Will private clinics drain Hamilton’s already short-staffed hospitals?

Hamilton hospital leaders aren't convinced that a plan to expand private surgery clinics in Ontario won't drain scarce staff.

I think there's always a concern of how do you keep your staff with you," said Dr. Anthony Adili, chief of surgery at St. Joseph's Healthcare. This is a new development, so this may have an impact. I just don't know what that impact will be."

The Conservative provincial government has said private clinics will have to submit plans to show they are not taking staff away from hospitals.

The community surgical and diagnostic centres will be expanded to help tackle pandemic backlogs in cataract and other ophthalmic surgeries, MRI and CT scans, minimally invasive gynecological procedures and some plastic surgeries, before eventually being expanded to other operations such as joint replacements.

We don't really know the impact at the moment," said Dr. Stephen Kelly, surgeon-in-chief at Hamilton Health Sciences (HHS). I think certainly I haven't seen enough detail as yet to fully be able to answer that question about how it's going to affect all aspects of the surgical care we provide."

Shortages of operating room staff have been particularly acute at HHS, which has struggled for years to recruit and retain the highly specialized workforce.

The hospital network created a controversial new position in 2021 called an operating room assistant because it was short at least five surgical nurses at any one time. The new unregulated role - open to a number of different health-care workers - requires 15 weeks of training compared to the four to six months that it takes for nurses to learn the regulated specialty. The assistant job doesn't take on all of the tasks of an operating room nurse. Instead, it's limited to managing the instruments on the sterile field.

In addition, HHS has offered a $30,000 signing bonus to surgical nurses in the past and has had to temporarily close services at Grimsby's West Lincoln Memorial Hospital at times due to shortages of operating room staff.

There's just not enough nurses," said Angela Preocanin, vice-president of the Ontario Nurses' Association. Hamilton Health Sciences has struggled. Over the years, they've tried everything - signing bonuses, moving bonuses and anything to entice people to come and they weren't successful."

Ontario hospitals already compete with each other for scarce surgical staff. In 2022, HHS lost more than one-quarter of its perfusionists - crucial medical professionals that operate heart-lung machines during cardiac surgery.

The Ontario Public Service Employees Union said in August that the five perfusionists were mostly lured to Toronto hospitals that paid significantly more, while promising less overtime and fewer weekend shifts.

It raises questions about where the staff will come from to expand the private clinics.

I don't trust that they are telling us the truth about not poaching," Preocanin said about the government's reassurances that the expansion won't lure staff away from hospitals.

Without a doubt, solutions are needed for pandemic backlogs that have left Hamilton's hospitals with a waiting list of nearly 15,000 surgeries as of March 2022. At least 50 per cent have been waiting longer than what is considered optimal compared to 13 per cent before the pandemic.

McMaster Children's Hospital alone had a backlog of 2,332 surgeries as of this month, with about 60 per cent of kids failing to get their surgery within the optimal window recommended to ensure there are no lifelong consequences for development.

St. Joseph's has tried to tackle the wait list by running its operating rooms at 120 per cent compared to before the pandemic. The hospital network has done this by scheduling surgeries at times like weekends that used to be used only for emergencies.

It also got funding from the province to open four additional operating rooms that had been sitting dormant. The extra rooms are used by surgeons from St. Joseph's, HHS and Niagara Health.

The staffing in hospital has been stretched to the absolute maximum," said Adili.

St. Joseph's has had fewer surgical staff shortages partly because it launched an education internship in 2018 that has helped 35 nurses obtain their operating room certification.

HHS has had some success easing its shortfall by hiring internationally trained operating room nurses.

In addition, the hospital network recently recruited seven anesthetists who will start in July. Kelly said part of the reason HHS was able to attract the doctors was because it has also hired 10 anesthetist assistants.

But the hospitals still have surgical vacancies they struggle to fill.

We're always looking to recruit and train new staff," said Kelly. That's an ongoing issue."

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