Surgical catch-up plan | “Unrealistic” targets, according to the FMSQ

(Quebec) As the deadline approaches, the targets of the surgical catch-up plan are “unrealistic” and must be revised, specialist doctors believe. They deplore the cancellations of planned cases and the lack of “mobilization” in the network. Christian Dubé maintains his objectives and asks establishments to do more.

“Call me a pessimist, I don’t think so, in the current state of things […] where we still easily tolerate end-of-shift cancellations, where I see very, very few teams mobilizing in [quarts] unusual, that it will be able to drop to the expected figures”, notes the vice-president of the Federation of Specialist Physicians of Quebec (FMSQ), D^r Serge Legault.

The president of the doctors’ union is hardly more optimistic. “In my opinion, the targets, currently, are not realistic and they must be revised,” maintains the D^r Vincent Oliva.

The Minister of Health has set the objective of bringing operations pending for more than a year to the pre-pandemic level, i.e. 2,500, by December 31, 2024. A first interim target of 7,600 was set for March 31, or in seven weeks. However, Quebec is still far from its goals.

As of January 27, 13,399 Quebecers have been on a waiting list for more than a year to go under the knife. This data will be made public this Tuesday in the dashboard of the Ministry of Health and Social Services (MSSS).

This performance corresponds to the approximate volume recorded at the beginning of November (13,539 pending cases). This decline is partly explained by the health workers’ strike days in November and December and the holiday vacation period, according to Quebec.

The MSSS estimates that the walkout forced the postponement of some 4,000 non-urgent operations.

Christian Dubé was nevertheless delighted, last week at the Salon bleu, with the progress made from December to January. “Do you know what? The figures that I received yesterday show that we completely made up for this delay in the month of January,” he explained.

In terms of all patients waiting, the figures went from 170,829 on December 30 to 166,502 on January 27 (-4,327). Quebec does not have a catch-up target for this data.

“Between fall 2022 and today, we have experienced a drop of almost 40% in surgeries waiting for more than a year,” underlines the minister’s office in a statement sent to The Press. After more difficult weeks, “however, today we see that we are already reversing the trend, which is encouraging,” we add.

The “scourge of cancellations”

For the FMSQ, the problem lies above all in the daily cancellation of operations even though they were scheduled. “A patient who does not show up, a patient who arrives late, a sick anesthetist… there are a host of causes [pour annuler une opération] », illustrates the D^r Legault.

“But there it is, that if the case has a potential to exceed [la fin du quart à 16 h]we are canceling it immediately,” laments the vice-president of the FMSQ.

Still in the House, Mr. Dubé did not deny the issue. “We have operating rooms that close too early,” he admitted, affirming that around 150 operations are postponed per day for different reasons.

“We have been asking the Ministry for these figures for more than six months,” lamented the D^r Legault.

Tackling the “scourge of cancellations” was also one of the priorities of the catch-up plan announced with the FMSQ and the minister, in May 2023, recalls the union.

In a letter sent to CEOs at the end of January, the Deputy Minister of Health, Daniel Paré, highlights an “increase in the overall list of users waiting for surgery” and reiterates that they must “put everything into works to meet the objectives.

“It is essential that you make full use of all available operating time during the day, during the week. We ask you to pay particular attention to reducing the number of case cancellations at the end of the day and to ensure that the instructions are transmitted to all of your teams,” writes Mr. Paré.

Currently, approximately 6% of operations carried out across the entire network have been pending for more than a year. Quebec asked CEOs to increase the pace to an average of 10 to 12% to succeed in reaching its targets. A “dedicated team”, a bit like the crisis unit in emergencies, was also created a few weeks ago.

Unfavorable quarters

The FMSQ also underlines that despite the allocation of a fund of 400 million dedicated to paying the additional time of health workers who agree, on a voluntary basis, to extend the operating hours of the operating theaters, the results are not very encouraging. “It doesn’t work at all,” said the D^r Legault, who affirms that the program remains little known on the ground.

The amounts come from the Institute for the Relevance of Medical Acts (IPAM), which results from an agreement between Quebec and the FMSQ. The Press reported in October that the kitty was still lying dormant in state coffers. The MSSS was not able to provide us with an update on the amounts spent.

According to the D^r Vincent Oliva, “a very small portion of this 400 million was spent”. That said, this does not prevent establishments from disbursing sums themselves for catching up.

The FIQ, which is still in negotiations with Quebec, did not want to comment on the progress of the catch-up plan.