Ontario doctors want to build stand-alone surgical centres to help clear wait lists
The Ontario Medical Association is calling for the creation of new surgical centres in the province to alleviate pressures on the hospital system and to help clear the backlog of scheduled surgeries that surged during the pandemic.
The proposed stand-alone centres would provide same-day surgeries and procedures, including those for hip and knee surgeries, freeing up operating rooms for sicker patients and shortening wait times overall, the OMA says.
These integrated ambulatory centres" would merge into the publicly funded health-care system, partnering with local hospitals to provide OHIP-insured medical services, said Dr. Jim Wright, a pediatric orthopedic surgeon and the OMA's executive vice-president of economics, policy and research.
Such centres have been shown to offer more efficient surgical care for some outpatient procedures and can help reduce the burden on hospitals, Wright said.
They shift patients out of the acute-care institution, allowing them to focus on the most seriously ill; that's what hospitals are best at," he said.
The OMA's call to expand how the province delivers surgical care was one of three solutions proposed Thursday during a virtual panel on how to relieve strain on the health-care system.
The organization, which represents Ontario's 43,000 practising and retired doctors as well as medical students, is also asking the government to create additional ways for foreign-trained doctors to work in the province to ease the physician shortage, and for an increase in funding for hospice beds.
We are calling on these solutions to be moved on now," said OMA president Dr. Rose Zacharias, noting these are extremely vital areas" that need to be addressed. We have had gaps in the health-care system prior to the pandemic, but the strain ... is now obvious to all of us."
In February, the OMA released a report which advocated for integrated ambulatory centres and stated that the province was facing a backlog of about one million surgeries as of the end of 2021. That analysis was done before the government was forced to issue a directive - its third of the pandemic - to pause elective surgeries during the winter Omicron wave.
Wright said the OMA has had very positive conversations" with several branches of the government and with several ministries" about integrated ambulatory centres, which will require new legislation to proceed.
We believe it's time to bring together an expert advisory group to help the government in this implementation," he said, noting the first of these centres could optimistically" open in 12 to 18 months. However, the OMA's February report suggests it could take between five and eight years to open such centres.
According to data from Ontario Health, about 212,000 people are waiting for a scheduled surgery, up from 198,000 in January 2019. Health system leaders have stated that patients waiting beyond recommended clinical targets are being prioritized for scheduled surgeries.
The OMA recommends integrated ambulatory centres be multi-specialty and says that many less-complex surgeries and procedures could be performed at such facilities, including hernia repairs, hysterectomies and some nose and throat surgeries.
Wright said Ontario lags behind other provinces, including Saskatchewan and Alberta, in adopting these centres and pointed to data showing outpatient facilities can deliver surgeries 25 per cent more efficiently."
The (surgical wait) list is getting bigger and bigger every day, so if we can deliver a broader range of procedures safely, with better efficiency, outside of an acute-care institution, that's what we should be doing," he said, noting any Ontario plans for integrated ambulatory centres should have funding models that do not disadvantage acute care hospitals.
The provincial government's new health-care plan outlines how it will reduce surgical wait lists, including an increase in surgeries in existing private clinics covered by OHIP" and potentially increasing the number of OHIP-covered surgical procedures performed at independent health facilities."
Critics and policy experts are concerned these statements signal the expansion of for-profit private facilities in Ontario, and that creating new outpatient clinics will lead to more competition for health-care workers.
The OMA said because integrated ambulatory centres would either partner with or be controlled by local hospitals, they are a different kind of care model than independent health facilities.
Megan Ogilvie is a Toronto-based health reporter for the Star. Follow her on Twitter: @megan_ogilvie