 3 P 287 90 197 2 43 1 77 45 4 25 1851 0 .42 8 .59 V • 2056 .20 772. 90 1283 .30 3 .20 171.60 12.00 662.70 255 .20 20 .00 158 .60 ************************ * * ^ OT AI P 671 282 388 2 83 2 128 101 13 59 8369 0.31 9 .03 Ul H L r V 5152 .20 2554 .30 2597 .90 3.20 331 .60 24 .00 1203.60 622 .70 106.00 3 06 . 80 MEAN P 223 .67 1 7 1 7 . 4 0 94 .33 85 1.43 129.33 865 .97 0 .67 1.07 27 .67 110.53 0 .67 8. 00 42 .67 401 .20 33 .67 207 .57 4 . 3 3 35 .33 19.67 102.27 2789 .67 0.31 9.02 ***************************************** ************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * V »W»I?*¥*»»*-H * -J CO *************** **************************************************************************************************************** 15*01 2.T *T T 0 0 * 9 T Z _ 8 * . _ Z £ £ * Z £ 2.9*16 £ £ * 5 T £ £ * I 8 5 2.9*85 £*7**76£ _ 9 * 0 £ 2.9**72. ££**/ 2Z*8T 00**7 0 *0 0 *0 £Z * 9 £ * 7 l £ £ * 5 * 7 l 02. *£T*7Z 2.9*6ZZ £6 *5 * /8£ 0 0 * 5 2 £ A d NV3 09*2.23 00*52Z 00**7*/_T 0 £ * £ 8 T T 00* * /ZZ 03 **7S 0*0 02. *33£*/ OT *T*7Z2. 08*6*/STI A TS 'OT 2. T *T I 8*>9 £6 9*7 92.T Z6 £1 ZT 0 9£*7 689 s z n d ********************************** ***************************)< ***************************************************************** 02 *99£ 00 **/6 08 *19 05 *065 OO'ZT 00*8 C O 05*8551 OS *20ZZ 00* 992. £ A LI'Ol £ 8 * 6 3 V I £T pz 52. \ Z 0 ZST 2.TZ 69£ d £ £ 8 * 0 1 *7Z*8 0 £ £ 00 *6Zc" 9£ 0 0 * T *7 l 5Z 00*Z50T *76 0 0 * Z 8 2. 00*2.61 OT 0 _ * I I Z c*o 0 02.*ZI8I •/AT 00*812.2 ISZ 02. *0£5*7 5Z*7 A d Z 9+-*0T 6*7*6 W Z 0*7*Z£T CZ 00*0*7 9 0 Z * V 0 9 Z9 09*0TT OT 00*51 Z O T * S £ 8 0 *0 0 05*2.£6 OT I 09 *5 IE-Z TZZ OT * E S Z £ I £ £ A d I .;!•; : <: : -J7 : :NOI_ • 1 * 1 * I * S • 3 * 0 2. 9 5 £ 2 T D3dS*gns oans*N_D 8 dflO ********************************* 00*58 00*5 05*802 09*9Z* 0*0 03 *VIZ 08 *Z OZ'2^6 Ot'ZZOT OO'SIOZ A 6T*8 59*0 00*Z99T 00*8T 00 *Z 00*9C 00*9*7 0*0 C0*£5 00*Z OO'ASI OCTET 00*88Z d NV3fc 00* 58 00*5 05*803 09*9Z^ 0*0 03 *VTZ 08 *Z 0_ *ZV6 Ot *Z_OT 00*5T0Z A 61*8 .9*0 Z99T 8T Z 9.t 9»? 0 £5 Z 1ST TET 89Z d 1V1C ********* **** ********************* ******* ********************** **************************************************************** • 00 *58 00*5 0S *80Z 09*9Z*? 0*0 0 9 ' M Z C 8 * Z OfZ*?b Oe*Z_OT 00*5102 A 6 T * 8 59*0 Z99T 81 Z 9 £ 9*7 0 i S Z £ 5 1 It! 88Z d T - . : :N0I9E 9 dOOc 1*3 «I*S *3*0 L 9 5 *f C Z I D3dS *9DS 9aTIS*N39 TVlOi I 318V1 Aa-O-OS in L * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ^ OS *8*rT S i ' Z V Z 6 * 0 9 £ 0*7*0Z OO'TZ 0 0 * £ £ 0*7*0 _ 6 * 9 Z 9 L*? *T99T S*7*89ZZ A £ 8 * 6 £6 *2 S Z * _ 9 S 5_ *6Z 00*01 S Z ' I S 00 *Z SZ*T SZ 'L S Z * 0 S Z ' Z O I 00*691 S Z ' U Z d NV3I £ 9 * 6 £ 6 * Z 69ZZ 00 **76S 6TT OO 'UT 0*7 0_*£*7*7l SOZ 09*T8 8 00*^78 L OO'ZST 6Z 09*1 T 06*_05Z 60*7 69 *5*799 9L9 bL*£ST6 S90I A d : * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ^ 1*7 *6 9_*Z 2.05 O Z ' Z S T £Z 0 0 * 6 £ L 0*7*9Z+? 8S 00*ZT I 00 *Z_ 9 . 00 * £ £ L 0*0 0 09'*r£L Z01 08*01 *1 OST 0 * * S M Z zsz A d *r 02 '^ VE 00*9*7 0S*6*72 08 *9T OO'ZT 09*6 0 *0 OT *08*7 0 _ * Z 0 M 08*Z39T A 88*8 Z S * £ 66£ S£ ST S£ Z T Z 0 06 8ST 9*72 ' d £ 1*7*01 Z Z ' Z __8 08 'OtT \z 00*5*7 06*885 09 08*ZS 5 0*0 0 09 *8Z 9 09*1 I 0l'L*70 OZT 0Z*_*76T 981 0&**?6_Z 90£ . A d Z 9 £ * 0 T 8 8 * £ 99^ 08 *99I 0*7 0 0 *6 ' IT 06*8_T Z£ 0*0 0 0*0 0 08 *09 •>! 0 *0 0 05*5*7*7 2.6 0 Z * S 8 8 I Z8T OL*0££Z 6LZ A d T - — - • :NOIO; ' 1 * 0 . • i * s • 3 * 0 L 9 S *7 £ Z T o_dS*ans o a n s * N 3 0 IViOi 8 dOO) I s i q y i A-39_ns 25*01 8 £ * 0 _ 9 * 8 T E 2 E T * 0 £ 00 *5 00 *_ I _9**7 0*7*_*7 _9 * IT _6**>ZS _9**7*7 0*0 0*0 £1 * £ 2 _9*S 0*0 0*0 E9*Z*79 L9'\L 0 8 * £ 8 8 00**78 £*7*92ST _9*SST A d NV3 0 V 0 6 00*15 0Z*2*/I 06**7_ST 0*0 0*7 *69 0*0 06*_26T 0*7*IS9Z 0£*6_S*7 . A 25 *0T 8£ * 0 9569 SI *>T S £ *>ET 0 i.1 0 512 ZSZ _9*7 d IV1 ************ * * * * * j ) t * * * ^ 0 * 0 00*2 09*91 00**> 0*0 0*/*9 0*0 00*62 OS *88 O S ' i T T A T8 *9 £ 0 * 0 2 6 £ £ 0 I ' 9 I 0 2 0 01 £ 1 £ Z d £ _S*0T 8 T 6 . 1+/ 09* U TT .00 * £ £ 5 00*69 91 0T*S88 £_ 0*0 0 0Z*9T £ 0*0 0 06 **/_0T 801 0 £ V909T 2 ST 0 Z * T 8 9 Z 09Z A d 2 O O ' T I _z*o ezse 08*81 00*9T 8 09*95 ET 08 '589 09 0*0 0 03*9*7 ZI 0*0 0 00**7Z8 Lb 09 *9S6 _8 09*08_T */8I A d I \ :N0I9 ' 1 * 0 * I * S * D * 0 _ 9 5 *7 £ z I o_ds *gns 9ans *N39 I V i O i 9 dno I 31991 Aa39el1S SLRGERY TABLE I t-OUP B TOTAL GEN. SURG s u e . S P E C 1 2 3 4 5 6 7 o . c . s . i . | C . I FGION: 1 P V 474. 5 3 5 5 . 2 0 305 3 4 1 0 . 0 0 169 1945 .20 0 0 . 0 2 9 . 70 2 2 4 . 0 0 90 1254.80 61 556 .90 • 3 10 .00 11 89. 80 776 4 . 3 9 11 .18 2 P V 124 7 2 6 . 1 0 40 285. 70 84 4 4 0 . 4 0 0 0 . 0 24 100 .80 0 0 .0 8 7 2 . 0 0 • 42 229 .40 1 2 . 0 0 9 36 . 20 2058 0 . 1 4 7 . 1 4 ****************************************** ******* 3TAL P V 598 6 0 8 1 . 3 0 345 3 6 9 5 . 7 0 252 2385 .60 0 0 . 0 26 110 .50 2 24 .00 98 1326. 80 103 7 8 6 . 3 0 4 12 .00 20 126.00 2834 1.30 10 .71 IE AN P V 2 9 9 . 0 0 3040 .65 1 7 2 . 5 0 1847.85 1 2 6 . 5 0 1192 .80 0 . 0 0 . 0 1 3 . 0 0 55. 25 1.00 12 .00 4 9 . 0 0 663.40 51 .50 3 9 3 . 1 5 2 . 0 0 6 . 0 0 10 .00 6 3 . 0 0 1417 .00 1.30 10.71 »***»»»•**»*********»»****************************************************^ 00 i ****************************************************^ 08*299 00*9 0*0 SZ*90T1 0Z*_98I S*/*£_6Z A OS**;. OS'O OS'S 0*0 OS'.TI 0S*69I 00*£8Z d N93W :—: 08**;SI 00*9_ 08 *89S 09 *SZ£T 00*21 OE*S_ 0*0 OS'ZTZZ 0*/**7£_£ 06*9*>6S A ~ ~ 20*11 £S*I 0V*/Z 12 £T 09 601 I - ,T 0 LZZ 6-£ 99S d IV10. _ — , . - / *^***************»g**»»*»*»***************************fr^  */o*n LL'9Z\ $Z 02*STT 91 00'* OV 6 0£*£_£ 0*7 00*068 99 00*21 .1 0S*8 2 S 0*0 0 00*6S*7l -EI 0£ *69T£ _8Z 0£*829*7 *>Z*7 A d Z _ 8*0I £2*0 SI*72 09*6£ II 00*9£ *? 0S*S6I 02 09*S£*7 • £*> 0*0 0 03 *9*7 21 0*0 0 OS *£S_ 06 01 *S9S 2S 09*8I£T 2*7l A d I I'D *I*S *0*0 1 9 S •/ £ 2 I 33dS*8nS 9_nS '*N_9 a dno_ 0*7*__ 00*8£ 0*7**78Z 30*11 £S*T OO'OZZT OS*£T 0S*9 00*0£ I 3 i q y i Ad39H1S f ;*************»*»***»*****»********************»*»»********»*****»**»»***»»»*****^ • • ' \ _• . : *_MST *E*0* 80*S£E S9'CLt? *T*6T Z.'*E9 9_"v6 8/.*08CT 8Z*__*I ~S0*8SSZ A~ O'OT 60*1 Z8*0S£T 9_'ZZ ' *iZ* L 68'Z* OS'S*' SVT ' S* *S I _£'0 -99'tET S*"Z.*T II'T8Z dNV3W 6Z'99_S OO'CEST 8I'££-ZT 8_*S9B_T O^Z-ZA Ofr'ZOfrZ OV TZ _.*'&90T* 9S'9£I9S 88*S0Z.6 A  0*01 6C *T T££TS 598 S_Z 0£9T £591 SS- _3S ~*T S2.0S £095 Z890T d lOi.'.O *************************************** ******** ** ******** ******* 9 dnO.9 3 M'S •3*0 2. 