Plastic Surgery Essay Example for Free

Plastic Surgery Essay Research Paper Outline Plastic Surgery Section Specialties Recruiting and Retention Fund November 6, 2012 Attn: Mr. Eric J. Harris, Q.C. From: Stan Valnicek, MD, Section Head – Plastic Surgery Dear Mr. Harris Thank you for taking the time to review our submission for the SRRF. We have tried to organize it into logical sections representing the issues that we face as a Section. Our argument is based on data from the following sources: 1. Canadian Institute for Health Information http://www.cihi.ca 2. Medical Services Plan (MSP) BC Payment Information 2010/11 report (Latest) 3. Survey of our section membership – October 2012 (83% response rate) i I have included the raw data in the appendix to this submission. We have tried to use the latest available data sets from sources independent to our section in order be fair and accurate in our claims. I am happy to provide all additional documentation and supporting evidence for items in this submission as required. The goal of this submission is to protect the provision of public hospital based plastic surgery services in the province of BC. Recent media attention in the Vancouver Sun has brought light to the long waits our patients face in the public system: http://www.vancouversun.com/health/Operation+Delayed/7494235/story.html Part of the public issue relates to limited hospital resources in the BC public health care system. Barriers to recruitment are primarily driven by availability of OR time and the willingness of Health Authorities to provide the necessary resources for new surgeons. Low remuneration does affect recruitment in areas of the province that are chronically unde rserviced since competitive rural opportunities exist across Canada even when major urban areas are well staffed. Our main issue as a section is retention of surgeons within the public system and this is primarily driven by significant intra and inter-provincial income discrepancies that put us near the bottom of all surgical specialties. Research Paper Outline 0. Definition of Plastic Surgery Plastic surgery is a misunderstood specialty and it is surprising to us how pervasive the misconceptions are among not just the public but also our colleagues in the medical profession. Media portrayals of cosmetic surgery have led to unfortunate distortions and harmful attitudes, which over the years have had significant negative impact on our profession and particularly on remuneration for public work. Plastic surgery as a specialty grew out of the need to address the management of complex wound healing issues in patients with severe burns, spinal cord injuries, major trauma or defects caused by the extirpation of cancers. This is still the core of our profession today. One hundred years ago skin grafting did not exist and even moderate burns were fatal or led to severe contractures and lifelong disability. Patients who had breasts or parts of their face removed spent their remaining lives disfigured and often shunned. Spinal cord injured patients lived with massive bedsores severely restricting their mobility and independence. Children born with congenital anomalies such as facial clefts were ostracized or worse. Those of us who carry out missions to the third world see the effects on patients and families in regions where plastic surgical care is not readily available. Plastic surgeons have also been pioneers in tissue transplantation, wound healing, nerve regeneration and tissue engineering. Rebuilding form and function has led to the development of entirely new areas such as hand and wrist surgery, facial trauma surgery, craniofacial surgery, microsurgery and skin cancer management. In the province of BC our plastic surgery section provides the majority of care in the following areas: Disease and injury to hand and wrist Disease and injury to the face Burns Congenital defects of the upper extremity or face Reconstruction for defects from cancer ablation Pressure sores in spinal cord injured or systemically ill patients Complex wounds Severe infections including necrotizing fasciitis Primary cancers of skin and soft tissue Microsurgical reattachment of amputated limbs or body parts (scalp, ear etc.) Microsurgical transplantation of tissue Gender reassignment surgery We are also the 3rd or 4th busiest surgical service (out of 10) in terms of emergency surgery due to our coverage of the majority of hand, wrist and facial injuries. ii Research Paper Outline I. Recruitment and Retention A: Demographics iii Prior to presenting our data, I would like to clarify some of the underlying demographic variables. We presently recognize a total of 81 BC plastic surgeons (defined as those with Canadian certification through the RCPS(C) or international equivalent) within our Section in BC. Some of these are part-time, semi-retired or in primarily private practice. These serve an estimated 2012 BC population of 4.5 million (Statscan 1). In order to determine â€Å"full time† practitioners, the Medical Services Commission (MSC) defines a cut off for low billings. This changes yearly and is currently set at $82,100 annual MSP billings or less. With this metric our numbers drop to 52 active surgeons for the last year data was available (2010/11)2. Government (MSP) plastic surgery census data differs slightly as they include anyone who â€Å"bills† primarily out of our section of the fee schedule as a â€Å"Plastic Surgeon†. There are about 3-5 of these physicians and may include Orthopedic surgeons with a primary hand surgery practice or temporary locums. For the purposes of this submission, we will use the most current MSP data sets for the following reasons: they are readily available to the BCMA and to each section. the BCMA uses them for their own calculations and allocations any allocated funds rightfully benefit physicians billing out of the plastic surgery section of the fee guide 1 2 http://www.statcan.gc.ca/ig-gi/pop-bc-eng.htm Medical Services Plan (MSP) BC Payment Information 2010/11 report attached Research Paper