Doug Thomson
CEO, Canadian Orthopaedic Association

Canada decided 40 years ago that relative medical necessity rather than relative ability to pay should be the determining factor in accessing the health care system. This principle of access has been widely accepted and, indeed, is legislatively protected. But while the principle of accessibility has been protected in legislation, the notion of timely access has never been explicitly recognized. Many Canadians are today increasingly worried that “access” may be a hollow notion. Not surprisingly, the number one public policy issue for Canadians (and certainly for the orthopaedic profession) has become “timely access to care.”

At the Annual Meeting, the COA’s National Standards Committee (NSC) chaired a symposium attended by over 100 COA members, on access to care. The audience responses recorded during the symposium illustrate the challenges:

Workload

The amount of time I spend working is:

i. 33% - Just right
ii. 7% - Not enough, I want to spend more time at work
iii. 60% - Too much, I need a break!

Hiring Resources

In the case that a qualified orthopaedic surgeon was available to work in your hospital, would your hospital have the sufficient resources to hire this individual?

i. 8% - Yes, resources are sufficient without negative impact on existing surgeons
ii. 34% - Yes, but existing surgeons would need to give up resources
iii. 59% - No, there are insufficient resources

Waiting for Surgery

The main reason my patients wait too long for surgery is:

i. 0% - Lack of surgical assistants
ii. 27% - Lack of anesthesiologists
iii. 49% - Lack of beds (and the resources to serve them such as nurses)
iv. 8% - Implant restrictions
v. 27% - Lack of operating room nurses

Access to Orthopaedic Care

Choose the statement that best describes patient access to care in your region:

i. 0% - There is no problem
ii. 7% - Vast majority get timely care but there are problems with access for some services
iii. 35% - Most receive timely care but there are problems with access for many services
iv. 57% - Most do NOT receive timely care
v. 1% - Don’t know

Dr. Ted Rumble noted that the NSC’s 2003 manpower report illustrated that Canada is short more than 400 orthopaedic surgeons and that nothing we can do will correct a shortage of this magnitude much before the end of the first half of this century. In fact, the shortages will get worse before they improve.

Dr. Rumble suggests that one way to address this imbalance is to improve and maximize the efficiency of existing surgeons. One means to do this may be to employ physician extenders. “Physician extenders are going to descend upon medicine like a tidal wave,” explains Rumble, “everyone is talking about them in virtually every specialty, not just orthopaedics. The government has a bad track record of establishing physician extenders such as nurse practitioners for family doctors or midwives for obstetricians. We need to be sure that whatever model is going to affect orthopaedic surgeons, that we have impact into the design to ensure it will work to the benefit of surgeons and patients.” The NSC’s mandate in 2005 will be looking specifically at maximizing surgeon efficiency.

According to audience polling at the Annual Meeting, most surgeons would consider using an appropriately trained assistant for such tasks as prescreening referred patients, preoperative workups, assisting in the operating room, completing insurance forms and taking care of patients in the ward. The assumption here is that surgeons could bill for the services of an assistant.