9 5 * £ Z T 33dS*"dnS 98flS*N39 I V i U i I 319V1 Aci___TS APPENDIX E Operative workloads and complexity index for surgeons grouped according to place of graduation, length of registration in B.C. and age with s t a t i s t i c a l analysis . OR. HEADMAN - TABLE II - GROUP A FILE FILE4 (CREATION DATE = VARIABLE CINOEX COMPLEXITY - CTH&R TRAINED 11/12/74) INDEX 11/ 12/74 PAGE 8 CODE 10.43 10.81 11.2-8 12.17 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 1 25.0 25.0 1 25. 0 1 25.0 nFSTRFO STATISTICS.. • MEAN 11.172 STD ERROR 0.375 MFD I AN 11.045 MODE 10.810 STD DEV 0.750 • VAR I ANCE 0.563 KURTOSIS -1.966 SKEWNESS 0.218 RANGE 1. 740 KIN I MUM 10.430 MAXIMUM 12. 170 VALID OBSERVATIONS - 4 KISSING OBSERVATIONS - 0 OR 0.0 PERCENT OF TOTAL 00 R O R . H E R O M A N ~ ~ T A _ L L T l ~ G R O U P A - O T H E R T R A I N E D 11/12/74 PAGE 9 F I L E F I L E A (CP F A T I C M D A T E = 11/12/74) V A R I A B L E C R V S L R G C F N E P A L S L R G F R Y C R V UMTS > — — ^ : • — : — — C O D E 281.00 1338.80 2210.90 3599.90' A B S O L U T E F R F 0 U E N C T ~ ' ~ 1 1 ' 1 ' " 1 R E L A T I V E F R E Q U E N C Y ( P F R C E N T ) 25.0 25.0 25.0 25.0 DESIRED STATISTICS..  MEAN 1857. 650 STD ERROR 702. 095 . MEDIAN 1774.850 MODE 281. 000 "~ STD DEV 1404.189 VARIANC E ********** KURTOSIS . -2.004 SKEWNESS 0.115 RANGE 3318.900 MINIMUM 281.000 MAXIMUM 3599.900 VALID CJbS ERVAT IONS - 4 MSSING OBSERVATIONS - 0 OR 0.0 PERCENT OF TOTAL 00 to DR-; HERDMAN - TAHLf: II - CP.CUP A - CiTHES TRAINED \ ' 11/ 12/74 PAGE TO FILE FILEA (CREATION r-ATE = 11/12/74) VARIABLE CRVSUBSP SUBSPECIALTY CPV UNITS CODE 41.6. 5 0 873.40 1U7.00 2409.50 ABSOLUTE FREQUENCY . RELATIVE FREQUENCY (PERCENT) 25 1 .0 1 1 25.0 ' 2 5 . 0 1 25.0 CESIREO STATIST ICS. . MEAN 1201.550 STD ERROR 427.432 MEDIAN 990. 200 .. MODE' 2409. 500 STD DE V 854. 865 VARIANCE 730793.875 KURTOSIS -1.820 SKEWNcSS 0.457 RANGE 1993.200 MINIMUM 416.300 FAX I MUM 2 409.500 VAL ID 05SERVAT IONS -MSSING OBSERVATIONS -4 0 OR 0 .0- PERCENT OF TOTAL 00 DR. HE REMAN - TABLE I I - G R O U P A - U K TR A I M ; i D 11/12/74 PACE 8 FILE FILEA (CREATION OATS = 11/1-/74) VARIAELE CINCEX COMPLEXITY INDEX CCDE 5. it 7'. <c9 P. . 94 9.3 1 9 .76 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 10.0 i s 1 .C 1 1 0 .0 1 10.0 1 10.0 • CCDE 10.12 10. 15 10.38 10.80 1C.95 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) •1 10.0 10 1 .0 1 10.0 1 10.0 1 10.0 DESIRED STATISTICS.. MEAN 9.345 STD ERROR 6. 548 MEDIAN 9 .940 MODE 10.330 STD DEV l . 734 VARIANCE 3 .007 KURTOSIS O.tl? SKEWNESS - l . 296 RANGE 5 .800 MINIMUM 5.150 MAX I MUM 10. 950 VALID OBSERVATIONS - 1C MISSING OBSERVATIONS - 0 OR 0.0 PERCENT OF TOTAL 00 D P . Ht R C M A N - T A B L E II - GROUP A - UK TK AI Ni i D F I L E F I L E A ( C R E A T I O N D A T E = 1 1 / 1 - / 7 4 ) V A R I A B L E C R V S U R G G L M E K A L SURGERY CRV UNITS 1 1 / 1 2 / 7 4 PAGE 9 C O D E 2 3 2 . 4 0 2 3 3 . 2 0 5 4 £ . 5 0 1 2 0 9 . 9 0 1 3 9 6 . 7 0 A B S C L U T E R E L A T I V E F R E Q U E N C Y F R E Q U E N C Y ( P E R C E N T ) 1 0 . 0 1 1 0 . 0 1 0 . 0 ' " " " I 1 G . 0 1 I C C C C D E 2 0 6 4 . 4 0 2 7 2 9 . 2 C 3 0 C 6 . 7 C 3 4 9 8 . 3 G 3 7 7 8 . C C A B S O L U T E R E L A T I V E F R E Q U E N C Y F R E Q U E N C Y ( P E R C E N T ) 1 1 0 . 0 . 1 • 1 0 . 0 1 1 C . G 1 1 0 . 0 1 1 0 . 0 D E S I R F D S T A T I S T I C S . . • M E A N 1 3 7 6 . 3 3 0 S T O ERROR 4 2 1 . 4 2 7 M E D I A N 1 7 4 0 . 5 5 0 M C D E . 3 4 9 8 . 3 0 0 S T D DEV 1 3 3 2 . 6 6 9 V A R I A N C E ********** K U R T O S I S - 1 . 7 5 4 S K E W N E S S 0 . 0 8 3 R A N G E 3 5 4 5 . 6 0 0 • M I N I M U M 2 3 2 . ^ 0 0 M A X I M U M 3 7 7 8 . C C C V A L I D M I S S I N G O B S E R V A T I O N S -O B S E R V A T I O N S -1 C 0 O R 0 . 0 P E R C E N T O F T O T A L --XXX. U1 DR. HERCMAN - TABLE II - GROUP T - UK TRAINED 11/12/74 : PAGE FILE FILEA (CREATION DATE = 11/12/74) VARIABLE CRVSUBSP SU3SPECIALTY CRV UNITS CCDE ABSCLUTE F R E Q U E N C Y ~ ~ ~ ~ " " RELATIVE FREQUENCY (PERCENT) 175.40 226.30 301 .10 440 .30 492 .6C ( 10.0 1 10 .0 1 • 10.0 1 10.0 1 I C C CCDE 512.60 618.4C - 868.10 1045.20 4089.7C ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 10.0 1 10.c 1 10.0 1 10.0 1 10.c DESIRED STATISTICS.. MEAN 877.020 STD ERROR 36 7.190 MEDIAN 50 2.600 MCDE 301.100 STD DE V 1161.158 VARIANCE ********** KURTOSIS 2.£94 SKEWNESS 2.053 RANGE • 3914.300 MINIMUM 175 .400 MAX I MUM 4089.7C0 VALID OBSERVATIONS - Tc :  MISSING OBSERVATIONS - C OR 0.0 PERCENT CF TOTAL -00. )R. HE. RDM AN - TABLE II - G3CUP A - CANADIAN TRMNED : : 11 /12 /7 4 PiTTH 8 ILE FILEA (CREATICN DATE = 1 1 / 1 2 / 7 4 ) 'ARIABLE CINDEX COMPLEXITY INDEX ;ODE 6 .01 7.77 8 .10 d . o 7 9 .2C tESCLUTE :E L AT I VE FREQUENCY FREQUENCY (PERCENT) I 3.8 1 3.8 1 .3.8 \ 3.8 2 7. 7 ;CDE 9.36 9 . 37 - 9 . 4 2 9.61 9 .69 BSOLUTE ELATIVE FREQUENCY FREQUENCE (PERCENT) 1 3.8 1 3.8 1 3 .8 1 3.8 1 3.8 .CDE 9 .70 9 .83 9 .68 10.37 10.39 BSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 3.8 1 3.6 1 3.8 1 3 . 8 1 3.8 ODE 10.54 10 .60 10 .66 10 .82 10.94 .BSCLUTE ELATIVE FREQUENCY FREQUENCY (PERCENT) 1 3.8 1 3.8 1 3.8 1 3.6 1 3.6 ODE 11 .39 11.54 12.C3 12.12 12.49 BSTLUTET ELATIVE FREQUENCY FREQUENCY (PERCENT) 1 3.8 1 3 .8 1 3 .8 1 3.6 1 3.6 ESI RE D S T A T I S T I C S . . EAN 9 .983 STD ERROR 0 .280 MEDIAN c .855 CDE 9 .200 STO DE V 1 .430 VARIANCE 2 .045 UR TOSI S SKE WNESS -0 .553 'RANGE 6 .480 IN I MUM 6 .010 MAXI MUM 12 .490 00 ALIO OBSERVATIONS -ISSING OBSERVATIONS -26 C OR 0. 0 P cRCENT CF TOTAL -P. HFROMAN - TAbLE II - GRCUP & - CANADIAN TJUIMET 11/12/74 'ILE FIL.A (CRt'ATIO'J OATL- = 11/ 12/74) AH I ABLE CRV Sir-G C_M-KiL $UKG< <Y CRV UNITS COE • 96 .10 . 14 7.70 451.7C 851.7C 1002.3C ELAlTvE FREQUENCY (PERCENT) . 3.8 3.8 - 3.8 3.6 3.8 ODE • 1131.20 122 4.80 135^.80 1-19 .00 1448.6C .BS CLUT1 FR cQU ENCY """ 1 ~'l " T 1 1 ELATIVE FREQUENCY (PERCENT) 3.8 3.6 3.8 3.8 3.6 CDE 1470.70 1554.CC 1667.CC 1877.30 1390.20 B scTuTf T R E QUTKTY ~ ' ~ i i i " 1 1 ELATIVE FREQUENCY (PERCENT) 3.6 3.8 3.8 3.8 2.6 CDE " 1928.60 19 3 6.50 2150.6C 2258.40 246C.4C B SO L U f t F R E Q U S N C*Y f " " ~ 1 ~ I T ~ 1 . EL AT 1 VE FREQUENCY (PERCENT) 3.3 2. 6 3. 8 3. 8 3 .8 ODE 3255.00 3300.30 40 24 .10 50 12.50 5146 .6C ."ETOLUT E FF'EQIJ'ENCY T ' .ELATI VE F R E Q U E N C Y ( P E R C E N T ) ' 1 3.6 1 3 p "1 3.8 "1" 3.8 1 3.6 CDF. 5 34 5.00 BSC LUTE FREQUENCY ELATIVE FREQUENCY (PERCENT) 1 3.6 'ESI RED STATISTICS.. 