Outline B: Plastic Surgery Manpower in BC over past 5 years iv If one looks at the numbers from the MSP dataset for the last six years, our growth as a section seems significant. I have compared us to all other surgical specialties (9 sections) and medical specialties (18 sections). It would appear that the total number of BC plastic surgeons grew rapidly for 3 years with a leveling off in the last two. 3 18% 16% 14% 12% 10% 20% Plastic Surgery Anaesthesia 8% 6% 4% 2% 0% Other surgical specialties Medical Specialties Chart 1: 6 Year Trend in BC Physician Manpower over 2005/06 Baseline looking at total physician numbers per category 3 Medical Services Plan (MSP) BC Payment Information 2010/11 report attached Research Paper Outline v When one applies the semi-retired/part-time payment cutoff (set by MSP) to determine the trend in â€Å"full time† plastic surgeons, the numbers change dramatically. Here the data shows that despite an increase in anesthetists, medical specialists and other surgical specialties overall, the number of full time BC plastic surgeons has dropped in the last 6 years. 20% Plastic Surgery 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 Anaesthesia 15% 10% 5% 0% Chart 2: 6 Year Trend in BC Physician Manpower over 2005/06 Baseline looking at full time physician numbers per category -10% -5% Other surgical specialties Medical Specialties The MSP billing data shows that despite a 17% increase in the number of plastic surgeons in the province over 6 years, the number who bill over a minimum cut-off and would be considered full time has dropped 7%. This trend is in stark contrast to the growth of other specialty groups in BC. The population of BC from the 2006 to the 2011 census grew from 4.1 million to 4.4 million for a 9% increase. Another way of looking at the data shows that in 2005/06 only 19% of BC plastic surgeons were billing under the $82,100 cutoff while in 2010/11 the proportion had grown to 35%. The impact of this on public access to plastic surgical care is enormous. Research Paper Outline C) Manpower issues related to recruitment and retirement vi Our UBC Medical School has a training program for plastic surgeons. We traditionally produce 2-3 graduates a year. Given a population of 80 surgeons and a career span of 30-35 years one would anticipate needing 2-3 new surgeons each year in BC. The majority (88%) of UBC graduates stay in the province (based on a review of all graduates since 1971) and this is reflected in the rise in total plastic surgeons in BC over the past 5 years. A recent survey of our BC section membership (86% response rate) shows 55% feel their hospital is understaffed for plastics and a further 8.6% call their situation severely depleted. A full 70% of respondents would like to recruit one or more plastic surgeons to their community in the next 3 years. The top three barriers to recruitment were OR availability, cooperation of the Health Authority and low MSP remuneration compared to other provinces. Only 17% felt that availability of suitable candidates was an issue for recruitment. The important question is this: Why has the number of full time plastic surgeons dropped over the recent 5 year period as shown in Charts 1 and 2 despite growth in all other groups? The answer we believe lays in an accelerating and profound shift in our sections’ manpower and focus from the public system over to the private (cosmetic surgery) sector. D) Private (Cosmetic) Plastic Surgery – Myths and Realities The private or cosmetic practice in plastic surgery has existed since our specialty originated. Many views about private surgery reflect the situation either in the media (movie/television portrayals of cosmetic surgery) or is based on historical behavior (30 years ago private surgery was the domain of those who had â€Å"put their time in† for 25-30 years of active public practice and could now enjoy a more elective pace with less after hours and weekend responsibility.) The private system allowed for more elective daytime work with greater financial rewards and a less hectic pace. The move to a private practice by this group of older surgeons has never impacted the total number of full time surgeons in this province in the past. Something is different in the last 6 years and we are concerned by the changing pattern. It is our position that chronically low plastic surgery remuneration compared to our colleagues is driving our membership into the private system. Unfortunately the perception that we Research Paper Outline can make up for low MSP payments by simply doing private work has allowed MSP fee suppression to continue and driven more people out of the public system faster than ever. vii The BCMA has effectively handicapped the Section of Plastic Surgery over the past 7 years by including a multiplier in their MANDI (Modified Adjusted Net Daily Income) formula that assumes all plastic surgeons receive 30% of their net income from private surgery. This formula is central to any BCMA attempts at correcting intersectional disparity via the â€Å"microallocation† process. Our section feels this assumption is based on inaccurate, incomplete and out of date information and has spent significant time trying to correct the situation. We would be happy to provide more detail on how this has crippled the attempts at fee and income parity for full time MSP plastic surgeons in BC if requested. The psychological and physical toll of being one of the busiest surgical services while remaining at the bottom of the surgical specialist pay scale has come home to roost. A survey of membership done last month online (65 out of 76 responded) shows that: Most plastic surgeons in BC are engaged full time in the public MSP system 51% feel that in the next few years the proportion of their time private work to public will increase The most common cause for this transition is cited as poor MSP remuneration 34.5% feel burned out often or most of the time 33% intend to retire in the next 10 years Only 40% would advise new UBC plastic surgery grads to stay in BC

