Operating room road trip: How rural Alberta hospitals are making space for urban doctors
Could small town surgeries help more Albertans avoid long wait times?
It was a Thursday morning in April and Dr. Richard Bochinski was starting the fourth of seven surgeries and 20 medical appointments scheduled that day in the small hospital of a central Alberta town.
The podiatrist was correcting a condition called hammer toe that can cause pain and difficulty walking. He sliced into a long bone in the foot then threaded a guidewire to direct the screw that would help straighten the bent joint.
At the end of the typically busy day, the doctor drove two hours from the hospital in Vermilion, Alta., to his home in Edmonton. The next morning, he'd embark on another hour-long commute to get to his weekly clinic hours in Camrose.
These prairie commutes, which take him past grazing bison and fertilizer plants, have become part of Bochinski's weekly routine.
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His clinic is in Edmonton but the surgeries he performs are in three rural hospitals located between 100 and 200 kilometres away. It's an arrangement he said is rooted in necessity — even if the travel schedule isn't exactly convenient.
Finding a space
After completing a medical residency at a busy Los Angeles hospital, Bochinski returned to his hometown of Edmonton in 1995 and opened a clinic for patients experiencing foot problems. But there was one problem: he couldn't find an operating room to perform surgeries, which severely limited the scope of what he could do.
"It was extremely challenging to find space in Edmonton at that time," he said.
It was 15 years before he found a solution.
His father, a urologist, was working as a visiting doctor in Vermilion, which is how Bochinski learned the hospital had a functioning operating room that wasn't being used full-time.
He realized there was a way to benefit his Edmonton patients while also providing new services for rural patients by doing his surgeries in Vermilion. Bochinski started with one day a month then expanded his surgical visits to two days every other week.
In time, he found more communities interested in this model of care. These days, he's on the road every week to work at three rural hospitals — Vermilion, Camrose as well as Wainwright, located near the Saskatchewan boundary.
And his patients — lured by the prospect of speedier surgeries — are travelling, too.
About 80 per cent of the patients he treats in the Vermilion operating room are from the Edmonton area; without them, his remote operations wouldn't be possible, Bochinski said. Vermilion has about 4,000 residents; the average podiatric surgeon needs a population base of about 10 times that size to make their practice viable.
And more doctors in Alberta have adapted their practices in similar ways.
In 2013, surgeons from Red Deer started offering cataract surgery in the nearby town of Innisfail, where the surgical facility had been shuttered since 2006.
Alberta Health Services (AHS) said it has plans to rotate more Red Deer surgeons in other specialties through the Innisfail Health Centre to help alleviate some pressures at the Red Deer Hospital.
According to the province's most recent Health Care Action Plan, the government is exploring more ways to capitalize on underused facilities to reduce growing surgical wait times. Many of these projects are in early stages of development.
Reducing wait times
The problem of long surgical wait times has grown in Alberta and throughout Canada. A report released March 23 from the Canadian Institute for Health Information found that patients in every province are waiting longer for knee replacements than they were before the pandemic.
According to the report, the benchmark wait time for the procedure is 26 weeks between booking it and having it done. In 2022, that benchmark was met only half the time across Canada and in Alberta, that number was 27 per cent.
In the province, far fewer people are meeting benchmark wait times for knee replacements than four years ago. In 2019, 70 per cent of people were waiting the recommended maximum of 182 days for knee replacement whereas in 2022, 38 per cent of people were seen within that time.
Avoiding a long wait was a big draw for Ed Donszelmann, who had knee replacement surgery in Camrose in March.
Donszelmann's doctor had put him on wait-lists with surgeons in both Edmonton and Camrose. After meetings with each surgeon, he was floored by the difference in wait times.
"It was about a year-and-a-half sooner. It was huge," he said.
For Donszelmann, the hour-long commute from his home in central Edmonton was worth it.
"The care was unbelievable. I emailed the knee and hip clinic afterwards and told them how positive my experience was and that if I ever need to go to a hospital, I want to go to Camrose."
And he will be returning soon. Donszelmann is scheduled to get his other knee replaced next month.
The doctor is in
Patients in rural communities also benefit from having access to specialists that they would ordinarily have to travel to see.
The Vermilion Health Centre has seven visiting surgeons including Bochinski, including some who even come from outside the province.
Even so, site manager Darlene McQuid said she was skeptical when she was first approached by Bochinski about bringing on a surgeon whose patients were primarily from outside the community.
She wanted to be certain of his long-term commitment. And the project had a price tag — the facility had to buy several $70,000 bone saws to accommodate the podiatric surgeon.
But it wasn't long before she was convinced.