00 00 iEAN 20^ 5 .C04 STU cFkijR 263.941 MEDIAN VARIANCE 178 2.1:>0 ICDE 96 .100 STO D2.V 1^ 4 7.821 F I L E FILEA (CREATION GATE = 1 1 / 1 2 / 7 4 ) VARIABLE CRVSLBSF SUBSPEC I AL' 1Y CRV U N IT S CCDE 35 .90 6 2 . ^ C 1 9 4 .70 219.30 233 . CC i,BSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 3.8 1 3. S 1 3.8 1 3.6 1 3 .8 :ODE 233.70 237 .90 260.20 3 1 2 . c C - 4C3.3C \BSCLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 3.3 1 2.8 1 3.8 1 3.8 1 3.6 :ODE • 4 32 .60 4 6 3 . 7 C 483.20 519 .40 577 . 10 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 3.8 1 3 .8 • 1 3 .8 1 3.8 1 3 .6 :CDE 6C8.90 6 3 4 . 2 C 699.60 725.50 760.1C iBSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 3.8 -1 3. g 1 ' 2.8 1 3.8 1 3 .8 :ODE 768 .60 7 7 0 . 6 0 1143 .20 1234.90 1298 .5C iBSCLUTE FREQUENCY 1ELATIVE FREQUENCY (PERCENT) 1 3.8 / 1 3.8 1 3.8 1 3 .8 1 3.6 :CDE 1634.80 • B S L L U I t h K c U U t M Y EL AT I VE FREQUENCY (PERCENT) 1 3.3 ESIRE0 S T A T I S T I C S . . EAN £ 7 4 . 9 2 7 STD E RROR 78 .162 MEDIAN 501.300 CDE 194.700 STD D EV 398 .551 - VARIANCE 158342.875 LR TO SIS 0 .173 SKEWN ESS 0 .9 10 RANGE 1593.900. INIMUM 3 5 . 9 0 0 VAXI MUM 1 634 . eco 03 _> ALIO OBSERVATIONS -ISSING OBSERVATIONS -26 C OR 0 . 0 PERCENT CF TOTAL DR. HEP OMAN - TABLE II -.GROUP A - B.C. REGISTRATION BEFCFE 19.5 0 11/12/74 PAGE 8 "FILE FILEA (CREATION CAT E = 11/12/74) VARIABLE CINDFX COMPLEXITY INDFX CODE 6.01 8. 6 7. 9. 36 10.37 10.39 ABSOLUTE RELATIV c FREQUENCY FREQUENCY (PERCENT) 1 16. 7 16 1 . 7 1 • 16.7 1 1 16.7 16.7 • CODE 10.66 • ABSOLUTE RELATIVE FREGUENCY FREQUENCY (PERCENT) 1 16.7 DES IRED STATISTICS.. MEAN. 9.243 STD ERROR 0. 716 MED I AN 9. 865 MODE 6. 010 STD DEV 1.754 VARIANCE 3. 078 KURTOSIS -0.945 SKEWNESS -0.8 71 RANGE 4. 650 MI M MUM 6.010 MAX IMUM 10.660 VALID OBSERVATIONS - 6 KISSING OBSERVATION'S - 0 OR O.G PERCENT OF TOTAL O OR. HEROMAN - TABLE II - GROUP A - B.C. REGISTRATION BEFORE 1950 11/12/74 PAGE 9 FILE . FILEA (CREATION DATE = 11/ 12/74) VARIABLE CRVSURG GENERAL SURGERY CRV UNITS CODE 96. 10 8 51.70 ' 1JJV.30 1448. 60 1890.20 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT ) 1 16.7 1 I 16.7 16.7 ' 1 1 16.7 16.7 ' CODE 1926.60 ABSOLUT E ' RELATIVE FREQUENCY FREQUENCY (PF C CENT) 1 16.7 DES I RED STAT 1ST ICS. . ME A.N 1202.917 STD ERROR 265.656 MEDIAN 1225. 450 MODE 96.100 STD DEV 699.711 VARIANCE 489595.250 KURTOSIS -1.594 SKEKNESS -0.334 RANGE . .1832.500 MINIMUM 96..100 KAXIMUM 1926.600 .VALID KISSING OBSERVAT IONS - '6 OBSERVATIONS - 0 OR 0 .0 PERCENT OF TOTAL -DR. HrERDiWM - TABLE II - (.-li-P /- - E.G. F E G I S T R A T I rjiv BE-FOP _ 19 50 FILE FILEA (CREATION DME = 11/12/74) VARIABLE CRVSUBSP SUBS Pf C I AL T Y CI-V UNITS CODE 62. AO 194.70 23 2.70 260.20 760.10 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 16.7 1 16.7 1 16.7 1 16. 7 1 16.7 CODE 1224.90 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 16. 7 DESIRED STATISTICS.. • MEAN 457.667 STD ERROR 183.494 MEDIAN 246. 950 MODE 19 4.700 STD DEV 44 9.4 66 VARIANC E 202019.500 KUR TOSIS -1.340 SKEWNESS 0.731 RANGE 1172. 5 00 MINIMUM 62.400 MAXIMUM 1234 .900 VALID OBSERVATIONS -KISSING OBSERVATIONS -6 0 OR 0 .0 PERCENT OF TOTAL Jsi. DR. HE RDM AN - TABLE II - GROUP A - B.C. REGISTRATION 19:;0 - 1563 11/12/74 PAGE FILE FILEA (C RE ATI CM DATE = 11/12/74) VARIABLE CINDEX . COMPLEXITY INDEX <^  CODE 7.77 3 .1 C 9 .20 9 .37 5.7 6 ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6.7 1 6 .7 1 . 6.7 1 6.7 1 6.7 • CCDE 9.83 5.88 10.43 10.54 10.6 0 • ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6.7 1 6.7 1 6.7' 1 o.7 1 6 .7 CODE lp.80 10.95 . 11 .54 12.12 12.45 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6.7 1 6.7 1 6.7 1 6. 7 1 6.7 DES IRED STATIST ICS.. MEAN 10.225 STD ERROR 0 .341 MEDIAN 10.3 20 MODE 10.950 STD Dt'V I .320 VARIANCE 1.743 KUPTOS IS -0.783 SKEWNESS -0. 144 RANGE 4.720 MINIMUM 7.770 MAX I MUM 12 .450 VAL IO MISSING OBSERVATIONS - 15 OBSERVATIONS - 0 OR 0 .0 PERCENT OF T0 T AL LO OR. HE RCM AN - TABLE II - GROUP A - B.C. REG ISTRATION"19 SO - 1963 FILE FILEA (CREAT1LN DATE = 11/12/74) VARIABLE CRVSUKG .GENERAL SURGERY CRV UNITS CODE 147.70 1419.00 1470.70 1354.00 1877.30 , •< • 1 — T — ABSCLUTE RELATIVE FREQUENCY FREQUENCY. (PERCE NT) 1-6.7 1 6.7 1 6 .7 1 1 6.7 6.7 CCDE 19.36.50 2034.*0 30C6.7C 3255.OC 3595.90 — - r ABSOLUTE RELAX IVE FREQUENCY FREQUENCY (PERCENT) 1 6.7 1 6.7 1 6.7 1 1 .6.7 6.7 CODE 3778.00 4024.10 5012 .50 5146 .60 5345.CC • ABSOLUTE RELATIVE FREQUENCY FREQUENCY ( PERCc NT) 1 6 .7 1 6.7 1 6.7 1 1 6.7 6.7 DES IR E D STAT 1ST ICS . . MEAN 2910.493 STD ERROR 404.79'6 MEDIAN 2838.199 MODE 3778 .000 STD DEV . 1 567.768 VARIANCE *#«#T-T< Klip Tt"c IS -1.23 5 SKEWNESS 0.0?3 RANGE 5197.297 MINIMUM 1^7.700 MAXIMUM 5 34 5 .0 00 VALID MISSING OBSERVATICNS -OBSERVATIONS -15 C CR 0 .0 PERCENT OF TOTAL 10 OR. HE P.OMAN - TABLE II - GSGUP A - B.C. REGISTRATION 1950 - 196? 'FILE FILEA (CREATION DATE = 11/12/74) VARIABLE CRVSUBSF SUBSPECIALTY CRV UNITS CCDE 233.00 312.60 -32 . 6 0 4-40.30 463.70 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6.7 1 6.7 1 b .7 1 1 6.7 6.7 CCDE 492 .6C 5 7 7 .1.0 6 08 .90 699 .6C 725.-5C ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6.7 1 6.7 1 6.7 1 1 6.7 6.7 CODE 768.60 863 . 10 1107 .00 1143 .20 1634 .SC ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6.7 1 6 .7 . 1 6.7 1 1 6.7 6.7 OES I RED MEAN STATIST ICS.. 700.520 STD ERROR 95 .092 MEDIAN 623.6 75 MODE 492 .600 STD DEV 363.2 88 VARIANCE 135636.000 K I P T O S I S 0.312 SKEkNESS 1.0C4 RANGE 1401.800 MINIMUM 233.COO FAX I MUM 1634.800 VALID MISSING OBSERVATIONS - l b OBSERVATIONS - C GP 0 .0 PERCENT CF TOTAL DR. HERDMAN - TABLE I! - GROUP A - B . C . REGISTRATION A F T F R 196J 11/ 12/74 PAGE 8 FILE FILEA (CF EAT I O N G A T E = 11/12/74) ' VARIA3LE C I N D E X CO'-'PU / I TY I K D E ' X CODE . 5.15 7.89 8. 94 9.2 0 9. 31 ABSOLUTE FREQUENC Y RELATIVE FREQUENCY (PERCENT) 5 . v . 1 5. ? 1 5.3 • 1 5.3 1 5.3 CODE 9.4? 9.61 9.69 9. 70 10. 12 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 5.3 1 5.3 1 5.3 1 . 5.3 1 5.3 CODE 10. 15 10.3 8- 10.81 10.82 10.94 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 5.3 1 5.2 1 5.3 1 . 5. 3 1 5.3 CODE 11. 2.8 11.2 9 12.03 12. 17 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 1 5.3 1 5.3 • 1 5.3 ~ * - ~ » ~ r - o v l - - l - f t - | - T C T T r C _ — — — ' Ur J 1 K t V j i n i i J i a c m MEAN 9.947 STD ERROR 0.365 MEDIAN 10.022 MODE 10.380 STD DEV SKEWNESS 1.592 -1.216 VARIANCE RANGE 2.535 7. 020 KURTOS IS . 