The president of Doctors Nova Scotia says it won't be an easy fix to do more medical procedures outside Halifax, an idea recently suggested by the premier as the province grapples with how to replace the aging Victoria General Hospital.

Dr. David Milne, head of the physicians' association, said complicated procedures that require a team should continue to be done at a facility near the Halifax Infirmary that has links to Dalhousie University's medical school.

"What we've found over the course of the last six months after the flood at the Victoria General Hospital is that it was very, very complicated to move services piecemeal from the [VG] complex because so many things are interrelated," he said.

Last week, the premier said a provincial review will determine what services should be moved off peninsular Halifax as the province eyes building a replacement to VG building. McNeil did not have a timeline for specifics on the possible service shuffling.

Milne said specialized surgical services need a team approach and "a critical mass of specialists" able to care for those patients.

He said there is evidence to support the theory that the more specialized surgeries done by a team, the better the outcomes. He uses the example of esophageal surgery.

"There's good evidence that shows if you're in an area doing fewer than five a year, the outcomes [are] very, very bad and high morbidity, whereas if you're doing more than 30 esophagectomies a year, you have the lowest amount of complications," Milne explained.

More than 30 esophagectomies are currently done each year at the VG and complication rates are low, he said.

But Milne thinks it would make sense to move some services to other areas of the province.

"We have infrastructure and buildings that exist throughout the province [where] some things could be done," he said.

Milne said an example of a service that could be moved is joint replacement surgery. The hospital in Kentville already does a lot of those procedures.

"The volume would be high and the quality would be high," he said.

Milne also said Doctors Nova Scotia wants to be part of the discussion about replacing the VG hospital.