A Writers Choice Essay -- Writing Style Styles Essays

A Writer's Choice "The words we use to communicate our impressions cannot alone constitute a vocabulary sufficient to describe style, but they are part of one†¦" (Williams 18-19). This excerpt from Joseph M. Williams' Style Toward Clarity and Grace conveys a common theme in his book: Style is complex, and it is a matter of choice. Although writers across the nation may have been taught similar features of style and therefore produce similar products, they may choose to use or disregard those elements of style at will. Writing parallels many other versatile fields - such as art, music, and dance - with the notion that in order to break the rules, one must first understand them. A creator needs a foundation to build on; in writing and style, this foundation is a combination of accuracy, consistency, clarity, and concision. Accuracy is arguably a facet of style. With their list of commonly misused words and expressions in Elements of Style, Strunk and White stress the importance of using language correctly and even identify its relationship with style. "Many of the words and expressions listed here are not so much bad English as bad style, the commonplaces of careless writing" (39). The authors do acknowledge that there is no ultimate authority who deems which words must be used over others, but their matter-of-fact tone and occasional jabs at writers who misuse certain words seem to forecast misfortunes for those who do not follow a recommended word usage. Williams is less concerned about such strict guidelines because "not all of us will agree on what counts as correct" (170). He attributes some rules to folklore, some to special formality, and a lot to personal choice. However, he acknowledges that precision may be ne... ...ingway was a renowned author said to have a distinct style: short sentences and paragraphs that used simple vocabulary. He also tended to avoid putting commas in places where many writers and language experts - Strunk and White, for example - would deem them necessary. And he won a Pulitzer Prize. Despite their solid rules and guidelines, Strunk and White never impose their own definition of style. Williams doesn't either; he depicts it, however, not as one entity but a flexible, evolving collection of writing applications. One can conclude, then, that style ultimately comes down to the methods that writers define and use to create their end results. Works Cited Strunk, William, and White, E.B. The Elements of Style. Needham, NY: Allyn & Bacon, 2000, 1979. Williams, Joseph M. Style Toward Clarity and Grace. Chicago: The University of Chicago Press, 1990.