1. J i . MINIMUM 5.150 MAXIMUM 12.170 -VALID OBSERVATIONS -MISSING OBSERVATIONS -19 0 OR 0 .C PERCENT OF TOTAL CTi DR. HERDMAN - TABLE II - GROUP A - B . C . FEGISTRAT IU N A F T E R 1963 1 1 / 1 2 / 7 4 PAGE 9 F ILE FILEA (CFtATICN DATE = 11 /12 /74 ) VARI ABLE CPA'S I F G .• GENERAL SURGERY CRV UNITS CODE 2 22 .40 261. CC. 283 .20 451 .70 544.50 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PFRCFNT) 1 5.2 1 r -j ^ m — 1 • 5.3 1 5 .3 1 5.2 CODE 1131.20 1209.90 1224.80 1338. 80 1359.80 -• ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5.2 1 5. 2 1 5.2 . 1 5 .3 1 5.2 CODE 1396.70 1687.00 21-50.60 2210.90 2298.40 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 5 .3 1 5 .3 1 5. 3 1 5.3 1 5.3 CODE 2460.40 2729 .20 3 300.30 2 45 3.20 ABSOLUT E RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 • 5 .3 1 5 .3 1 5.3 1 5 .3 • -DESIRED STAT 1ST ICS . . MEAN 1567.847 STD ERROR 230. 171 MEDIAN ' 1363. 775 MODE 349 8. 300 STD DE V 1 00 3 . 291 VAR I ANCE ********** KURTOS I S - 1 . 0 6 2 SKEWNESS 0.3 25 RANGE 3265 .900 MI M MUM 232 .400 MAXIMUM 3498 . 300 VALID OBSERVATIONS - 15 M S S I N G OBSERVATIONS - 0 OR 0 . 0 PERCENT OF TOTAL DR. HE RDM AN - TtL-LE II - GROUP A - (?.C. REGISTRATION AFTFP 1563 'FILE FILEA (CRFATIOM GATE = 11/12/74) VARIABLE CRVSUtSP SUP SPEC IALT Y CP V UMTS CODE 35.90 175.40 219.30 226.80 237.90 ABSOLUT E RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 1 5.3 5.2 1 J. 5.3 I 1 5.3 CODE 2C1.10 • ' 402.7C 416.30 482.20 512.60 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 1 5.2 5.3 1 5.2 1 5.2 1 5.2 CODE 519.40 618.4C 634.20 770.60 873.40 ABSOLUTE RELATIV E FREGUENCY FREQUENCY (PERCENT) 1 1 5.2 5.2 1 5.3 1 5 .2-1 5.3 CODE 1045.20 1298.50 ^ 2 4 ^ 9 ^ 0 ^ ^089 . 7 c T ^ ABSOLUT E RELATIVE FREGUENCY FREQUENCY (PERCENT) 1 1 5.3 5.2 1 5. 3 1 5.3 ncc TQ cn STAT I ST IC ^  . . U L J 1 i \ U J MEAN 1 rA 1 I ^? 1 I I . • • 803.721 STD ERROR 22 0.C38 MEDIAN 506. 950 MODE 301.100 STD DEV 959.125 VARIANCE 919 921. 500 KURTGS I S .MM MUM SKEUNE SS 2.275 RANGE 4053. 8 00 35.900 MAX IMUM 4C89.7C0 VAL ID MSSING OBSERVATIONS -OBSERVATIONS -19 u OP. 0.0 PERCENT OF TOTAL 00 OR. HE RDMAN - TABLE II - GROUP A - 55 + 1 1 / 0 8 / 7 4 F ILE F ILEA (CREATION DATE = 11 /08 /74 )" ' VARIABLE CINCEX COMPLEXITY' INDEX CCDE 6.01 7 .77 8 .67 5. 36 9.61 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 12.5 1 12. E 1 12 .5 12 1 C • -> 1 12.5 CODE 10 .37 10 .39 10 .31 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 12.5 1 12.5 1 12 .5 n F <s I R F n S T A T I S T I C S . . - -MEAN 9 .124 STD ERROR 0 .567 ' MEDIAN 9.485 , MODE 10.810 i STD DEV 1 .605 VARIANCE 2 .5 75 ^ KURTGSIS - 0 . 9 1 7 SKEWNESS - 0 . 7 2 2 RANGE 4 .800 MINIMUM 6 .C IO NAX I MUM 10.810 VALID OBSERVATIONS -MISSING OBSERVATIONS -8 C OR 0 . 0 PERCENT OF TOTAL DR. HE ROMAN - TABLE II - GROUP A - 55 + ; : ~ ~ 11/0.8/74. PAGE F ILE FILEA (CREATION DATE = 1 1 / C 8 / 7 4 ) ! VARIABLE CRVSURG GENERAL SURGERY CRV UNITS CCDE - 56 .10 147.7C 281.CO ' 451.70 851.70 ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 12 .5 1 12.5 1 12 .5 1 12.5 1 12 .5 CODE 1448.60 1890 .20 1928.60 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 12 .5 1 12.5 1 12 .5 DESIRED S T A T I S T I C S . . MEAN 886 .550 STD ERROR 271.752 MEDIAN 651 .700 MODE 281.COO STD DEV 76 3.746 VARIANCE 590969.750 KURTOS IS - 1 . 6 7 2 SKEWNESS 0 .3C6 . RANGE 1832.500 MINIMUM 9 6 . 1 0 0 MAXIMUM 1928.6C0 VALIC MISSING OESERVATICNS -OBSERVATIONS -e 0 OR 0 . 0 PERCENT CF TOTAL • o o DP. hERCMAN - TABLE II - GROU 0 A - 55 + 1 1 / 0 8 / 7 4 PAGE 10 F ILE FILSA (CREATION DATE = 1 1 / 0 8 / 7 4 ) VARIABLE CRVSUBSP SUBSPECIALTY CRV UNITS CODE 62 .40 194.7C 233. CO 260 .20 483 .20 ABSCLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 12.5 1 12.5 12 1 .5 1 12.5 1 12.5 CODE 760 .10 1234.9C 24 C 9 . 50 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 12.5 1 12. 5 12 1 .5 DESIRED S T A T I S T I C S . . MEAN 704 .750 STD ERROR 278.142 MEDIAN 371 .700 MODE 2409 .500 STD DEV 786 .703 VARIANCE 618902 .063 KURTOSIS - 0 . 1 1 1 SKEWNESS 1.156 RANGE 2347 .100 MINIMUM 6 2 .400 MAXIMUM 2409.500 VAL ID OBSERVATIONS - 8" MISSING OBSERVATIONS - 0 OR 0 . 0 PERCENT OF TOTAL I— 1 O DR. HFRCMA.N - TABLE II - GROUP 4 - 45 TO 54 • 11/12/74 PAGE 8 F I L E F I L E A (CREATION DATE = 1 1 / 1 2 / 7 4 ) VARIABLE CINDEX COMPLEXITY INDEX CCDE 5.15 7 .89 _ 8 . 10 9 .37 9 .76 ABSOLUTE R.ELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6 .7 1 6 .7 1 6 .7 1 1 6 .7 CODE 9 .83 9 .88 10.43 10.54 10 .66 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6 .7 1 6. 7 1 6 .7 1 6 .7 1 6 .7 CODE 10.94 1 0 .95 12 .12 12.17 12.45 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6 .7 1 6 .7 I 6 .7 1 6 .7 1 6 . 7 DESIRED S T A T I S T I C S . . MEAN 1 0 . C 1 9 STD ERROR 0 .489 MEDIAN 10 .320 MODE 10 .550 STD DEV 1 .893 VARIANCE 3 .584 KURTCSIS 0 . 5 0 9 SKEWNESS - 0 . 9 4 3 RANGE 7 .340 MINIMUM 5 .15C MAXIMUM 12.490 VALID OBSERVATIONS -MISSING OBSERVATIONS -15 C OP 0 . 0 PERCENT CF TOTAL DR. HE ROMAN - TABLE II - GFOUP A - 45 TO 54 F I L E FILEA (CREATION DATE = 11 /12 /74 ) VARIABLE CRVSURG GENERAL SURGERY CRV UNITS CCDE ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 283 .20 1 6 .7 5 4 4 . 5 C 1 6 .7 1002.30 1 6 .7 1224.80 11/12/74 1 6 .7 1338.80 PAGi 1 6 .7 CCDE ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1470.70 1 6 .7 1877.3C I 6 .7 1936.50 1 6 .7 3006.70 3255.CC 1 6 .7 1 6 .7 C 0 D E 3599 .90 3778 .00 4024 .10 5146.60 5345.CC ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6 .7 1 6 .7 1 6 . 7 1 6 .7 1 6 .7 DESIRED S T A T I S T I C S . . MEAN 2522 .226 STD ERROR 418 .639 MEDIAN 2185 .250 MODE 3778 .C0C STD DEV 1621.383 VARIANCE ********** KURTOSIS - 1 . 3 3 8 SKEWNESS 0 .309 RANGE 5061.797 MINIMUM 263 .200 MAX I MUM 5345 .000 VALID OBSERVATIONS - 15 MISSIMG.OBSERVATIONS - C OR 0 . 0 PERCENT CF TOTAL 1—1 -©• OR. HE ROMAN - TABLE II - GROUP A - 4 5 TO 5 4 FILE F I L E A (CREATION DATE = 1 1 / 1 2 / 7 4 ) VARIABLE CRVSUBSP SUBSPECIALTY- CRV UNITS 11/12/74 PAGE 10 CCDE 2 19. 30' 2 3 3 . 7 0 312.60 416 .30 432.6C ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 1 6 .7 6 .7 1 6 .7 1 6 .7 1 6 . 7 CODE 440 .30 4 9 2 . 6 0 512.60 577 .10 725.5C -ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 1 6 .7 6 . 7 1 6 .7 1 6 .7 •1 6 .7 CODE 768 .60 1107 .CC 1143.20 1634.80 4089.70 ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 1 6 .7 6 .7 1 . 6 . 7 1 6 .7 1 6 .7 DFS IRED S T A T I S T I C S . . L/ *>— J 1 i y U. \J MEAN £ 7 3 . 