TORONTO — Preventing the poaching of staff is the top concern hospitals have about a new system of private clinics that will be used to cut the surgical backlog, the head of the province's hospital association said.
Anthony Dale, the president of the Ontario Hospital Association, said there will be many risks along the way as Ontario looks to private facilities to tackle the backlog that currently stands at 206,000 procedures.
"The No. 1 question relates to health human resources," Dale told The Canadian Press in an interview.
"We certainly aren't interested in seeing members of the hospital teams being poached by other employers."
The province announced earlier this week it would use private surgical centres, including for knee and hip replacements, as part of its strategy to reduce the surgical backlog. It's also expanding the number of cataract operations performed in private clinics.
The government said there will be safeguards to prevent hospital staff being taken away by the new surgical centres. Organizations applying to be designated as those centres will have to show staffing plans that don't negatively affect the publicly delivered part of the health system, which includes hospitals.
Dale said he is worried about the staffing situation in hospitals once the new model is up and running, which the government has said will occur by 2024 for knee and hip surgeries.
"I'm reassured with the high-level commitment, but there is a lot of work to do to figure out the details and make sure that what actually is put in place is effective enough," he said.
"Some surgeons, nurses and anesthetists will be interested in working in community-based surgical clinics and what we have to do is make sure that their responsibilities in public hospitals are safeguarded."
One safeguard, Dale explained, involves doctors who work in the new system having privileges at a hospital.
The privileges come with rules, regulations and requirements, including laying out how and when physicians work. The privileges also carry accountability and can be revoked, Dale said.
"That's the thing that we have to be very alive to as we move to create this new model of care," Dale said.
The province has said some of the doctors in clinics will have to have privileges with local hospitals.
The new model has sparked both support and criticism.
The regulatory organization for doctors, the College of Physicians and Surgeons of Ontario, said hip and knee replacement surgeries should remain connected to the hospital system.
Dr. Nancy Whitmore, the organization's registrar, also said the college told the government it was concerned the new system would create further strain on an already stressed health-care system.
Dale said he's heard Whitmore's "forceful" concerns and plans to work with the college to address those.
"Perhaps it means for surgical activity of this nature the quality-of-care regime in a clinic has to be much closer to a hospital," Dale said.
"I can easily see the requirement for direct connections between hospital and clinics in order to deal with uncertainty and risk."
One area of particular concern is what happens when complications, although rare, occur during a hip or knee replacement in the new clinics.
"You need to have standby plans and access to the hospital should lifesaving care be needed," Dale said.
Dale said the new hip and knee surgical centres represent a "big change" to the province's health-care model that will require a ton of work to implement.
Currently, hospitals receive money for hip and knee replacements on a "bundled care basis," he said. The funding not only allows for the surgery, but also managing home care after a procedure, usually through an agency.
Last year, there were 36,805 hip and knee replacements in Ontario – all performed at hospitals, Dale said.
Day surgeries for hip and knee replacements are a recent development, Dale said.
Two years ago, fewer than 100 patients underwent those procedures and walked out of the hospital the same day. Last year, that jumped to more than 8,000 patients.
Health Minister Sylvia Jones said Monday the province will introduce legislation in February to begin the move toward the new model.
"This legislation would strengthen oversight of community surgical settings so that patients can continue to receive the health care they deserve and provide the province with more flexibility to continue to expand access to more surgeries and further reduce wait times," Jones said.
The hospital association said it will continue to fight for a long-term health-care plan.
"We have to make sure that we remain absolutely serious about long-term health services, capacity planning, and not just in hospitals, but in home care, in long-term care and community services," Dale said.
"We also cannot forget the lessons of the pandemic and how we need to do a far better job in our society, in our province, in our country, at making sure our frail seniors get the care they need in the right place at the right time."
This report by The Canadian Press was first published Jan. 18, 2023.
Liam Casey, The Canadian Press
