OBJECTIVE: In restructuring the Quebec health care system with hospital budget cuts, salary ceiling of physicians and a small number of practising cardiac surgeons, the future of this specialty needs to be defined beyond individual self interest. To evaluate the actual situation and to suggest changes that will improve surgical care delivery in cardiac surgery, surgeon and centre case loads in the province of Quebec were reviewed. DESIGN: Retrospective study. SETTING: Province of Quebec, 1994. PATIENTS: Patients who underwent coronary artery bypass grafting in 1994. RESULTS: The rate of coronary bypass grafting in Quebec was similar to that in Canada as a whole. The number of patients undergoing coronary artery bypass grafting increased at a rate of 6.5%/year during the five years preceding 1994, when operations numbered 5000. Thus, 7000 procedures will be performed in the year 2000 if the actual increase remains similar. There are 12 centres performing cardiac surgery in Quebec, with one centre/600,000 population and 3.4 surgeons/centre, compared with one centre/800,000 population and 3.7 surgeons/centre in Canada. In the year 2000, to accomodate 7000 cases, 18 centres will be required for a minimal case load per centre (300 cases/centre) or nine centres for an optimal case load per centre (700 cases). CONCLUSION: Each centre of cardiac surgery should perform an optimal volume of cases to achieve maximal use of human and physical resources devoted to the care of cardiac surgical patients in the province of Quebec.
