Surgical waiting lists have been growing since the start of the COVID-19 pandemic. Nearly 159,000 Quebecers have been waiting for an operation, 36% of them for more than six months. The recovery will be long and arduous. The staff is lacking. Medical specialists believe that more use should be made of specialized medical centers (CMS), private clinics that carry out interventions on behalf of the public network. Others speak of tough choices on the horizon.
“Does a patient of a certain age, for cancer X, really need to be operated? ask the Dr Jean-François Joncas, president of the Quebec Orthopedic Association. Can we do otherwise: chemotherapy, radiotherapy? Is it justified to operate on people who have reached the end of their life for heart surgery? Does the prognosis of life justify an intervention, while access to resources is currently extremely limited? We have arrived [à réfléchir à ça]. »
Oncological and cardiac operations are given priority. The Dr Joncas thinks that the “prioritization criteria” should be reviewed. “There are cancers that obviously require rapid treatment, in less than a month, he says. But there are cancers that could perhaps be delayed in terms of surgical management. Of course, based on scientific evidence. »
Orthopedics is the specialty that suffered the most from the load shedding during the pandemic. Hip osteoarthritis can, however, have “disastrous consequences” on patients, has been insisting for months on the Dr Joncas. “Some find themselves in wheelchairs or who can no longer live in their apartment because of the stairs,” he recalls.
The president of the Quebec Association of Surgery, Dr.r Mario Viens, believes that a “strictly medical” reflection must take place concerning the remediation and the prioritization of patients. He sits on a committee that is developing an electronic form to help clinicians determine “reasonable time” for any type of surgery. “It is extremely complex and long because there is no patient who is the same [à un autre] he says.
According to him, catching up must first go through a full resumption of surgical blocks as well as a contribution from specialized medical centers.
The Dr Luc Monette, president of the Association of otolaryngology and cervicofacial surgery of Quebec, abounds in this direction. The operating theaters must operate at 100% if we want to stop accumulating delays, he points out. They could open until 6 p.m. and even on Saturdays, depending on available manpower, he adds.
However, there are no illusions. The situation varies from one health institution to another. At the CHU de Québec, the operating theaters are operating at 85% of their capacity. “But in the Outaouais, we are really at the bare minimum in the operating rooms, notes the otolaryngologist, who practices at the Gatineau hospital. In Gatineau and Hull, [le niveau d’activité] is below 50%. Retired nurses are already lending a hand to the teams.
The Association hopes that its members will have access to specialized medical centers when contracts are renewed, which was not the case with previous agreements. Some 2,000 Quebecers, including children, are waiting for an operation, for example for sleep apnea, recurrent sinusitis or perforated eardrums. That number was less than 500 before the pandemic, says the Dr Monetta.
Clinics awaiting contracts
Some CMS say they want to improve their service offer to help catch up. But they regret that the Ministry of Health and Social Services (MSSS) has still not renewed their contracts, which will expire soon.
This is the case of Chirurgie DIX30, whose agreements with health establishments in Montérégie will end on June 8. “We arrive at 1er March and I still don’t know if I will have business or not on June 9, says its director general, Normand Laberge. I know the government needs us. He says so. But I don’t understand, between these words and the contracts, where is the gap? Why do we find ourselves in this situation? We don’t have an answer. »
Chirurgie DIX30 says it wants to build a clinic in eastern Montérégie to meet the needs in this sector. “But I won’t invest 12 million in construction without having a contract,” says Normand Laberge. I think it’s normal. We are in the total unknown of what will happen on June 9. »
RocklandMD Surgery and Opmedic are also awaiting news from the ministry. “There are no ongoing negotiations,” says Annick Mongeau, who notably represents these two clinics. We have made many follow-ups over the past few months. “A situation that she can hardly explain since “it will take years for us to catch up on the backlog in surgery”.
The MSSS recalled last week that it would invest $400 million in the resumption of operations and colonoscopies. This additional funding will be used to “increase the number” of interventions carried out daily, specifies Quebec.
The office of Health and Social Services Minister Christian Dubé says it wants to “continue [ses] partnerships with private clinics so that the resumption of [opérations chirurgicales] be done with the help of the private network”. “Without these contracts, we would do 62% of surgeries in Quebec, whereas we currently do 76%,” it says.
Before presenting his plan for catching up on operations, the minister wants caregivers to regain their strength, underlines his cabinet. No question of “adding additional pressure” on caregivers at the front for 22 months.