Quebec catch-up surgery: “I can’t operate because there’s a shortage of nurses”

“I can’t operate because there’s a shortage of nurses,” a surgeon who has worked on Montreal’s South Shore for ten years told a conference of the Council for the Protection of Patients on Thursday. Several physicians expressed deep concern about the staff shortage, which makes it almost insurmountable to catch up on the backlog of surgeries.

The surgeon testified following a presentation by Dr. Serge Legault, Vice-President of the Fédération des médecins spécialistes du Québec (FMSQ). He identified three main bottlenecks: difficulty accessing primary care, delays in seeing a specialist through the Service Request Distribution Centre (CRDS), and access to the operating room.

“Currently in Quebec, performance is variable. It’s about 85 per cent of the surgical activity we had before the pandemic.”

“85 per cent of what there was before,” he repeated, a little discouraged. “And we’re being asked to make up for lost time.”

“We’re doing our best. The waiting lists have improved a little, but we’ve stretched the elastic very thin. What that means is that the people who are there are exhausted,” said Dr. Legault.

He stated that at the Cité-de-la-Santé Hospital in Laval, an operating room was recently closed because three anesthesiologists were absent due to illness and two others went on maternity leave. Even though staffing was reduced, the operating room was operating at maximum capacity, said Dr. Legault.

“What that means is that nurses are falling behind because they’re asked to come back the day after their shift. We’re always asking more of them,” he said.

“The bottleneck that worries me, and I’ve seen this for ten years, is the staff shortage,” commented the general surgeon on the South Shore. “How many surgical priorities do I have this week? I have zero. I can’t operate because there’s a shortage of nurses. Our operating room is operating at 70 per cent capacity.”

“We’re heading for a brick wall. In ten years, I don’t know who will assist me, and I need a team to operate. […] I’m very worried about the situation in Quebec,” he shared.

Dr. Legault also expressed his deep concern about the staff shortage.

He indicated that many nurses, respiratory therapists, and perfusionists are turning to the private sector or changing provinces due to unattractive working conditions. “There’s no attractiveness in Quebec.” “People go either to the northern United States or to Ontario to practice because the difference is often 1:2 in salary scale,” mentioned Dr. Legault, who has also been a surgeon for over 30 years.

One of the solutions he put forward is to adopt a zero-cancellation policy. Currently, the last patient of the day is often canceled if the operating room has to close. “You’re scheduled, we’ll do what we can to get you operated on. If the operating room closes at 4:00 a.m., you’ll still be operated on. We’ll find something. It’s too easy to cancel the last patient,” argued the FMSQ Vice-President.

IT glitches in healthcare

The Service Request Distribution Centre (CRDS) allows family physicians to refer patients who need an initial consultation to a specialist in one of the 26 participating specialties.

Not only is the CRDS also struggling with a labor shortage, but paper and faxes account for 15 to 20 per cent of forms.

“If it were just human resources, with the rise of artificial intelligence and information technology over the past several years, we could say it would help, but right now, it’s a provincial mess, and information technology, and health, is no exception,” says Dr. Legault.

Furthermore, the CRDS’s electronic forms do not allow for exchanges between the specialist and the general practitioner, for example, regarding a missing consultation report. It is also impossible to know the delay the patient experienced before the appointment, said Dr. Legault.

Furthermore, he points out that many hospitals do not confirm patient appointments. However, he says that more and more are doing so.

“If we confirmed the patients, if the patient wanted to say that they didn’t need the appointment after all, they would have the opportunity to say so, and we would have the opportunity to replace them,” he explains.

The Patient-Physician Relationship

Santé Québec is working to reorganize operating times with the aim of reducing the surgical waiting list, giving priority to patients who have been waiting for more than a year.

To improve waiting lists for patients with overdue wait times, Alexis Guilbert-Couture, director of specialized physical health services at Santé Québec, explained in an interview with The Canadian Press last month that more operating time should be allocated to specialties with the longest wait times. In other words, the group of doctors with the most overdue patients should have more operating time. This way, one doctor could take another doctor’s patient and operate on them more quickly.

Dr. Legault criticized this approach. According to him, it amounts to “treating caregivers as pawns that can be moved around without recognizing their uniqueness.” He argued that the relationship between a patient and their doctor is unique.

“To say: here are ten patients who need hernia surgery, we’ll take five surgeons who don’t have a waiting list and have them operated on by those five. It’s a good idea on paper, but it completely ignores the specificity and importance of the therapeutic bond that is created between a doctor and their patient,” Dr. Legault said.

He adds that if both the doctor and the patient agree to this procedure to speed things up, there’s no problem. However, he reiterates that the relationship with the doctor is certainly important for the patient.

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Health content from The Canadian Press is funded through a partnership with the Canadian Medical Association. Editorial choices are the sole responsibility of The Canadian Press.

–This report by La Presse Canadienne was translated by CityNews