The Quebec Orthopedic Association is asking the College of Physicians of Quebec to review its position regarding retired physicians who perform surgical assistance. The College requires them to complete 250 hours of continuing education activities every five years, even if their practice is limited to removing tissue or manipulating a limb during an operation. Orthopedists deplore that this obligation leads to the departure of “precious” assistants, in full resumption of surgical procedures.
The Sherbrooke University Hospital Center (CHUS) lost a “golden assistant” in April, laments the DD Annie Deshaies, head of orthopedics at the CIUSSS de l’Estrie. The Dr Jean-Luc Bergeron, a retired plastic surgeon, gave up his license to practice after the College of Physicians told him he had to complete 250 hours of continuing education activities over a five-year period if he wanted to continue to provide operative assistance. All active members of the College are required to abide by these regulations.
“This man was doing us great service, underlines the DD Deshaies, who practices at the CHUS. If we had a problem, we called him at the last minute and he was available. »
The Dr Bergeron was happy to be able to prevent an operation from being cancelled. “It was a bit of my social contribution, says the 62-year-old doctor, who has been providing surgical assistance at the CHUS since 2018. I had made a promise to my orthopedic colleagues that I would help them for two or three more years. . »
The decision of the College of Physicians changed his plans. The Dr Bergeron refuses to devote 250 hours of his retirement to continuing medical education activities for a task, he judges, that does not require it. His license to practice, granted by the College, restricted him to surgical assistance. He couldn’t prescribe medication, for example. “I was just having the surgeons help by pushing tissue apart or manipulating limbs,” he says. It was disarmingly simple. »
The Dr Bergeron estimates that the training activities would have cost him more than the income derived from this practice. He worked about 100 hours at the CHUS last year. “I billed $20,000 to the RAMQ [Régie de l’assurance maladie du Québec]. It costs me about $5,000 or $6,000 to keep my licenses,” he says.
The former owner of a cosmetic surgery clinic, who says he has been “financially independent for a long time”, points out that the College’s decision “harms the patient and the health care system more” than himself. “If I don’t do that, I’m going to drive old gentlemen to their chemotherapy appointments and I’m going to be just as happy,” he said. He will also be able to enjoy his retirement more. When The duty joined him, he was on a sailboat off the Côte d’Azur and was beginning a three-month journey.
Puzzles in hospitals
The Quebec Orthopedic Association (AOQ) maintains that “a few” retired physicians have already abandoned operative assistance because of this College requirement. She fears that others will do the same. According to the president of the AOQ, the Dr Jean-François Joncas, these resources are precious in the context of labor shortages and catch-up operations.
The orthopedist explains that one nurse is needed for “simple” procedures, but two are needed for more complex operations, such as a hip or knee replacement. One of them is in charge of the instrumentation, the other of the assistance to the surgeon. When there is a shortage of staff, retired doctors come in to help.
According to a recent survey conducted by the AOQ, nearly 17% of orthopedic department heads call on them for surgical assistance. “I find it hard to understand why the College says on the one hand that it does everything to help patients obtain care, that it collaborates, and on the other hand, that it gives them a little few spokes in the wheels [dans ce dossier] “says the D.r Joncas.
“How can the College require that a retired doctor, who goes to the operating room to hold retractors or help the surgeon, have continuing education in the same way as someone who is in active practice? he adds.
The AOQ believes that the College of Physicians should reduce the obligation of continuing education for this category of members. Orthopedist Marie-Lou Rodrigue-Vinet is also convinced. At the Shawinigan hospital, where she works, 80 to 90% of cases require operative assistance, she reports. “Before, things were going well, we had assistance from the nurses,” said the assistant head of orthopedics. But for two years, with the shortage of personnel aggravated by COVID, we had to assist each other [orthopédistes]. »
For the moment, his team can count on two family doctors who provide surgical assistance. But these are at the end of their careers, she says. The requirement of the College could be a hindrance to the continuation of their practice once they are retired, she thinks. She would like a boost from college. “The CIUSSS is working hard to increase staff and provide us with assistance,” she says. But we believe that the more solutions we have, the better. »
Asked about retired doctors doing surgical assistance, the College of Physicians of Quebec responds that the “Regulation respecting the compulsory continuing education of doctors” applies to “all doctors who perform medical activities”. “We consider this maintenance of skills essential for any doctor carrying out professional activities. […] including in the context of operative assistance, ”we wrote in an email.
The College adds that the regulation has been in force since 1er January 2019, but that “the first sanctions for doctors in default for the years 2019 and 2020 were applied only this year”. “Numerous communications were sent to members in default, informing them of their situation with regard to their continuing education obligations and the next steps in the study of their file,” it says. According to the College, “more than 99% of doctors have complied with the training requirements, including doctors practicing only in surgical assistance”.