1) Access to Quality Care
Http://www.thoracicsurgery.bc.ca is the website of BC Thoracic Surgery. The Thoracic surgeons of British Columbia through the BC Chest Surgery Association (BCCSA) have linked with the Ministry of Health and the Provincial Health Services Authority the PHSA to create the BC Programme of Thoracic Surgical Care(BCPTSC).

The programme aims to deliver Thoracic Surgical Care at a levelrecognized by Canadian standards. Thisshould be optimally delivered and universally accessible to all patients in British Columbia.

In British Columbia, thoracic surgical services are concentrated at 4 designated centres in Vancouver, Victoria, Surrey and Kelowna. The centralized care allows for optimal resource and manpower utilization to maximize patient benefit. It is acknowledged that better outcomes and lower costs are achieved by developing these high volume centres. Access to Thoracic Surgical care by patients living in rural or distant BC jurisdictions is optimized by Telethoracic assessment.

2) History of the British Columbia Thoracic Surgery Program
The inception of the BC Thoracic Surgery Program was a proposal made to the Ministry of Health by the British Columbia Chest Surgery Association on December 12, 2001.

The Programme officially went into effect on January 1, 2003 as a combined initiative the BC Ministry of Health, the Provincial Health Services Authority, the British Columbia Chest Surgery Association and individual Health Authorities.

At its inception, it had agreements with The Vancouver Coastal Health Authority and the Interior Health Authority and negotiations are underway with additional health authorities elsewhere in the province.

The plan involves the concentration of thoracic surgical manpower and its supporting services into designated centres to allow optimal utilization of resources with maximum patient benefit. In addition, thoracic surgical outreach services will allow for consultative and follow-up thoracic surgical care to be delivered in multiple medium sized communities in British Columbia.

The aim is nothing less than to establish exemplary standards of thoracic surgical care for all four million citizens of British Columbia. The Provincial Programme has grown from seven thoracic surgeons in 2003 to 10 in 2006. Future manpower recruitment is expected.

3) The scope of Thoracic Surgery Practice in Canada
(Defined by the Canadian Association of Thoracic Surgeons at a symposium held in Quebec City, Sept 2001, and Chaired by Dr Richard Finley.)

Can J Surg. 2004 Dec;47(6):438-45. The practice of thoracic surgery in Canada. Darling GE, Maziuk DE, Clifton J, Finley RJ; Canadian Association of Thoracic Surgery.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=
AbstractPlus&list_uids=15646443&query_hl=3&itool=pubmed_docsum

The scope of thoracic surgical practice in Canada includes the diagnosis and management of benign and malignant diseases of the lung, esophagus and mediastinum. The definitive management of some conditions may not be surgery, yet the thoracic surgeon is the best qualified to determine or coordinate the appropriate therapy whether it is surgery, radiation, chemotherapy or percutaneous drainage performed by the radiologist.

	Bullous lung diseases: including surgery for giant bullae, diffuse emphysema (LVR).
	Chest wall tumours.
	Empyema.
	Esophageal cancer: including esophagectomy and palliative approaches with stent, laser and PDT.
	Esophageal motility disorders (achalasia, Nutcracker esophagus, diffuse esophageal spasm): diagnosis including manometry, management with balloon dilatation, surgical myotomy including laparoscopic approaches.
	Gastroesophageal reflux disease via transabdominal approaches including laparoscopic repairs as well as transthoracic repairs, assessment including endoscopy, 24-hour pH testing and esophageal manometry.
	Hemoptysis: diagnosis and management.
	Lung Cancer: diagnosis, staging, treatment, including coordinating multimodality therapy.
	Mediastinal tumours including neurogenic tumours, germ cell tumours, thymic tumours.
	Pneumothorax.
	Pulmonary resection for cancer including sleeve resections, Pancoast and Superior Vena Cava resections.
	Pulmonary transplantation.
	Septic Lung disease: fungal and mycobacterial disease (including increased role of surgery for multidrug resistant TB), lung abscess, bronchiectasis.
	Surgery for myasthenia gravis.
	Thoracic outlet syndrome.
	Tracheal diseases/tumours: assessment, resection, stents.

Thoracic surgeons provide comprehensive care to patients with non-cardiac thoracic conditions. Thoracic surgery encompasses lung and esophageal conditions both malignant and benign as well as mediastinal, pleural, diaphragmatic and chest wall diseases. The Royal College of Physician and Surgeons of Canada recognize Thoracic Surgery as a separate specialty.

Within the current Royal College of Physicians and Surgeons of Canada training guidelines, thoracic surgical training requires completion of medical school followed by six years of general surgical and three years of thoracic surgical training. The nine years of post medical school training is longer than the vast majority of specialty programs. This length of training is necessary due to the complexity of thoracic surgical diseases. A programme of thoracic surgical care must be delivered by surgeons with full Canadian Thoracic Surgical Certification to provide standardized and optimal care to all British Columbians.

Lung and esophageal cancer are major components of thoracic surgical practice. Lung cancer is the most common cause of cancer deaths among both men and women. Deaths due to lung cancer total more than the deaths for the four next most common malignancies combined (colorectal, breast, prostate, pancreas). While the mortality rate for males due to lung cancer appears to have stabilized the incidence of lung cancer mortality in women has significant increased. It is projected that lung cancer mortality in women is not expected to decline until at least after 2010. Lung cancer can expect to remain a major health care issue for at least the next 30 to 40 years even if there is a decrease in incidence of lung cancer as a result of smoking cessation. Eighty percent of lung cancer is non-small cell lung cancer and surgery remains the mainstay of therapy.

Esophageal cancer is becoming an increasing health care concern and thoracic surgeons play a major role in its management. Squamous cell carcinoma and adenocarcinoma, the two histologic subtypes, account for greater than 95% of primary esophageal tumors. The incidence of squamous cell carcinoma of the esophagus varies significantly throughout the world amongst regions and populations. The incidence of squamous cell carcinoma of the esophagus in North America appears stable. The Worldwide incidence of adenocarcinoma of the esophagus is less than that of squamous cell carcinoma, however, there has been a dramatic increase in the incidence of adenocarcinoma of the esophagus in the western World over the past 25 years.

Advanced technologies such as minimal access surgery have led to major changes in thoracic surgical practice over the past 10 years. The role of minimal access approaches in thoracic surgical procedures can be expected to increase. Over the next 25 years, the population of British Columbia is projected to increase from the present 4.1 million in 2001 to 5.7 million by 2026. This increased population combined with increase patient requirements will place an increasing burden on the thoracic surgeons to provide thoracic surgical care to the patients of British Columbia.