Letting surgeons work

Issue: BCMJ, vol. 50, No. 10, December 2008, Page 547 Editorials

I read an article in the newspaper recently stating that the new president of the Canadian Medical Association, Dr Robert Ouellet, during his inaugural address, had called for an increased private sector role in delivering health care to Canadians. Specifically, he stated that surgeons working in public hospitals should also be allowed to perform operations in private clinics. His predecessor, Dr Brian Day, was often called Darth Vader for his stand on public medicine. I guess that makes Dr Ouellet the Evil Emperor as his initial speech was even more controversial. Dr Ouellet went on to outline how the private sector could intervene in a complementary way in areas where the public sector is unable to provide services. As usual his views were immediately denounced by various other groups as leading to the end of medicare. These stakeholders warned of decline of health care by bringing up the themes of commercialization, queue jumping, and pandering to the rich. Examples of other countries’ failed experiments with a blended system of private and public systems were then paraded out.

I don’t know which type of health care delivery system would best meet the needs of the population, or even if one system fits all of our diverse social and geographic groups. I can only speak of my own experience. It appears that the current gauge of health care quality used by industrialized nations is the length of surgical waiting lists. In my community, despite a rapid increase in the patient population, the number of surgeons and the amount of operating room time has increased only marginally. Numerous resources are used to train surgeons, whom we don’t allow to operate. Surgeons in my town get 1 day a week to operate—if they are lucky. Their day is lost if it falls on a holiday, and they don’t get any elective time during winter and summer breaks when the OR is cut back to an emergency level. These cutbacks are based on budget restraints and support staff availability, not on a lack of patients requiring surgery. On a daily basis surgeons can be bumped by emergency cases and are at the mercy of slow changeover times, mech­anical problems, and staff breaks. Their lives are also made miserable by waiting in line with their colleagues for after-hours add-on cases. No one seems bothered by doctors sitting unpaid in the OR lounge for 2 hours in the evening waiting their turn to perform an appendectomy, but if those same surgeons request more regular operating hours or new equipment they are often labeled as unreasonable.

The reason that waiting lists are so long is not that our surgeons are working at 100% capacity. So how can we say that allowing them to work in private clinics is such a bad thing? Queue jumping already occurs and has for years. I suspect that the number of patients who have gone south to get their procedures is significantly underestimated. It must be a nice change for those Canadian surgeons who operate in private clinics. Imagine being sought after, appreciated, and well paid for your expertise and time. I think the tendency would be to enjoy this treatment and say the hell with socialized medicine. Yet, the majority of our surgeons stay. They stay because they are hardworking and care about their patients and, dare I say, socialized medicine. So why not let them operate in private clinics? This would only become a problem if we had operating room hours in the public system that weren’t being used. As long as our surgeons are fulfilling their public duty, so to speak, why not allow them to use their skills to do what they were trained to do—operate?


David R. Richardson, MD. Letting surgeons work. BCMJ, Vol. 50, No. 10, December, 2008, Page(s) 547 - Editorials.

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