Médecins québécois pour le régime public (MQRP) has taken note of recent reports on the delays in obtaining permits for certain specialized medical centers (CMS) in orthopedics and plastic surgery.
Currently and in the very short term, CMS can temporarily help reduce certain surgical waiting lists linked to the backlog accumulated during the pandemic. It’s a harm reduction approach. However, in the same way as private employment agencies, it is the very existence of CMS in the medium and long term that must be called into question.
The various recent governments have encouraged the development of CMS, these private structures which subcontract the care of patients from the public network. These companies are therefore largely subsidized in their lucrative mission: the contracts established with the government provide their owners with a profit margin from the outset, paid from public funds. Profit margins of up to 15% have been signed with different CMS since the pandemic1.
It is unthinkable that patients have to wait more than a year or two for a medically necessary operation in the public system. But the solution cannot go through the establishment of a private system parallel to the public network.
Operating a patient in CMS involves patient selection; those with too many health problems and presenting too many risks of postoperative complications are left to the public system. Also, operating in CMS certainly involves surgeons, but also anesthesiologists, nurses and orderlies. The vast majority of these people already work in the public network; recruiting them into CMS further weakens this same public network.
CMS are therefore a false solution. Well beyond new operating theatres, it’s staff to operate the existing ones that we need. Already in 2017-2018, only 30% of Quebec hospitals had reached the operating room utilization target of 85%2. Recent examples demonstrate this same trend; state-of-the-art operating rooms, but not used due to lack of staff3.
It is therefore important to greatly increase the resources and working conditions of the personnel already working in the operating theaters of our public establishments in order to increase operating capacity in a sustainable manner.
We have the tools to make our public network efficient, in particular by restoring workplaces on a human scale as well as interesting, flexible and respectful working conditions for staff and patients. It is by strengthening our public health system that we will succeed in improving access to care, for all, within acceptable time frames. Not by privatizing it.