"We felt this would be such a huge bonus for our community," McQuid said.
"We have a lot elderly patients and we have a lot of folks who really can't afford to drive all the way to the city or maybe they don't drive and need someone to take time off work to bring them and so wouldn't it be nice if they could just come and have their surgery here."
There are also business benefits, she added, with out-of-towners having lunch in the area or opting to stay overnight rather than drive home the same day.
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Neighbouring communities have also started to take notice.
Lorne Halisky, the reeve of Smoky Lake, met with AHS administration in February to discuss the possibility of reopening the town's surgical facilities, which closed more than 12 years ago.
He sees it as an opportunity for doctors in the Edmonton region who are willing to undertake the 100-kilometre drive, and a potential economic and health-care win by bringing their patients to his community for the day.
Halisky said many medical services that used to exist in rural areas have been moved to urban centres over the last two decades, but he thinks that could change.
"Our vision is if we could get more of that back into the rural areas, we could take the pressure off the bigger centres and hospitals where there's big lineups and delays," he said.
Unused operating rooms
There are a variety of factors that contribute to long wait-lists for major surgeries. Staffing shortages are a significant concern and the conditions of many rural facilities aren't up to scratch.
The UCP government has promised to spend $312 million next year on expanding surgeries in the province. But at a March 29 announcement on upgrading rural health-care facilities, Health Minister Jason Copping also acknowledged that staff shortages are part of the issue.
"We know it's not just about adding more money, and building or modernizing facilities," he said. "Improving rural health care also means investing in our workforce, so that doctors, allied health professionals and nurses, EMS workers and other health-care practitioners are available to Albertans right in their own community."
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As a result, many functioning operating rooms in Alberta are not meeting their operating usage targets or simply not running at all.
A representative from Alberta Health said there are 268 functional operating rooms out of the 299 available at AHS facilities. Some have closed while capital redevelopment continues through renovations and upgrades to meet new practice standards. Others have been repurposed.
A spokesperson from Covenant Health, which oversees 18 hospitals in Alberta, said all of its 25 ORs are in use, though they do have some temporary closures.
With about eight per cent of Alberta's available operating rooms not in use, some rural health centres have gone months or years without surgeries.
Staff shortages can be a big part of that, said Dr. Alika Lafontaine, an anesthesiologist in the northwestern Alberta city of Grande Prairie.
"The biggest issue with availability of OR time and access to surgeries really comes down to people," says Lafontaine, who is also president of the Canadian Medical Association. "It's not physical spaces or equipment."
The health centre in Lac La Biche, which serves a surrounding community of 10,000 people, has been without an anaesthetist since May 2022. It hasn't been able to provide C-sections or support high-risk deliveries since then, despite having an obstetrician with surgical capabilities on staff.
But Lafontaine said there is potential to alleviate some of those pressures by having some medical staff work at multiple sites.
"The people that aren't available are also different from site to site. Sometimes it's nurses, sometimes it's surgeons, sometimes it's anesthesia," said Lafontaine.
"The more that we can promote mobility between different sites and the better we can co-ordinate a tracking of which bottleneck we're actually trying to address, the more successful a strategy like this will be."
Lafontaine pointed to how surgeons in Grande Prairie have begun travelling to smaller hospitals as well. For example, an initiative in Hinton aims to reduce wait times.
Rural solutions?
People who live in small communities regularly deal with the challenge of travelling to the city for medical appointments and procedures, but Bochinski said the idea comes as a surprise to his Edmonton patients.
"They get these big wide eyes and say, 'You want me to drive that far?' "
But once they have their surgery in a smaller hospital, they appreciate a more personal approach than what they've experienced in the past at a major hospital, he said.
Several initiatives are based on the idea that more people could be willing to travel for medical care in order to avoid long wait times.
In an announcement earlier this month, the government promised to move more surgeries to rural communities by modernizing surgical facilities in places like Innisfail, where there is a plan being developed to bring more surgeons to the facility.
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Another initiative is a surgical referral program called FAST, created in 2022 by AHS, surgeons and primary care networks. It creates a central access and intake program for referrals to specialists in each medical zone — connecting more urban patients to rural surgeons in places like Drumheller or Wetaskiwin — with the goal of standardizing wait times.
In many ways, FAST will be a system that offers patients throughout Alberta the same opportunity that Bachinski has offered his patients in Edmonton.
"You don't want to drive two hours if you're just getting a 10-minute mole removal, and you also don't want to go out there if you're having brain surgery or cardiac surgery," he said.
"I believe that there is that that sweet spot of surgeries which fit really into the fit really nicely into this model of health care."
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