7 2 7 STD ERROR 250.617 MEDIAN 523 .725 MODE 492 .600 STD DEV 970.636 VARIANCE 942134 .813 KUR TOSIS 5 .106 SKEWNESS 2 .378 RANGE 387C.400 i \ \j r \ i i . / «J A *J MINIMUM 219 .300 NAXIMUM 4G89.7C0 VALID MISSING OBSERVATIONS -OBSERVATIONS -15 C OR O . C PERCENT CF TCTAL o FILE FILEA (CREATION DATE = 11/12/74) VARIABLE CINDEX COMPLEXITY INDEX CCDE 8.54 5. 2C ° . 3 1 9.42 9.o5 • ABSOLUTE RELATIVE FREQUENCY ' FREQUENCY (PERCENT) 1 5.9 2 11.8 "' "" . 1 5.9 I 5.9 1 5 .5 CODE 9 .70 10.12 10.15 10.36 10 . 6 C ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5.9 1 ••• 5.5 1 5.5 1 5. 5 1 5.5 CODE 10.80 10.82 11 .28 11 .39 11.54 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5.9 1 5 .9 1 5 .9 1 5.9 1 5.5 CCDE 12.03 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5.9 DESIRED STATISTICS.. MEAN 10.269 STD ERROR 0.228 MEDIAN 10.200 MCDE 9.200 STD DE V C.-5 3S VAR I £l\Ct 0 .8 -i 1 KLPTOSIS - 1 .305 SKE WNESS 0.260 RANGE 3.090 MINIMUM 8.54C MAXI MUM 12.030 VALID MISSING OBSERVATIONS -OBSERVATIONS -1 7 C OR 0. 0 PERCENT CF JO TAL O OR. HE ROMAN - TABLE II - GROUP A - UNDt I- 45 FILE FILEA ( C RE AT I CM OAT c = 11/12/74) VAFIAELE CRVSUPG GENERAL SURGERY CRV UNITS 11/ 12/74 RAGE CODE 232.40 1131 .20 120° .90 1359.80 1356.7C ABSOLUT E FREQU ENC Y RELATIVE FREGUENCY (PERCENT) 1 5.9 . r 5.9 1 5.9 r — r 5.5 CCDE 1419.00 1554.CO 1687.00 2084 .40 2150.60 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 5.9 1 5 .9 T 5 .9 5.9 T 5.5 CCDE 22 10.90 2298.4C 2460. AC. 2729.2C 3 3 C C . 3 C ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 5.9 1 5.5 5.9 r 5.9 : — r 5 .9 CODE 3498.30 ,501 2.50 , ABSOLUTE FREQUENCY RELATIVE FREQUENCY' (PERCENT) 1 5.9 1 5.9 DESIRED STATISTICS.. MEAN 2102.059 STD ERROR 268.757 MEDIAN VARIANCE RANGE 2001.6OU MODE . KURT OS IS 349 8.3CC 0.6U3 STO OEV SKuWNESS 1 108 .279 0.861 4780.098 MINIMUM 232.400 MAX I MUM 50 12.5CC n •C OR VALID OBSERVATIONS MISSING OBSERVATIONS 0.0 PERCENT OF TOTAL I—1 - £ 3 — DR. HF.RCMAN - TABLE I I - GROUP A - UNDER 45 11/12/74 : PAGE TO FILE FILEA (Cki.ATit vi DAT= = 11/12/74) . VARIABLE CRVSURSP SUBSPECIALTY CRV UNITS CODE 25.90 175.AC 226 • 80 2 37 . 90 3 C 1 . 1C ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5.9 1 5 .9 1 .9 1 . 5 1 5.5 • CCDE 403.30 463.7C 5 1-3 • 40 t o p 9C 618.4C ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5.9 1 5.5 c 1 .9- 5 1 .9 1 5 .9 CODE 634.20 699.80 7 70 « 60 6 63. 10 873 .4C ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5 .9 1 5.5 e 1 .5 1 .9 1 5.5 CODE 1045.20 1298.50 ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5.9 1 5.9 DES IRE D STATIST ICS.. X MEAN. 575.229 STD ERROR 81 .010 MEDIAN 588. 900 MCDE 201.100 STD DE V 3 34. C12 VARIANCE 11L5O4. 13b KLRTOSIS -0.713 SKE WNESS 0. 338 RANGE. 1262. 600 MINIMUM 35.500 MAX I MUM 1298. 500 VALID OBSERVATIONS -MISSING 'OBSERVATIONS -1 7 C OR 0. 0 PERCENT CF ' TCTAl. O #4 DR. HER OMAN - TAf.LF II - GROUP R - OTHER T p. AI NEC FILE FILEB (CP EAT I Of.; r i T [ = 11/12/74J VARIABLE CINDtX CGNPLExiTY INDEX CODE 7.6 6 9.. 1 7 9. 53 10. 3 6 11. 04 ABSOLUTE FREQUENCY 1 — i , , ' RELATIVE FREQUENCY . (PERCENT) 16. 7 16. 7 33,2 16 .7 i 16.7 DESIRED STATISTICS.. MEAN 9.548 STD ERROR 0.469 MEDIAN 9.647 MODE 9.550 STD DEV 1. 148 VARIANCE 1.319 KURTOSIS -1.263 SKEWNESS -0.323 RANGE 3. 3 80 MINIMUM 7.660 MAXI MUM 11.C40 VALID OBSERVATIONS - 6 ~ " ~ •-—: MISSING OBSERVATIONS - 0 OR O.C PERCENT CF TOTAL © -03 DR. HER DMAN - TABLE II - GROUP B - CTHE R TRAINEC 11/12/74 PAGE FILE FILEB (CREATION BATE = 11/12/74) VARIABLE CRVSUPG GENERAL SLPGERY CPV UNITS CODE 283.30 609.90 7 88. 9 0 IB65.20 1945.10 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (pfF.CFNT) 1 16. 7 1 16. 7 16 1 . 7 1 a. 16.7 1 16.7 CODE 3169.30 ABSOLUT E RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 16.7 CESIR ED STATISTICS. . MEAN 144 6.549 STD ERROR 442.263 MED IAN 1337.050 MODE 316 9.300 STD DEV 1085.768 VAR I ANiC E ********** KURTOS IS -1.622 SKEWNESS 0.3 74 RANGE 2886.000 MINIMUM 282.300 MAXIMUM 3 169. 200 VAL ID MISSING OBSERVATIONS -CBSERVAT IONS -6 0 OR 0 .C PERCENT OF TOTAL • DR. HERCMAN - TABLE II - GRCLP B - CTHER TRAINED FILE FILER (CREATION1 BATE = 11/12/74) VARIABLE CRVSUPSP SUBSPECIALTY CP V UMTS 11/12/74 PAGE 10 CODE 42 6.40 445.50 73 5.60 639. 40 1459.00 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (P E P C E NT ) 1 16 .7 1 16.7 1 16. 7 1 1 16.7 16.7 CODE 2676.10 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCE NT) 1 16.7 r P U 3 F n <;T AT TC.T If <; . . _ MEAN 1C97.000 STD ERROR 250. 9 85 MEDIAN 787. 500 MODE 1459.000 STD DEV £59. 735 VARIANCE 739 144.563 K UP T 0 SIS -0.975 SKEWNESS C. £77 RANGE 2 249.700 MINIMUM 426.400 MAX I MUM 2676. 100 VALID OBSERVAT IONS -MSSING OBSERVATICNS -6 0 OR 0.0 PERCENT OF TOTAL — S O , FILE FILES (CRSATIDJ GATE = 11/12/74) VARIABLE CINDEX COMPLEXITY INDEX CODE AESOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) DESIRED STATISTICS.. MEAN 9.752 MODE KURTOSIS 9.90C -2.02 1 MINIMUM 3.98C VALID OESERVATICNS -MISSING OBSERVATIONS -6 .96 9.33 ':' .^0 1 20.0 1 2C.C 1 2 C. C STD ERROR 0.261" STD OEV SKEWNESS 0 .563 -0.2 19 MAXIMUM 1C.3 7C OR 0.0 PERCENT CF TOTAL 11/12/74 10. IS 1 2 0.0 ME CI AN VAR I ANCE RANGE 1C . 3 7 1 2 C.C PAGE 9.527 C. 340 1.390 FILE FILES (CREATION DATE = 11/12/74) VARIABLE CRVSURG GENERAL SURGERY CRV UNITS CCDE 831.50 122 1.30 1329. 3 0 1843.20 2043.40 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 20.0 1 20.C 20 1 .0 1 20 .0 1 2 C.C ' n c c T - c n c T A T T C T i r c : : : MEAN 1464.740 STD ERROR 212.092 ME CI AN 1432 .025 MCDE 881.500 STD DEV • 474.253 VARIANCE 224916 .125 KURTOSIS -1.59 5 SKEWNESS 0.065 RANGE 1161 .900 MINIMUM 881.500 MAXI MUM 2 04 3. 4 CO VALID OBSERVATIONS -MISSING OBSERVATIONS -c C OR 0. 0 PERCENT CF TOTAL DR. HE RDM AN - TABLE II - GROUP 6 - UK TR AI K~ i) • 11/12/74 PAGE 10 FILE FILES (CREATION.GATE = 11/12/74) VARIAELE CRVSLBSP SUBSPECIALTY CRV UMTS > CODE 494-.40 7 0 1.30 88? .00 1 2 7 3 . 7C 1 7 1 2 .2C A e S C L U T E FREQUENCY RELATIVE F R E Q U E N C Y (PERCENT) 1 ' 2 0.0 1 • 20.C 1 2C.C 2C 1 .0 1 2C.C OFS TRFD STATIST ICS.. MEAN 1013.120 S T O ER.ROR 216.664 ME D I A N 535.2 5 C MODE 454.400 S T D DEV 484 .475 VARIANCE 234716.375 KURTOSIS -1.819 SKEWNESS C.33C RANGE 1 2 1 7.300 MINIMUM 494.4G0 MAX I MUM 1712 .200 VALID OBSERVATIONS - £ MISSING OBSERVATIONS - C CP 0.0 PERCENT CF TOTAL H M .in. OR. HE RDMAN - TABLE II - GROUP B - CANADIAN i K A l N t L FILE FILEB (CREATION DATE! = 11/12/74) VARIABLE CINDEX COMPLEXITY INDEX CCDE 2.43 ABSCLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 3 .7 ft. 8 1 3 .7 " . 