Cardiac surgery in crisis at Hamilton Health Sciences over shortage of key staff

Cardiac surgery is in crisis" in Hamilton because of an exodus of key members of the team.

Hamilton Health Sciences (HHS) has funding to do nearly 200 more cardiac surgeries a year but can't get to them because so many of the medical professionals who operate heart-lung machines have left.

In fact, HHS is so short of perfusionists that staff from out-of-town hospitals come and work there on their holidays.

The union that represents the profession says a $30,000 signing bonus hasn't been enough to attract more of the scarce specialty to Hamilton. The Ontario Public Service Employees Union (OPSEU) says perfusionists at Hamilton General Hospital have worked more than 20 days straight at times to keep cardiac surgery running.

It has resulted in the hospital network no longer offering a last-ditch treatment for the sickest heart and lung patients that became crucial during the COVID pandemic.

It certainly, about a month ago, really hit a crisis point where physicians and HHS recognized that we're in trouble and began really working closely with provincial leadership to ensure we maintain service," said Hamilton cardiac surgeon Dr. Richard Whitlock. We are meeting at least once a day to review our cases, our wait lists, things that we can do to mitigate this crisis."

Before the pandemic, HHS had 17 perfusionists. That number dwindled to 12 by August. Now, HHS is down to four full-time perfusionists. A hospital leader says there are four more who are supposed to be part-time but work full-time hours. OPSEU says only three part-time perfusionists are currently working and a fourth has been recruited but hasn't arrived in Hamilton yet.

They're working seven days a week ... and no end in sight," said Sara Labelle, chair of the hospital professionals division at OPSEU. They're doing it because you have to ... You can't delay patient care - it's life-saving procedures and treatment."

The only relief has come from visiting perfusionists who work at other Canadian hospitals but come to help out Hamilton during their time off. Labelle says it's an expensive fix as HHS pays them roughly $121 an hour and covers all of their travel and hotel expenses. The aim is to have two a week.

Everybody's doing everything they possibly can to not impact patient care," said Labelle. You have people who are working who are exhausted and running on empty and the potential to make a critical error goes up the longer you work and you don't have a break. People need time to relax. There's a reason why we take days off. It's so that you recharge your battery and you are working at your best."

The shortage is already having an effect on patient care. HHS is funded for 1,500 cardiac surgeries a year but can't do 13 per cent of them because there aren't enough perfusionists or nurses in the intensive care unit (ICU).

Performing 195 fewer surgeries annually has increased wait lists. So far, no patients have had to be transferred out of Hamilton for cardiac procedures but surgical leaders at nearby hospitals have been made aware of the crisis in case urgent cases need to be sent to Toronto, London or other parts of Ontario.

Our wait times have slightly increased," said Whitlock. We're still within the safe zone for patients ... and we have plans in place if we think anybody is in danger. Other centres are there to help us out should the need arise."

The hospital network had to halt treatment used for the sickest patients called extracorporeal membrane oxygenation (ECMO) that takes over the job of delivering oxygen to the body when the heart and lungs are incapable. Hamilton General Hospital started doing the treatment one month before the pandemic hit in March 2020. It is one of only four hospitals in Ontario to provide the last-chance treatment that has been critical during COVID.

Our team did an exceptional job to launch ECMO in the midst of the pandemic," said Leslie Gauthier, vice-president of surgery at HHS. Our physicians are provincial leaders in ECMO and we are very committed to getting it back to where it was prior to the perfusionist shortage."

For now, HHS will look to send any ECMO patients to the other centres - ideally before the treatment begins. If the situation is urgent, ECMO will be started at Hamilton General and the patient will be transferred once they are stable enough.

Essentially we will take care of anybody that arrives on our doorstep that needs ECMO immediately to save their life," said Gauthier. Then we will work with the province for where's the most appropriate bed for that patient to be in for the long term."

