As Quebec postpones surgeries, breast enhancements and butt lifts still a go

As Quebec's beleaguered public health-care system struggles with a shortage of nurses and respiratory therapists, non-essential plastic surgeries are continuing in the private sector, with clinics hiring these categories of health professionals for their operations.

Anesthesiologists are also being called in for procedures that require sedation.

"Breast augmentation, Brazilian [butt lift], which is liposuction and fat transfer to their buttocks" are still being done, said a doctor familiar with these surgeries. The doctor also said the industry's operating rooms have been going "full force" despite COVID-19.

CBC News has granted them confidentiality because they fear professional repercussions if identified.

This week, the province warned that staffing shortages have pushed the public system to the brink, with thousands of health-care workers out of commission because of COVID-19. "Each extra nurse who can come and help us right now would be welcome," said Christian Dubé, Quebec's health minister.

The doctor said that "90, 95 per cent" of the nurses and respiratory therapists doing the private cosmetic procedures also work in the public health system. They say staff are drawn to plastic surgery in private clinics because the pay is much better. 

And while many are uncomfortable that these kinds of non-essential surgeries are taking place while the public health system is cracking under a staffing shortage, for most, the work is just too lucrative to pass up, the doctor said.

"Nobody wants to do the right thing," they said. "It's money, money and money."

Procedures require nurses, respiratory therapists and anesthesiologists

In order to carry out the cosmetic procedures such as facelifts, liposuctions, and rhinoplasties, plastic surgeons use private operating rooms and hire nurses to assist them, often from private placement agencies.

When patients are required to go under, respiratory therapists and anesthesiologists are also called in to help.

CBC doesn't have data on how many of these operations are currently happening, but in an email, a spokesperson for the province's Health Ministry said the government hasn't issued any special instructions for private clinics during the pandemic, and they are free to carry out their usual surgical procedures.

Anesthesiologists and respiratory therapists are key health personnel involved with intubating COVID-19 patients in intensive care.

"I'm not sure if the government decides to close all the clinics it will be the big solution," said Josée Prud'Homme, director general of the Ordre professionnel des inhalothérapeutes du Québec, which regulates some 4,450 respiratory technicians in Quebec. 

Prud'Homme said not all of her members would be able to immediately make the jump from private clinics to hospitals, saying it's not the same set of skills to work in an ICU.

Still, she welcomes a discussion with government and other medical regulatory bodies about how resources can best be used in a crisis.

Denyse Joseph, vice-president of the FIQ nurses' union, said while some plastic surgery, like hand reconstruction, is important, procedures like facelifts shouldn't be taking medical personnel away from the public sector in a time of need.

"Doing these surgeries takes these people away from the network," she said.

'We really need everyone'

According to the province's Health Ministry, nearly 8,000 health-care workers are currently absent because of COVID-19 — either because they are infected or in isolation because of exposure.

Dr. Karyne Pelletier, a nephrologist and a board member with Médecins québécois pour le régime public (MQRP), acknowledged that she doesn't know exactly how many health-care workers are helping with medically non-essential duties in private facilities, but she said the public system could use all the help it can get. 

"Even one staff [member] that is not available for the public system is too much, actually, because we really need everyone," Pelletier said, noting that there is a particular need for respiratory therapists to help with COVID-19 patients. 

"The thing with respiratory therapists is that they are highly needed in intensive care units and, actually, the main difficulties that we see in hospitals is the intensive care units that are overwhelmed at the moment."

Cosmetic surgeries keeping private clinics afloat, association says

According to the province's association of specialists in plastic and cosmetic surgery, procedures in private clinics have slowed down during the pandemic, but they don't have data to show by how much. They said they too are struggling to recruit staff.

A spokesperson for Dr. Éric Bensimon, the association's president, told CBC News in a statement that cosmetic surgeries have helped to keep many clinics operational, and the private sector has made efforts to reduce the burden the pandemic is placing on the public sector.

Private clinics are also performing medically necessary procedures, which "alleviates pressure on the [public] network," Mari-Claude Hotte said, before adding that there hasn't been an increase in the number of personnel transferring from public to private since the start of the pandemic.

Hotte also pointed out that nurses working in private facilities account for less than one per cent of the 76,000 nurses who are part of the provincial order.

When asked about the issue in a news conference on Thursday, Dubé said he's not ruling out calling in private health workers for reinforcements.

"If we need to do additional things every option is open at this stage," the health minister said. "At this stage we're trying to keep the right balance."

Is a facelift an essential service?

But the doctor who spoke to CBC said the issue is about more than a potential drain on key medical personnel. It's about showing solidarity in a pandemic.

They question why procedures like tummy tucks and facelifts are being allowed to continue, while so many other non-essential businesses, like restaurants, have been forced to close.

They hope the government will shut down non-essential cosmetic surgeries until mass vaccinations get the disease under control.

"You just have to do the right thing," they said.