14 1 3 .7 CCDE 8 .63 8. 8 8 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 3.7 1 3.7 CODE 9.33 9.34 ABSCLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) CCDE 1 3.7" 1 3.7 10.48 10.53 ABSCLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 3.7 1 3 .7 CCDE ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) CODE ABSCLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 10.87 10.92 1 3.7 1 2.7 11.13 1 1 .86 1 3.7 1 3.7 8.91 1 3.7 9 .41 1 3.7 10. 57 1 3.7 11.00 1 3.7 8.19 1 3.7 9.04 1 3.7 10.17 1 3.7 10.69 1 3.7 11.01 1 3.7 8 .59 1 3.7 5. In 1 3.7 10.47 1 3.7 io .s: l 3.7 11.1C 1 3.7 _D ES I RED STATISTICS.. MEAN 9.53 8 MCDE KURT OS I S 10 .870 4 .637 MINIMUM 2.430 VALIC OESERVATICNS ii T c r T M i ™ na c; C D W A TT f l M C 27 STD ERROR STD DEV SKEWNESS MAX I MUM 0.367 1 . 9 G5 •1.521 11 .8 60 C flR 0.0 PERCfcNT CF TOTAL MEDIAN VARIANCE RANGE 10.055 3.627 9.430 DR. HLRCMAN - TABLE II - GROUP 3 - CANADIAN Tf A PTEO FILF FILEB (CREATICN DATE = 11/12/74) VARIABLE CRVSURG GENERAL SURGERY CRV UMTS COCE 7.30 a s . 5C 26 c .70 565.10 6C5.EC ABSCLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 3.7 l 3.7 r 3.7 • 1 3.7 1 3.7 CCOE 772.90 9 5 6 . 6 C 1C67.4C 10 72.3C 1175.6C ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 3.7 1 3.7 1 3.7 1 3.7 1 3.7 CODE 1402.70 1410 .80 1434 .70 i 4 a 9.cc 1SC7.2C ABSOLUTc FRbQUENCY RELATIVE FREGUENCY (PERCENT) 1 3.7 1 3.7 1 3.7 l 3. 7 1 -CCDE 16C6.30 i 6 i f . e c . 1905 .00 1947.20 21C8.6C " ABSCLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 3.7 1 3 .7 1 3 .7 1 3.7 1 3.7 CCDE f Q C n l i i T r r n r n> i r i r i / — — — — — — 2 140 .00 2148.OC 2167.CO 2207.50 2315.6C ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 3.7 1 3.7 1 3.7 1 3.7 1 3.7 CODE 2718 .00 3410.OC ABSOLUTE FREQUENCY. RELATIVE FREQUENCY (PERCENT) 1 3.7 1 3.7 DESIRED STATISTICS . MEAN 1486*341 Hit f~~\ r\ r~ f— > <• ^ STD ERROR 15 5.668 MEDIAN 1430.275 MODE SoS.lOC . KURTOSIS -0.409 STO SKE DEV WNESS 808 .978 0.C97 VAR IANCE RANGE 654446.300 340 2.700 M h-1 tn MINIMUM 7.30C MAXIMUM . 34 10.GOG VAI TH ppc, FSU AT Tf'MC _ FILE FILES- (CREATION D'A T 2 = 11/12/74) VARIABLE CRVSUB5P SUBSPECIALTY CRV UNITS' • CODE 9.4-0 2 9.00 440 .40 4 00 .10 552.7C ABSCLUTE RELATIVE . FFEGUENCY FREQUENCY (PEKC- NT ) 1 3.7 1 2.7 1 3.7-1 3.7 1 3.7 CCDE 6 13.70 70C.9C 73^.60 7 51.60 753.50 ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCE NT) 1 3.7 1 3.7 1 3 .7 1 3.7 1 2.7 CCDE 324.00 84 7.70 5 37.5C 942.70 1C74.9C ABSOLUTE R EL AT IV E FREQUENCY FREQUENCY (PERCE NT ) 1 3.7 1 2.7 1 2.7 1 3.7 1 CODE 1121.70 1139.70 1168 .20 1254 .10 1283.2C ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCE NT) 1 3.7 1 3 .7 1 3 .7 1 3.7 1 2.7 CCCE 1558.50 156 5.70 1812.70 1945.20 2108.30 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCE NT ) 1 3.7 1 3.7 1 3 .7 1 3.7 1 3.7 CCDE 2115 .30 2652.5C ABSOLUTE RELAT IVE FREQUENCY FREQUENCY (PERCE NT ) 1 3.7 1 2.7 -DESIRED : STATISTICS.. MEAN 1089 .700 STD ERROR. • 122.821 MEDIAN 974.450 MODE 753.500 STD DtV 6 38 . 199 VARIANCE 4C7298.063 KURTOS IS -0 .273 SKEWNESS 0. 5 34 RANGE 2643.100 MINIMUM 9 .400 MAX IMUM 2652. 5 CO M OV VALID OBSERVATIONS -MISSING OBSERVATIONS -27 0 OR O.C PERCENT OF TOTAL DR. HERDMAN - TABLE II - GROUP 3 - B.C. REGISTRATION BIT ORE 19 50 11/12/74 PAGE 3 FILE FILEB (CREATION DATE = 1 1/ 12/7 4 ) VARIABLE . CINDEX COMPLEXITY INDEX CCDE 2 .43 6.R I 7 . 14 15 E. 59 ABSCLUTE FREQUENCY RELATIVE .FREQUENCY (PERCENT) 1 11.1 1 11.1 11 1 .1 . 11 1 . 1 11 1 .1 CODE 9.04 10.87 11 . 00 11. 16 ABSCLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 11.1 1 11 .1 1 1 1 .1 11 1 . 1 DES I RE C STAT 1ST ICS.. MEAN 8.361 STO ERROR . o. 9 19 MEDIAN 3 .602 MCDE 10.6 70 STO DEV 2. 757 VARIANCE 7 .60 3 . KLRTOSIS -0.315 SKEWNESS -C. 6 24 RANGE 3 .750 MINIMUM 2.430 fAX I MUM 11. 180 VALID GBSERVATICNS - 9 MISSING OBSERVATIONS - C CR 0. 0 PERCENT CF TOT AL i DR. HERCMAN - TABLE II - GROUP 6 - B.C. REGISTRAT ICN BEFORE 1950 11/12/74 PAGE 9 FILE FILEB (CREATION GATE = 11/12/74) VARIABLE CRVSLFG GENERAL SURGERY CRV UNITS CODE 7.30 8 8.50 26 = . 7C 56:;. 1C 6C3.6C ABSOLUTF RELATIVE FREQUENCY FREQUENCY (PERCE NT ) 1 1 I. 1 1 11.1 1 1 I . 1 11 1 .1 1 11-1 CODE 772 .90 956.60 10 72 . 30 34 10. OC ABSOLUT E RELATIVE FREQUENCY FREQUENCY (PERCt NT) 1 11.1 1 11 . 1 1 1 1 .1 1 1 1 . 1 DESIRE D STATIST ICS. . MEAN 862.639 STO ERROR 340.917 MEDIAN 637.400 MODE 56 5 .ICO STD DEV 1022.750 VARIANCE KURTOSIS 1 .379 SKcWNESS 1.560 RANGE 3402.700 MINIMUM 7.300 MAXIMUM 3410 .000 -VALID O e S E R V A T I C N S - 9 MISSING OBSERVATIONS - C OR 0.0 PERCENT CF TOTAL DR. HE RDMAN - TABLE II - GROUP P - B.C. REGISTRATION BEFORE 1950 11/12/74 PAGE. 10 FILE FILEB ( C R t A 1 I C N DATE = 11/12/74) VAPIABLE CRVSUBSP SUBSPECIALTY CRV UNITS CCDE 9.40 29.00 440.40 700.90 753 . 5C ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 U . l 1 11.1 1 11.1 1 11.1 1 11.1 .CODE 824.00 94 2.7C 1283 .30 1945.20 ABSOLUTE FREQUENCY 1 1 1 1 RELATIVE FREQUENCY (PERCENT) 11.1 11.1 11.1 11.1 DESIRED STATISTICS.. MEAN It 9.822 STD ERF OR 201.335 MED I AN 757.975 MODE 753.500 STD OEV 6 04 .006 VAR 1 ANCE 364823.375 KURTOSIS -0.807 SKEWNESS O.445 RANGE 1935.300 MINI MUM 9.400 MAX I MUM 1945.2CC VALID MISSING OBS CBS ERVATICNS -ERVAT1CNS -c 0 OR 0.0 PERCENT OF TOTAL 5D DR. HER C MAN - TAFLF II - GROUP E - E . G . REGISTRATION 1550 - 1963 11/12/74 PAGE 8 F I L E FILEB (CREATION DATE = 11 /12 /74 ) VARIABLE CINDEX COMPLEXITY INDEX CODE - 8.63 8 .91 9.33 . 9 . 2 4 9.41 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 7 .7 1 7 .7 1 7 .7 1 7 . 7 1 7.7 CODE . 52 10. 18 10 .47 10.53 10.57 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 7 .7 1 7 . 7 1 7 .7 1 7 , 7 1 7 .7 CODE 10.83 10.92 11. 10 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 7 .7 1 1 7 .7 DESIRED S T A T I S T I C S . . MEAN 9 .581 STD EPRCR 0.228 MED IAN 10 .090 MODE 10 .570 STD DEV 0. 823 VARIANCE 0 .677 KURTOSIS - 1 . 6 0 9 SKEWNESS - 0 . 162 RANGE 2 .470 M M MUM 8 .630 MAXIMUM 11 .100 VALID OBSERVATIONS - 13 KISSING OBSERVATIONS - 0 OR O.C PFPCENT OF TOTAL to o D R . H E R D M A N - T A B L E - T i - C R O U P B - E . C . R E G I S T R A T I O N 1 9 5 0 - 1 9 6 2 . F I L E F I L E B ( G R E A T I C N L A T E = 1 1 / 1 2 / 7 4 ) V A R I A B L E C P V S L R G G E N E R A L S U R G E R Y C R V U M T S 1 1 / 1 2 / 7 4 P A G E 9 1 1 1 5 . 6 0 1 2 2 1 . 3 C 1 4 1 0 . 8 0 1 4 3 4 . 7 0 1 6 0 6 . 3 0 A B S O L U T E R E L A T I V E F R E Q U E N C Y F R E Q U E N C Y ( P E R C E N T ) 1 ' 7 . 