Definition Of Friendship Example Essay Essay

Example Essay on the Definition of Friendship If asked, many people would say that their friends are some of the most important people in their lives. However, sometimes it is hard to recognize the value of a friend and see exactly how much they do for us and make our lives better. Charles Caleb Colton once said, â€Å"True friendship is like sound health; the value of it is seldom known until it is lost.† Colton points out the high value of a good friend, but more importantly he suggests that friendship itself is ambiguous and hard to define: something that can be taken for granted and go unnoticed until it is gone. If you asked those same people to define their friendships, you would probably receive a wide variety of answers, with some common threads. For most people, friends are people who know you inside and out, can tell you things that you cannot tell yourself, and most importantly, they support and care for you even in the roughest times of your life. True friends are those people from whom you never want to be apart, who know you so well that they can practically read your thoughts. Growing up, there was a girl named Anita who lived a couple streets down from me, and we had that kind of friendship. We could spend the entire day together, talking, playing softball, and simply enjoying hanging out with each other. After such a full day, we could then go home and call each other, because we still  had more to say. We told each other our deepest, darkest secrets, and it was okay, because we understood each other. True friendship simply cannot last without building this type of affection and trust. However, friendship is not always so bright and happy. Sometimes, the most important thing that a friend can do for you is to make you see things that you don’t want to see, even if it means risking your anger. For example, in the movie The Wedding Singer, Adam Sandler’s character, Robbie Hart becomes a good friend to a waitress, Julia, helping her to plan her wedding. However, when Robbie finds out that Julia’s fiancà © is a creep who is cheating on her, he decides that he needs to tell her and stop her from making a really poor life decision. Even though he knows that Julia will be extremely hurt by this knowledge, Robbie knows that she will be much better off by knowing the truth. Robbie is an example of a great friend because he refused to let her make such a bad decision, even if it meant risking his own friendship with her. While taking a stand and refusing to let you make decisions is indeed an important part of being a good friend, friendship isn’t always quite so dramatic. Simply by being there, caring and supporting you no matter what, friends can show you just how important you are to them. My friend, Sharon, showed me the depth of our friendship when she refused to let me push her away. When I was a freshman in high school, my grandfather became very ill with cancer and died in January. It was an extremely hard time in my life, and rather than deal with the pain, I began shutting down, not talking to any one. I lost a lot of friends that year, but Sharon refused to leave. She would come over to my house everyday simply to listen when I felt like talking and to give me a hug when I didn’t. On the night that my grandfather died, I called Sharon, weeping uncontrollably, and asked her to talk to me about anything so that I could take my mind off of the situation. I am not sure that I would have made it through my grandfather’s death without the love and support that I received from my friend Sharon. Beautiful, dangerous, and heart-wrenching, friendship is not something that can be easily defined. It is something that must be seen, lived, and  experienced.. Poets can write about it, musicians and sing about it, but until you make a true friend, and become one in return, the definition of friendship will always be a bit slippery and hard to hold onto. From my experience, this much I know is true: friends are those people who love you for who you are, and who you want to be. They know your deepest secrets and understand because they have the same secrets. They are not afraid to tell you the truth when you really need to hear it, and most importantly, they will always be there for you. Albert Schweitzer once said â€Å"Sometimes our light goes out but is blown into flame by another human being. Each of us owes deepest thanks to those who have rekindled this light.† So, to my friends who have rekindled my light, I thank you. Example Essay Questions: These questions will help you to look for the things that make essays really excellent. Read the essay on the backside of this sheet and then do the following things: (1) Circle the attention grabber. (2) Find and highlight the thesis. (3) Find and highlight topic sentence of each support paragraph. (4) Find and highlight the concluding sentence of each support paragraph. (5) List the main idea of each support paragraph. Support paragraph 1 – Support paragraph 2 – Support paragraph 3 – (6) Underline the transition between each of the support paragraphs. (It may be the same as the as the topic sentence or it may come before the topic sentence.) (7) Looking at how the author transitions from one body paragraph to the  next, explain why he or she organized his or her ideas in this order. In other words, how does the main idea of each support paragraph lead to or relate to the main idea of the next paragraph? (8) Circle transition words within paragraphs. (9) Circle the essay’s concluding thought. Is it a quote, thought provoking question, or dramatic statement? (10) What is one specific thing about this essay that you want to try in your own writing? Use examples. (Do NOT just say: â€Å"I like the attention grabber!† Instead, say, â€Å"I like how the author uses marriage vows as an attention grabber because everyone is familiar with marriage vows and readers will be intrigued to find out how the essay will relate marriage and loyalty. It also connects to the third support paragraph!)

Strategic Action Disney On Consumer Focused Initiative Essay

Assessment 1 Buyer Behavior MKT 220 Rosella Ramos 14115251B Anika Vats May 13, 2015 MKT 220 !#$ Rosella Ramos Page 2 Part A 1. Which strategic action Disney took in terms of consumer focused initiative? Due to the unwelcome vibe and immense failure that happened to the establishment of Disney in France, in 1992, its executives had to learn the hard way, that in order to be globally recognized, a company branching out to a different country, should know the importance of studying the cultural aspects of the different nations that they plan to do business with. Understanding other countries culture, ethics and language are invaluable in creating a successful business internationally. By taking into consideration the countries’ beliefs, cultural values and traditions, the company would be able to set out its plan to successfully tap into the consumers’ interest and values. The strategic actions that Disney made in France and Hong Kong were executed by giving importance, emphasis, and adaptation to both French and Chinese cultures (Carillo Carlos, 2012). Some of these specific strategic actions in accordance to those principles are as follows: Hong Kong †¢ The use of the 5 elements of Feng Shui (water, wood, fire earth and metal), particularly the heavy use of water were incorporated in the placement, design and orientation of the park. †¢ The use main entrance gate was shifted 2 degrees to maximize the good flow of energy. †¢ Ritual burning of incense was done after theShow MoreRelatedConsumer Focused Initiative : Strategic Action Disney Essay1739 Words   |  7 Pages5/11/2015 Assessment-1 â€Æ' Part-A 1. Consumer focused initiative: Which strategic action Disney took in terms of consumer focused initiative? Examples. 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It launched a theme park, Disneyland, in Hong Kong in 2005 which was the smallest of the five already existing disneylands in different parts of the world. It was started mainly to cater the Hong Kong people as the chinese market is rapidly growing and it was a good and profitable move to open up disneyland in Hong Kong. The strategy which Disney adopted is highlyRead MoreStrategic Action Disney On Consumer Focused Initiative Essay1872 Words   |  8 Pages Assessment 1:Buyer behaviour Student Name: vipin attri ID NO. :14095360B Stream: B Date: 13/05/2015 Tutor Name: Mrs.Anika sharma Ques-1: which strategic action Disney took in terms of consumer focused initiative? Give Examples. 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