SMH surgery waits blamed on doc shortage

SURREY – A lack of anesthesiologists are what’s to blame for surgery wait times at Surrey Memorial Hospital, according to Fraser Health’s top surgeon.Dr. Peter Blair, program medical director of surgery for Fraser Health, said the health authority has been using data from the waiting list to work on a strategy to improve capacity at various sites throughout the Lower Mainland. But without more anesthesiologists, there will continue to be a backlog in the list."It doesn’t matter how many operating rooms you have," he said. "If you don’t have enough anesthesiologists then that interferes with your capacity to do surgery."Dr. Roland Orfaly, CEO of the BC Anesthesiologists’ Society, said there’s been a known shortage in the province for about a decade now, with an estimated 400 full-time anesthesiologists for the entire province. Compounding matters, roughly half of those doctors are expected to retire in the next 10 years.Orfaly is a clinical assistant professor at UBC, currently the only school in the province that has an anesthesiologist program. He said that to be trained as an anesthesiologist, high school graduates need to complete a four-year undergraduate degree, then four years of medical school, then five years of post-graduate residency training. These 13 years of post-secondary study and training are equivalent to what is required to become a surgeon. Many anesthesiologists also complete additional years of training to sub-specialize in intensive care, pediatric anesthesiology or complex pain management.Although the school produces a dozen graduates each year, Orfaly said they can’t replace the 25 doctors retiring simultaneously."It takes a lot of years to train someone to be an anesthesiologist so if we’re looking for short and medium term solutions it’s not going to come through training two or three times as many," he said.Traditionally, B.C. has always looked to other provinces to shore up the supply of anesthesiologists but as the average age of those doctors tips above 50, Orfaly warned of an impending crisis.However, he said there may be a solution to the problem that won’t require simply hiring more doctors."This is where we feel that it’s an opportunity by working together with the government to recruit the right number of people and also the right type of anesthesiologists so that we can make the system more efficient," said Orfaly. "That benefits the patients, it also benefits the taxpayer."His idea for Surrey Memorial is to create a dedicated obstetrical anesthesiologist program. Currently, there are on-call anesthesiologists who have to "run back and forth" between the operating room and the maternity unit, which Orfaly said puts those services in competition with one other."When one of those anesthesiologists is in the maternity unit the OR is left waiting," he said, adding that’s why it’s not a simply a matter of increasing the number of doctors, but finding a better way to handle patient care.Although each hospital operates independently, Fraser Health has integrated the departmental needs for surgeriesthroughout all of its hospitals with a goal of improving efficiency."We’ve been building up infrastructure to collect data on surgical activities, case volumes, wait lists and all that sort of stuff," said Blair.He said that strategy has helped to reduce the number of surgeries on the wait list exceeding one year down to four per cent from 10 per cent in 2013.Currently, there are 10 operating rooms at Surrey Memorial Hospital performing an average of 850 surgeries a month, with an additional four operating rooms at Jim Pattison Outpatient Care and Surgery Centre.Blair said the number of surgeries that are performed each month depends largely on how many patients each surgeon chooses to add to their workload."We have no control over that," he said. "The surgeon makes the decision regarding surgery."Some surgeons with children may see fewer patients because he or she doesn’t want to put in the 60-or 80-hour work weeks of their colleagues, explained Blair.Once surgeries are booked with a surgeon, the practice will send a booking package to the operating room at Surrey Memorial and then administrators begin to put together a surgical slate. Operating rooms are then assigned time to surgeons based on wait list prioritization.According to a document obtained by the Canadian Taxpayers Federation in November, Surrey Memorial had 226 bookings in which patients had waited more than one year to undergo surgery. In a Nov. 4 memo to surgeons across the Fraser Health region, Blair noted the Ministry of Health has a funding structure known as Pay for Performance which penalizes hospitals for surgical bookings that remain on a wait list for more than 52 weeks.As of Oct. 9, Surrey Memorial had 3,415 surgeries booked that are below 26 weeks in wait time, 1,044 that are between 26 and 52 weeks, and 226 that exceed 52 weeks, creating a potential funding shortfall of $781,