Enhanced Surgical Skills describe a set of defined competencies of rural family physicians, which generally include one or both of appendectomy and Caesarean section.
As a general rule, with many individual exceptions, the ESS workforce is divided between two distinct skill sets. The first represents a broad skill set, including operative delivery, which is acquired either overseas or through one of the twelve month R3 programs at the University of Alberta or University of Saskatchewan.
In 2000 there were 151 ESS/OSS rural family physicians sustaining local surgical programs in rural communities in western and northern Canada. Although the number of these rural surgerical programs has shrunk significantly – 80 in 1995; 55 in 2011 – the number of ESS/OSS has remained stable at 140 (2011). There is some evidence that several of these smaller programs grew larger in volume, absorbing a workforce displaced from programs which closed.
Although there has been a sizeable attrition between 1995 (80 communities) and 2011 (55 communities), these are distributed across all of the western provinces - 11 in BC, 27 in Alberta, 8 in Saskatchewan, 5 in Manitoba, as well as 3 in Northern Ontario and 1 in NWT. These small volume rural surgical programs can generally be found: