Private operations | The Minister of Health on a wire

The young man arrived at the Montreal General Hospital on Friday in the middle of an appendicitis attack… and in full congestion in the operating room. All weekend, he remained on a stretcher in the emergency room, enduring his pain with morphine, while the surgeon on duty tried to sneak his case onto the list of “lucky ones” who would go under his knife.

We have reached this point, in Quebec.

While hospitals are struggling to carry out urgent operations, some 160,000 Quebecers are waiting for surgery, or 40% more than before the pandemic. Despite promises of catch-up, the list has practically not decreased, although the number of patients waiting for more than a year has halved, it should be noted.

If you’re waiting for a hip replacement or cataract surgery, good luck! The specialties with the longest list are orthopedics (38,652 people) and ophthalmology (34,453 people).

This is where specialty medical centers (SMCs) come into play.

Since the pandemic, these private centers financed by the State have made it possible to operate on 260,000 Quebecers, in particular to cure knees, hips, cataracts… All this costs nothing to patients, unlike entirely private clinics which charge thousands dollars to those who knock on their doors, overwhelmed by deadlines.

The population is open to this type of hybrid formula, as demonstrated by a recent Navigator Discover survey. Three-quarters of Canadians (73%) believe that the health care system needs major reform and believe (71%) that we should let the private sector provide care, as long as the state pays the bill. This feeling is even stronger in Quebec.

It is in this context that the Minister of Health, Christian Dubé, has just announced his intention to broaden the range of operations that can be entrusted to the CMS. From now on, they will also be able to perform gynecological, urological, otorhinolaryngological operations, etc.

Good for the patients. But be careful: this remedy could have side effects.

In the short term, CMS are an essential valve to reduce the unacceptable waiting list which cannot be overcome. But in the medium term, there is a risk that this parallel network will undress the public network.

The Minister of Health is therefore walking on a tightrope.

Currently, Christian Dubé is bending over backwards to wean the public network from private placement agencies, which had drained nurses by offering them more attractive salaries and hours. He would surely not want to recreate the same problem by entrusting more operations to the CMS, which has nicer hours and handles less heavy cases.

Before further deploying CMS, it is therefore crucial to provide safeguards.

First, there should be more transparency on the costs of operations carried out by the CMS. Does it cost more or less than the public? We have no idea. Prices are set by call for tenders. But in certain regions, the few bidders mean that there is no competition, which is worrying.

Second, we should ensure that CMS cannot siphon staff from the public network. Their contracts already prohibit them from recruiting workers (nurses, respiratory therapists, attendants, etc.) who were in the service of the health network during the previous 90 days. But this delay could be longer.

As for doctors who work in CMS from time to time, they are paid directly by the government, as when they worked at the hospital.

Here, it is important not to create positions for surgeons or anesthesiologists assigned to CMS, as this could create an exodus of the public where on-calls and complex cases make the task much heavier.

With the necessary safeguards, CMS can give the public a temporary reprieve to get back on track, while waiting to return to pre-pandemic levels (approximately 100,000 pending operations, 2,500 for over a year).

But until then, the public network has its issues to resolve.

An anesthetist might tell you that it took her four years – yes, four years! – just to standardize a form in order to optimize the protocol of recovery rooms in a hospital. All this because of the heaviness of the machine which multiplies the levels and committees.

Less bureaucracy and more flexibility would certainly improve the organization of work.

Currently, operating rooms are only operating at 70% of their capacity, either due to a lack of staff in the operating room or a lack of beds to care for patients after their operation. The worst thing is that 15% of these beds are occupied by patients who no longer need care, but who have no place in a CHSLD or elsewhere.

When the hospital is overflowing, it backs up into the operating rooms. This is why one in ten surgical operations is canceled in Quebec. This is why patients suffer on a stretcher, waiting for an urgent operation.