As physicians, we prefer to work in the shadows. An anesthesiologist ensures life-threatening situations never occur while monitoring from the back of the OR; an emergency physician stabilizes patients during their worst moments to get them home or to specialized care.
We understand that patients do not seek us out by choice, but rather require our expertise to improve the quality and duration of their lives. We would prefer to remain silent and simply do our work, having our best saves not even knowing who we are.
Sadly, the clinical reality in Alberta no longer allows for that. Our system has lost the ability to keep people safe.
Underemployment of Surgeons
As an anesthesiologist, I (Duttchen) have a unique vantage point across most surgical services. Our surgeons are among the best in the world, yet in most specialties, there is an underemployment problem. The bottleneck is not the surgeon. The rate-limiting resource is the infrastructure and specialized health-care workers required for pre- through to post-operative care.
In Alberta, a politically driven shift has occurred through contracts to for-profit chartered surgical facilities (CSFs). For three years, we have witnessed a disturbing trend of public hospital operating room closures due to a lack of hospital-based anesthesiologists, while our groups have been forced to staff elective, lower acuity, private facilities.
Perverse Prioritization
This has resulted in a perverse prioritization. Simple elective orthopedic and cataract cases are given preference, while cancer and emergency procedures in public hospitals are delayed or cancelled. My department has been forced to provide staff to for-profit facilities while our quaternary referral centre, which handles the most complex trauma and cancer cases, has underutilized operating rooms. My oncology surgeon colleagues relay extreme stress from too many patients, not enough surgery time and witnessing many of their patients dying while surgical wait times for cancer grow past double the recommended timelines.
Even as anesthesiologist staffing slightly improves, wait lists for cancer and cardiac surgery do not. The government's plan to sink another $525 million into private surgical facilities will not reach public hospitals and will only worsen these trends.
Human Cost in Emergency Departments
In the emergency department, I (Parks) witness the human cost of this diversion. Overcrowding is fuelled by ongoing neglect of hospital capacity. When emergency surgeries stall, the hospital backs up into hallways.
I see patients with surgical emergencies — acute infections, traumatic injuries or escalating cancer needs — suffering in the ER and hallways because the specialized teams needed have been diverted to private facilities. We continue to divert resources while those with surgical emergencies suffer, and newer patients are left stranded in our overcrowded wards and ERs.
Our objections are not driven by ideology. Private facilities do not create new capacity; instead, they cannibalize it. As they expand, public operating rooms remain empty as staff are prioritized for private facilities. Not only do we have underutilized public ORs, but taxpayers are forced to pay higher rates for the same procedures in private facilities.