7 1 7 . 7 1 7 . 7 1 1 7 . 7 7 . 7 C O D E 1 6 1 5 . 8 0 1 9 4 5 . 1 0 1 9 4 7 . 2 0 2 1 0 8 . 6 0 2 1 4 0 . 0 0 A B S O L U T E R E L A T I V E F R E Q U E N C Y F R E Q U E N C Y ( P E R C E N T ) 1 7 . 7 1 7 . 7 1 7 . 7 1 1 . . 7 . 7 7 . 7 C O D E 2 1 4 8 . 0 0 2 1 6 7 . 0 0 . 2 7 1 8 . 0 0 A B S O L U T E R E L A T I V E F R E Q U E N C Y F R E Q U E N C Y ( P E R C E N T ) 1 7 . 7 1 7 . 7 1 7 . 7 n Fs t R Fn C.T A T T<;T rr<; U LsJ 1 (<LlJ M E A N 1 8 1 8 . 3 3 8 S T D E R R O R 1 2 4 . 7 7 8 M E D I A N 1 8 6 3 . 3 0 0 . M O D E " T . 6 C 6 . 3 G 0 S T D D E V 4 4 9 . 8 9 2 V A R I A N C E 2 0 2 4 0 3 . 1 8 8 K U R T O S I S - 1 . n ? 7 S K E W N E S S 0 . 2 C 9 R A N G E 1 5 4 2 . 4 0 0 M I N I MUM 1 1 7 5 . 6 C C "VAX I MUM 2 7 1 8 . 0 0 0 V A L I D O B S E R V A T I O N S - 13 M S S I N G O B S E R V A T I O N S - 0 OR 0 . 0 P E R C E N T O F T O T A L to D R . • h c R C ^ t N - T.'.l L ? i | - ( ;?(i ,P p - i-.f.. P EC I bTf ii T ICR K 5 u 1 J J o T FILE -FILER (CF t All (','•! W " f = 11 / ] 27 74 ) VARIABLE CPVSWFSP S i i bS (-• f C 1AL r Y Cf V U M T S C O D E A b S C L U T E F R t ^ ; r r - : C Y r ~ R E L A T I V E F R E Q U E N C Y ( P F & C E f T ) ( ! 3 . 7 0 7 « 7 C O D E A B S O L U T ; : FRECUEf-X Y RELATIVE F R E G U F N C Y (PFFCEKT! C O D E i i _ < ; . 7c 1 7. 7 A B S O L U T E F R E Q U E N C Y R E L A T I V E F R E Q U E N C Y ( P e r : C E N T J 2 1 1 5 . 3 0 i 7 . 7 7 ? 4 . 6 0 I 7 . 7 i 5 6 <;. 7 C l " 7.7 7 3 1 . 6 0 1 7 . 7 84 7 . 7 0 7 . 7 1 7 1 2 . 2 0 7 . 7 1 8 1 2 . 7 0 7 . 7 26 5 2 . 5 C l 7 . 7 2 6 7 6 . . 1 0 1 7 . 7 1 1 / 1 2 / 7 4 1 0 7 4 . 9 0 r 7 . 7 2 1 0 8 . 3 0 _ f 7 . 7 PAG t 10 D E i . I . R . E D . . . S T A i ' S T J . C S _ , . _____ _ _____ _ _ *IEAN 1 5 2 3 . 769 STO ERROR 2 0 0 . 447 MEDIAN 1 4 9 7 . 8 2 5 ^GOE 10 7 4 . 9 0 0 \ STD DE V 7 2 2 . 7 20~ VAR IA NC E 5~?2 3 2 4 . 7 5 0 < OR TO S I S zX-AlL SK.E b N F S S 0 .2 .54 P AN.G E 2.0J2.400 v IM MUM 6 1 3 . 700 f' A X I M L M 2 6 7 6 . I C O _ _ _ 0 B S r c . V ; . T i CNS ~ 13 : " I S S I N G OBS EkV AT I ON S - 0 OP O.C P E R C E N T CF T C T A L-, . . . „L . OR. HERDMAN - TABLE II - GROUP E - E i C . REGISTRATION AFTER 1963 11/12/74 PAGE 8 F I L E FILEB (CREATION DATE = 11/12/74} VARIABLE CINDEX COMPLEXITY INDEX CODE. 7 .66 6.6 6 8.98 9 . 14 9.17 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6 .3 1 . .6 .3 1 6 .3 1 6 . 3 1 6 .3 CODE 9 .33 9 .53 9 .90 10. 17 10.36 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6 .3 1 6 .2 1 6 .3 1 6 . 3 1 6 .3 CODE 10 .37 10.48 10 .69 11 .01 11.04 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) • 1 6 .3 1 6 . 3 1 6 . 3 1 6 . 3 1 6 .3 CODE 11 .86 ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6 . 3 CESIREC S T A T I S T I C S . . MEAN 9.911 STD ERROR 0.261 MEDIAN 10.035 MODE . 11 .040 STD DEV 1.043 VARIANCE 1.088 KURTOSIS - 0 . 5 4 8 SKE WNESS - 0 . 1 8 6 RANGE 4 . 2 0 0 MINIMUM 7.660 NAXIMUM 11.860 VALID . 1 M S S I N G l OBSERVATIONS -GBSERVAT ICNS -16 0 OP 0 .0 PERCENT OF TOTAL w OR. HE ROMAN. - TALLE II - GROUP 8 - B . C . REGISTRATION AFTER 1562 FILE FILEB (CR EAT I C N C AT E = 11 /12 /74) VARIABLE CRVSURC GENERAL SURGERY CRV L M T S 11/12/74 PAGE CODE 283 .30 609 .90 783.90 881 .50 1067.40 ABSOLUTE RELATIVE FRFOUENCY FREQUENCY (PERCENT) 1 6 .3 1 6 .2 1 6 .3 1 6 .3 1 6 .3 COOE 1325 .30 1402 .70 1489.60 1507.20 1848.20 ABSOLUTE FREQUENCY , RELATIVE FREQUENCY (PERCENT) 1 6 . 3 1 6 . 3 1 6 .3 1 6 . 3 1 6 .3 CODE 18e5 .20 19C5.CC 2043.40 2207 .50 2315 .60 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) 1 6 . 3 1 6 . 3 1 6 .3 1 6 . 3 1 6 .3 CODE 3169 .30 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT ) 1 6 .3 DESIRED S T A T I S T I C S . . MEAN 1545.875 MODE 3169 .300 KURT OS IS - C . 500 KI M MUM 283.200 STD ERROR STD DEV SKEWNESS MAXIMUM 182.965 131.862 0.252 2165.300 VALID OBSERVATIONS -MISSING OBSERVATIONS -16 0 OR 0 .0 PERCENT OF TOTAL MEDIAN 1498 .400 VARIANCE RANGE 535621.813 2886.OOP DR.- HERDMAN - TABLE II - CRT UP B - E . C . REGISTRY TICK AFTER 1963 ~ ~ ~ ~ : '. ~ 11 /12/74 PAGE To F I L E FILEB (CP EAT tON DATE = 11/12/74) VARIABLE CRVSLBSP . SUBSPECIALTY CRV U M T S CODE 426 .40 445. 50 480 .10 4 9 4 . 4 0 552.70 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) • 1 6.2 1 6 .2 1 6 .3 • 1 6 . 3 1 6 .3 CODE 703.30 735.60 839.40 882 .00 937 .50 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT ) 1 6 .3 1 6.2 1 6 .3 1 6 .3 1 6 .3 CODE . 1121.70 1168.20 1254.10 1273.70 1459.00 • ABSOLUT E RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6 .3 1 6 .2 1 6 .3 1 6 . 3 1 6 .3 CODE 1556.50 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 6 .3 DESIRED STATIST I C S . • MEAN 895 .756 STD ERROR 93 .438 MEDIAN 860. 700 MODE 1455.CCO STD DE V 373.753 VARIANCE 129691.063 KUPTOSIS - 1 . 299 SKEWNESS 0 .262 RANGE 1132 .100 MINIMUM 426 .400 fAXIMUM 1558.500 VALID O B S E R V A T I O N S - 16 M S S I N G OBSERVATIONS - 0 OR 0 . 0 PERCENT OF TOTAL DR. HLRCMAN - TABLE i i - GROUP 8 - 55 + FILE FILEB (CREATION DATE = 11/12/74) VARIABLE CINDEX COMPLEXITY INDEX 11/12/74 PAGE 8 CCDE 2 .43 6.91 14 8.19 3 .59 ABSCLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) CCDE ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) • 1 11.1 9.04 1 11.1 1 11.1 1 1 1 . r l l i . i 1C.87 1 11.1 11 .CO 1 11.1 11.18 1 11.1 1 11.1 DESIRED STATISTICS.. MEAN 8.361 MCDE AURTOSJ.S MINIMUM 10.870 -0.315 2 .430 VALID OBSERVATIONS -MISSING OBSERVATIONS -STD ERROR STO DEV SKEWNESS 0. 919 2.7 = 7 -0.834 OR MAXIMUM 11. ISO 0.0 PERCENT OF TOTAL MEDIAN VARIANCE RA-NGE S .602 7.603 8 .750 H to 0> DR. HE P. CM AN - TABLE II - GROUP B - 5 5 + FILE FILEB (CREATION DATE = 11/12/74) VARIABLE CRVSUPG GENERAL . SURGERY C R V UMTS 11/12/74 PAGE 9 C C D E 7.30 88.50 235.70 565.10 605.60 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCE NT) 1 11.1. 1 11.1 11 1 .1 1 11.1 1 11.1 CCDE 772.90 95 6.cC 1C72. 30 3410.00 ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCE NT) 1 11.1 1 11.1 . 11 1 .1 1 11.1 DESIRED STATISTICS.. MEAN 662.639 STD ERROR . 34-0.917 MECIAN 637.400 MCDE 565.100 STD DEV 1022.750 VARIANCE ********** KURTOSIS 1.379 SKEWNESS. 1 .530 RANGE 3402.7C0 MINIMUM • 7.300 MAX I MUM 3410.CCC VALID OBSERVATIONS -MISSING OBSERVATIONS -c C OR 0. 0 PERCENT CF TOTAL • to •si: OR. HE-ROM AN - TABLE II - GROUP B - 5 5 + 1 1/12/74 PAGE 10 FILE FILES (CREATION DATE = 11/12/74) VARIABLE . CRVSUBSP SUBSPECIALTY CRV UMTS CODE 9 . 40 2 9.00 4 AG . 