The heavy load that ECMO puts on perfusionists is one of the reasons for so many leaving, said both Gauthier and Whitlock. ECMO patients are the sickest in the hospital and need to be cared for by a perfusionist 24-7.

The stress involved in that really deteriorated and diminished the work-life balance for the perfusionist group," said Whitlock. They see other opportunities in programs without ECMO, with different staffing models and higher pay, and they started migrating away."

A massive wage discrepancy has been raised as another key factor when the shortage first came to light in August. At the time, Labelle said Hamilton perfusionists were being lured to Toronto hospitals paying between $10 and $17 more an hour while also promising less overtime and fewer weekend shifts.

She predicted in August that it was just the start of what was to come as Ontario hospitals competed with each other for what was becoming an increasingly scarce health human resource.

Ultimately, when you're going to be overworked, you're going to go where there's more money," said Labelle. It really does come down to money."

The situation in Hamilton has deteriorated considerably since the summer despite the divide in pay narrowing between the hospitals and an improvement in working conditions. Labelle says that to compete, HHS has used bonuses to get its top hourly wage up to $84 an hour from $58. The hospital network also started giving the perfusionists two days off after they worked seven in a row.

The solution to this is that we have to pay the same wage across the board for all hospitals," said Labelle. And it has to be competitive."

However, wages aren't the only divide. Hospitals have also been giving out incentives to compete, including HHS offering a $30,000 signing bonus, said Labelle.

We're a publicly funded system so having competition between centres is not the greatest situation," said Whitlock.

Hamilton General was particularly vulnerable to losing perfusionists to lucrative offers, he said.

The resource became scarce and some centres reacted quicker and started offering incentives and all sorts," said Whitlock. Our group was a young group of perfusionists that weren't tied down to Hamilton strongly so they were easily transportable and that's what we saw."

Labelle said the province desperately needs to find ways to attract new perfusionists to Ontario and stop the poaching between hospitals.

We need to recruit people from outside the existing hospitals rather than poaching because this is never going to solve the problem," said Labelle. We're just going to go back and forth and juggle the same exhausted workforce around if we don't come up with a solution for recruitment of new staff into the system."

Labelle also called for the province to open up more training spots for perfusionists as it did for medical schools in the budget tabled on March 23.

Canada only has three schools that offer the specialty - the Michener Institute for Applied Health Sciences in Toronto, the University of Montreal and the British Columbia Institute of Technology. To be accepted for the training, students must have a bachelor of science degree or higher, or be a practicing registered nurse or respiratory therapist.

Right now, there's insufficient numbers coming out," said Whitlock. There was only 12 last year. All programs are feeling it, but HHS particularly."

Gauthier said HHS is in talks with the Michener Institute about sponsoring some of its own staff for training. However, those that start this fall wouldn't be ready to practice until spring 2025.

There is not a lot of perfusionists available on the market in Canada and internationally there's challenges," said Gauthier. I really want to encourage people to consider working in the perfusion field."

Gauthier estimates it will be at least a year before HHS is able to turn the drastic shortage of perfusionists around.

Labelle agrees there is no quick fix and worries whether the current workforce can hold out that long.

We don't want anybody leaving the field because they're overworked and exhausted," said Labelle. We can't afford to lose anybody."

Whitlock said adding to the precarious situation in cardiac surgery is a shortage of ICU nurses.

The pandemic was very damaging on many levels to human resources and the fallout from it has been tremendous," he said. We are in a crisis mode for perfusion ... but when that's solved, we still need more ICU nurses."

Cardiac surgery is on such a knife's edge that Whitlock says even a couple of staff off sick could leave HHS unable to care for urgent patients.

I went into medicine to take care of patients," said Whitlock. Having the stressor of worrying that if two perfusionists go off sick, suddenly I'm having to cancel someone where I'm concerned about the urgency - we've certainly been feeling that"

Joanna Frketich is a health reporter at The Spectator. jfrketich@thespec.com