Orthopedic wait times need resources, not money, says surgeon
Number of beds, joints, operating room time add to wait list problems
For the 38 or so full-time orthopedic surgeons in Nova Scotia, including just 24 who do hips and knees, it's daunting to know that thousands of people are waiting for their attention.
The most frustrating part is that the surgeons don't need a single new hire or buckets of cash to make a significant dent in the list, says one Valley surgeon. The problem is buying things in exactly the right balance.
"We could easily do 50 per cent more joints than we're doing with the numbers that we have if we were given the resources," said Dr. Eric Howatt.
"That was told to the [Conservatives] two governments ago, it was told to the last government," he said. "And we're telling the present government."
'I call it my crying clinic'
Howatt's patients wait about four to six months to meet with him, then another two years for surgery. Those numbers are typical across the province, he said.
"Right now I'm sitting in the clinic," he said last week. "I call it my crying clinic, because when I see these people and I tell them, 'OK, you're going to wait two years for your joint,' the next thing I have to do is hand them a Kleenex, right?"
In his last report, Auditor General Michael Pickup found the wait for orthopedic surgery in Nova Scotia is among the longest in the country, far exceeding the national benchmark of a six-month wait for hip and knee surgery. He said it would take $35 million to meet that goal.
The problem won't be completely solved without funding, said Howatt. But it's not that simple, either.
In each part of the province, there are one or two things in short supply that slow down the whole process, he said. For example, some district health authorities simply run out of prosthetic hip and knee joints.
"Other hospitals are limited by the number of beds they have," Howatt said. "Other hospitals are limited by the operating-room time."
In some places, there aren't enough physiotherapists, nurses or occupational therapists to match the number of surgeons. That means the operating rooms lie empty some of the time.
Health Minister Leo Glavine says he knows that small spending decisions are key, and he wants surgeons to help write the shopping lists.
For the first time, all the province's orthopedic surgeons have formed a formal group to advise the government, and Glavine responded by hiring a coordinator for them.
In last year's budget, $4.2 million was dedicated to orthopedic surgery, and as similar sums keep coming the surgeons will advise where they should be spent.
'We're just going to keep pushing'
"This will be left to the orthopedic working group, to say where, what and when can we now interject with more human resources, more surgical time, more small procedures," Glavine said.
"They know they could be doing more."
Glavine says merging health authorities next year will also centralize purchasing, making things more efficient. But it's "not realistic" to think Nova Scotia will meet the national benchmark in a year or two, he said.
"We have gotten behind over a decade, at least a decade, when we've been adding to the wait list," he said. "We're a long ways off. I'm very optimistic, but guardedly so."
In the long term, money as well as reorganization will be crucial. In a few subspecialties, like shoulder surgery, more surgeons need to be hired. A 10-year wait for foot and ankle surgery became infamous last year when one of two specialists left the province, but a new surgeon is being trained to enter that field in 2016, said Glavine.
Demand for orthopedic surgery is also a moving target as Nova Scotia's population ages and as more retirees move here, said Howatt.
Seniors want to stay more active nowadays, and as the specialty evolves quickly, there are more surgeries offered than in the past. However, keeping seniors active also means cost savings, he said.
The $4.2 million in the last budget didn't make a dent in the waiting list, but it did stop the list from growing, said Howatt.
However, he believes that if the money is spent with surgical-like precision, it will slowly start to overtake the list.
"We're just going to keep pushing," he said.