40 7CC .90 7 5 3.5C . ABSOLUTE RELATIVE FREGU ENCY FREGUENCY (PERCE NT) 1 1 1 .1 1 11.1 • 1 1 1 .1 1 11.1 1 11.1 CCDE 824. 00 94 2.70 1283. 30 1945.20 • ABSOLUTE RELATIVE FREGUENCY FREQUENCY (PERCE NT) 11 1 . 1 1 11.1 1 1 .1 .1 1 i l . l DESIRED STATIST ICS.. MEAN 769.622 STD ERROR 201.335 MEDIAN 757.975 MCDE 75 3.500 STD OEV 6C4.CC6 VARIANCE 364823.375 KURTOSIS -0.807 SKEWNESS 0.44 5 RANGE 1935.8.00 MINIMUM 5.400 MAXI MUM 1945.2 CO VALID MISSING OBSERVATIONS -OBSERVATIONS -9 C OR 0. C PERCENT CF TOTAL DR. HE RDM AN - TABLE II - GROUP B - 45 TO £4 FILE FILEB (CREATION DATE = 11/12/74) VARIABLE CIMDEX . COMPLEXITY INDEX CODE ABSCLUTE FREGUENCY RELATIVE FREQUENCY (PERCENT) CODE ABSOLUTE FREQUENCY RELATIVE FREQUENCY (PERCENT) CODE ABSOLUTE FREQUENCY RELATIVE FREGUENCY (PERCENT) 5.33 1 9.1 9.90 1 9.1 11 .01 1 9.1 9.3 3 9. 34 1 9.1 1 9.1 1 C . 1 E 10.4 7 1 5.1 1 9.1 11/12/74 PAGE 9 . t l 1 9.1 10. 57 1 9.1 9.53 1C . 6 3 1 9 . 1 DES I RED STATISTICS, .. MEAN 9.950 MODE KURTOSIS 10.570 - 1 .606 MINI MUM 3.880 VALID OES ERV AT IONS -MISSING CBSERVATICNS -1 1 OP STD ERROR STD DEV SKEWNESS MAX I MUM 0.213 0 .706 0. 0 88 11.CIO 0 . 0 PERCENT CF TOTAL MEDIAN VARIANCE RANGE 9. 377 C.458 2.130 to «3-DP. HE RDMAN - TABLE II - GROUP B - 45 TO 54 F I L E F I L E B (CREATION DATE = 1 1 / 1 2 / 7 4 ) VARIABLE CRVSUPG GENERAL SURGERY CRV UNITS 11/12/74 PAGE 9 CCDE 881 .50 1175 .6C 1221 .30 1402.70 1410.80 ABSCLUTE RELATIVE FREQUENCY FPEQUENC Y (PERCENT) 1 9.1. 1 9 .1 1 9.1 1 9 .1 1 5.1 CCDE 1606 .30 1615.8C 19C5 .GO 1945.10 1547.2C ABSOLUTE RELATIVE FREQUENCY FR ECU ENCY (PERCENT) I 9 .1 1 5 .1 1 5 .1 1 ' 5 . 1 1 9 .1 CODE 2718 .00 ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 9 .1 DES IFF D S T A T I S T I C S . • MEAN 162 0 .645 STD ERROR 150.5 32 MEDIAN 1555.300 MODE 1606.300 STD DEV .." • 499 .259 VARIANCE 245259.433 KURTOS IS - 0 . 2 9 9 SKEWNESS 0.611 RANGE 183 6.5 00 MINIMUM 661 .500 PAX 1 MUM 2718.000 VALID OBSERVATIONS -MISSING OBSERVATIONS -11 0 OP 0 . 0 PERCENT CF TOTAL DR. FERCMAN - TABLE II - GROUP B - 4 5 TO 54 • 11/12/74 PAGE 10 FILE FILEB (CREATION DATE = 11/12/74) VARIABLE CRVSUBSP . SUBSPECIALTY CRV UNITS CCDE 480.10 49 4.AC 613. 70 734 .60 847 .70 ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 9.1 1 9.1 c 1 .1 1 9.1 1 5 .1 • CCDE 1074.90 1254. 10 1712. 20 1812.70 2 1C6.3C . ABSOLUTE RELATIVE FREQUENCY FREGUENCY (PERCENT) 1 9.1 I 5. 1 9 1 ••1 1 9. 1 1 9.1 CODE 2676.10 ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 9.1 DESIRED STATISTICS.. MEAN 1255.345 STD ERROR ' 220.064- MEDIAN 1062. 900 MODE 1C74.90C STO DL. V 729.370 VARIANCE 532709. 5o3 KURTOSIS -1.170 SKEWNESS 0. 5 54 RANGE 2196. 000 M IN IMUM 460.IOC MAX1MUM 2.676 .100 VALID MISSING OBSERVATIONS -OBSERVATIONS -1 1 C OR 0 .0 PERCENT CF TOTAL OJ Hi OR. FERCMAN - TABLE II - GROUP 3 - UNDER 45 FILE FILEB. (CREATION DATE = 11/12/74) VARIABLE CINDEX COMPLEXITY INDEX 11/12/74 P A G E CODE • 7.6t 3 .63 .9 I 3.58 9. 14 ABSOLUTE RELATIVE FREQU ENCY FREQUENCY (PERCENT) 1 5.6 1 5.6 1 5.6 1 5.6 C 1 e. CCDE • 9.17 9.33 9. 5.3 10.17 10. 36 ABSCLUTE . RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5.6 1 5.(. 1 5 .6 1 5 .6 c 1 .6 CCDE 10.37 10.48 10.5 3 10.69 10. 92 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5.6 1 5.6 1 5.6 1 5.6 5 1 .6 CODE 11 .04 11.10 11 .36 ABSOLUTE RELATIVE FREQUENCY ^ FREQUENCY" (PERCENT) 1 5.6 1 5.6 1 5.6 DESIRED : STATISTICS.. MEAN 9.937 STD ERROR 0.252 MEDIAN 10.265 MODE 11.040 STD DEV 1.071 VARIANCE 1.146 KURTOSIS -0 .636 SKEWNESS -0.241 RANGE 4.200 MINI MUM 7.fc6C MAXIMUM 11 .860 VALID OESERVATICNS -MISSING OBSERVATIONS -i e C OR 0. 0 PERCENT CF TOTAL CvJ DP. HE ROMAN - TABLE II - GFOUP E - UNDER 45 " 11/12/74 PAGE 9 FILE FILEB (CREATION DATE •= 11/12/74) VARIABLE CRVSURG GENERAL SURGERY CRV UNITS CODE 283.30 60 9. 50 786.50 1067.40 1329.30 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5.6 1 5.6 1 • 5 .6 1 5.6 1 5.6 CODE 14 34.70 1489. ec 15C7.20 1848.20 1885.2C ABSOLUTE R EL AT IV E FREQUENCY FREQUENCY (PERCENT) 1 5-. 6 1 5.6 1 5.6 1 5.6 1 • 5.6 CCDE 2043.40 210 8.60 2140.00 2148.00 2167.CC ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5.6 1 5 .6 1 5.6 1 5.6 1 £.6 CODE 2207.50 2315.ec 3169.30 ABSCLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5.6 1 5.6 1 5 .6 DESIRED STATISTICS.. MEAN 1696.fi35 STD ERROR 166.309 MEDIAN 1866.70C MCDE 316 9.300 STD DEV 705. 551 VARIANCE 497858.313 KLRTOSI S -0.458 SKEWNESS -0. 193 RANGE 2886.000 MINIMUM 283.300 MAXIMUM 3169.300^ VALID MISSING OBSERVATIONS -OBSERVATIONS -1 8 C OR 0. C PERCENT CF TOTAL U) u> DR. HF P DM AN - TABLE I I - GROUP- E - UNDER 45 -11/12/74 PAGE 10 FILE FILEB (GREAT ICN DATE = 11/12/74) VARIABLE- CP.VSLESP SUBSPECIALTY CRV UNITS CCDE 4 26 .40 445.50 / 5 52.70 703.3C 735.6C ABSOLUTE RELATIVE FREQUENCY FREQUENCY. (PERCENT ) 1 5.6 1 5.C 1 5.6 1 1 5-6 CODE 751.60 839.40 882 .00 937 .50 1121.7C { ABSOLUTE FREQUENCY 1 1 l 1 1 RELATIVE FREQUENCY (PERCENT) 5.6 5 .6 5 .6 5. c 5.6 CODE 11-39.70 1 168. 20 1273. 70 1459.00 1556.50 ABSOLUTE RELATIVE FREQUENCY FREQUENCY (PERCENT) 1 5.6 1 5.6 1 5 .6 I • 5.6 1 5 .6 CCDE 1569 .70 2115.30 2652 ,5C ABSOLUTE FREQUENCY 1 1 1 RELATIVE FREQUENCY (PERCENT) 5.6 5.6 5.6 DESIRED STATISTICS. . MEAN 1 129 .572 STD ERROR 137.163 .MEDIAN 102 9 .6 00 MODE 1459.000 STD DEV 58 1 .9 32 VARIANCE 338644 .936 KURTOS IS 0.425 SKEWNESS 1.013 RANGE 2226. 100 MINI MUM 4 26 .'00 MAX I MUM 2652.SCO VALID '•" MISSING OBSERVATIONS -OBSERVATIONS -16 C OR O.C PERCENT OF TOTAL i—• 135 APPENDIX F Total Income (1) and % of Income (2) Earned by Operative Surgery  GROUP A 1. 2. 1. 2. 1. 2. $57320 19.6 41515 52.6 24545 51.7 66280 47.3 63018 83.3 57208 74.9 29087 64.9 60786 62.4 45375 68.8 20124 83.2 53315 84.6 48485 73.1 100158 66.8 45546 42.4 38775 69.8 34461 65.5 36913 61.8 54468 73.7 47568 70.2 21253 25.9 58701 63.0 33717 13.5 93379 78.6 22682 76.4 45796 32.4 35142 71.4 85361 79.0 57555 73.8 32223 10. 56395 75.9 53012 39.7 47840 48.5 49639 83.3 24423 83.9 64840 79.0 49875 67.8 42538 75.9 107359 52.6 59633 76.4 62916 87.8 GROUP B 1. 2. 1. 2. 59022 85.8 37595 41.7 43062 88.0 50179 49.2 42768 82.3 51886 75.2 34569 56.5 63652 85.4 26754 60.3 55547 81.4 48089 82.8 45732 52.9 53696 57.0 39207 71.3 53492 57.7 48330 69.4 23152 0.9 36683 61.6 55646 56.7 38023 67.7 21800 89.2 59814 35.7 66032 87„5 39355 81.7 54837 81.5 27592 5.1 60249 64.0 72790 88.3 141668 39.1 29705 29.3 27650 30.8 43202 36.6 55975 62.0 63274 87.8 45389 69.5 56155 79.4 27406 60.2 60875 35.3 Source: M.S.C. data 

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