Quebec misses surgery waitlist target, backlog grows despite catch-up plan

The Quebec government has failed to meet its goal of reducing its surgery backlog despite the adoption of a catch-up plan by the Health Ministry almost a year ago. 

The number of patients waiting for surgery for more than a year in Quebec was 12,221 in February — far from the goal of 7,500 planned for March 31.

The government had set this interim target in May 2023, when it announced its catch-up plan. The end goal is to bring the waiting list for surgeries down to the pre-pandemic level of 2,500 by the end of 2024.

People waiting more than a year are prioritized under the current plan, but the total number of patients waiting for surgery in Quebec was 161,760 as of Feb. 24.

"That's a lot of patients waiting, and it hasn't gone down in a year," said Dr. Vincent Oliva, president of the Fédération des médecins spécialistes du Québec (FMSQ). 

"What we deplore is that the catch-up plan we agreed on in May 2023 has not been implemented." 

To reach the ultimate target by the end of this year, Quebec needs to "correct its course" and "send the right instructions to the field," said Oliva. 

Not enough staff, ORs available

Under the plan, the government intended to optimize the use of operating rooms already in service and reopen those that had been closed. 

The objective is to "enable doctors to complete their daily operating schedule by ensuring, in particular, the availability of the required manpower as well as bed capacity," said FMSQ spokesperson Pâris Psychogyios, in an email to Radio-Canada.

"Unfortunately, doctors are still coming up against the [Health Ministry's] inability to implement the conditions required to ensure that operating rooms are maintained or opened in sufficient numbers to follow the catch-up plan," Psychogyios added. 

Dr. Hai Nguyen, an orthopedic surgeon at Charles-Le Moyne hospital and Jean-Talon hospital, agrees.

"We don't have the staff to [operate] the wards and [follow] the programs that have been set up to reduce waiting lists," he said. 

"A surgical team is made up of an anesthetist, three nurses and attendants," he said, adding that it's not the physical space that's in short supply but the staff to keep the operating rooms running.

The FMSQ is concerned about the number of surgical procedures cancelled every day — one in 10 in Quebec health-care establishments. 

That's around 150 of the daily average of 1,200 surgeries that have to be cancelled when hospital staff realize that the operation could take longer than the end of the working day, which is around 4 p.m.

"We talk about waiting lists and caseloads, but these are patients. When a patient gets to 2 p.m. and is told, 'We won't do your surgery because we're afraid of overloading,' that's not acceptable," said Oliva. 

He said the ministry must send clear directives to hospitals so that administrations can organize themselves to ensure operations are not cancelled. 

According to a Health Ministry spokesperson, early cancellations, patients who are no longer available on the day of the operation, sick employees and staff shortages are all to blame for cancelled surgeries. 

Numbers don't show entire picture

Nguyen says the waitlist the government is offering is likely an underrepresentation of the real problem.

"There are a lot of ways these days [in which] the lists can be manipulated to make them look better than they are," he said. 

"You have to bear in mind that the practice of hiding patients who have been waiting for more than a year may intensify [as] we get closer to the elections and the time when it counts."

Nguyen gives the example of patients who have been waiting for over a year but who, for whatever reason, have been unavailable for a certain period. They are only counted again when they become available again.

While the FMSQ says data sharing by the Health Ministry is a step in the right direction, Oliva would like the number of cancelled surgeries per day to be indicated on the government's website to provide a precise portrait of surgical procedures in Quebec. 

In the meantime, Nguyen is concerned about the arrival of the new health agency, Santé Québec.

"[It's] a beast we don't yet know. What we do know, however, is that it's a centralized entity that's even further removed from the field than what we've known in the past," he said. 

"Any entity that's far from the field, that's in its offices, that makes strategies — is that really something that's going to be applicable in hospitals, with patients, in everyday life? We have our doubts." 

The FMSQ, for its part, is concerned not enough energy will be put into the organization of care and directives.