Thursday, February 25, 2010

Anesthesia Manpower

When I finished my residency 20 years ago and was sitting my oral exams, I was talking with the 4 other people being grilled at the same time as me and I was the only one who had a job after his residency. Times have changed and now we have a shortage of anaesthesiologists in Canada.

A couple of weeks our oil-rich government decided they were actually not as poor as they thought they were and announced that in order to reduce the wait lists for total joints, and cataracts they were going to have a blitz of surgery, involving opening closed operating rooms for a short period of time to do this. The time line was of course very short.

This is not an issue at our hospital because we don't have any closed OR's but 2 of the larger hospitals are running under capacity and have physical space. I was at a meeting where this was discussed. The site chief of one of the larger hospitals stated that there was no way he could get 2 more bodies for the couple of week blitz but that he would post the opportunity and see if part-timers and people on holiday were interested in working. He also pointed out that he had had to turn down qualified applicants to his department because the hospital had closed operating rooms.

I was therefore amused last week to read in our local paper an article on the proposed surgical blitz. The article pointed out that there was a hitch in performing the proposed surgeries because of a shortage of anaesthesiologists which it attributed to the fact that 2 are currently doing a mission in Ecuador (true).

This reminds me of an event early in my career during my first run as an administrator. I was at a meeting where a senior administrator announced that for budgetary reasons it would be necessary to close a room for the month of March. At that time we were already down one person which meant that nobody could take vacation without getting a locum. Therefore innocently I opened my big mouth and said that there wouldn't be a problem because people wanted to take vacation in March and closing a room just meant we wouldn't have to look for a locum.

To what shouldn't have been a surprise, I read in the local paper the next day, that the hospital would have to shut down an OR in March because of a shortage of anaesthesiologists. I should have written a letter explaining what actually happened except that I suspect I would have been the target of some reprisal plus the hospital actually at that time had a gag order on doctors.

Anesthetic manpower is of course a complex issue which seems to be beyond the understanding of most physicians. Anaesthesiologists are completely dependent on what work the hospital can give them. In the past 20 years people have found creative ways of making work for themselves like acute pain services,pain clinics, private surgical suites, sedation etc but the bulk of our work is still hospital based. I found it amazing when I worked at my first hospital how during my brief tenure as chief I was constantly under pressure to hire another anaesthesiologist at the same time as the hospital clearly didn't have the funding to run the rooms it had, let alone an extra room.

As I said to the chief of staff during one of the numerous meetings I had to attend during that time, "It's not like we can just hang up our shingle and start practising". He still didn't seem to get it.

There are a few other interesting angles to the surgical blitz. The areas targeted were total joints, cataracts and MRIs. Total joints currently have an average wait time of 6 months which may sound like a lot, however if you consider that most patients are referred earlier so they are less disabled and in less pain plus the fact that total joint surgery is a major life altering event (especially when it goes wrong) that people may actually need some time to reflect on whether they actually want the operation. Judging from some of the medical wrecks coming through the OR now for total joints I sometime wonder whether they have any wait list or whether they are just bringing in patients off the streets. Cataract wait lists are currently measured in weeks. I am not sure what the case is for MRIs except the patients I see in the Pain Clinic seem to be getting theirs quite quickly.

There are a lot of things in the healthcare system that are underfunded like chronic pain management, we have patients in stretchers in the ER waiting for hospital beds, chronic patients in acute beds waiting for chronic beds, and patients with no family doctor. Therefore I am wondering why the geniuses who run the healthcare system decided to focus on 3 particular surgeries (cardiac surgery was also addressed) and one diagnostic procedure. Is it any coincidence that 4 of the most highly paid specialties are getting their needs addressed. Oh BH, you are getting way too cynical.

In the announcement was also the fact that most of the extra total joints in the province will be done at a private hospital in Calgary for $12,000 a pop. The spokesman commented that he realized that that was a lot more than a total joint costs in the public system but that there were intangible costs in the public system that made the costs relatively equal. He didn't outline what the intangible costs were; treating the complications from the private hospital at the public hospital? paying 6 figure severance packages to recently dismissed political appointees.

I used to disgusted.....


burnttoast said...

When I read in the Globe and Mail about a nursing shortage in Canada, I was baffled. Why in the system of universal health care, would this be an issue? Until I read that hospitals could be forced to shut down beds due to acute funding shortfalls. So nursing becomes an insecure profession, college grads do something else, and the short term thinking of bureaucrats has set up a major long term problem. In the US, in the late 1980s, a government sponsored manpower survey predicted a surplus of anesthesiologists. Med students chose to do something else. Seems the survey neglected to take into account the "graying" of American, with its accompanying increase in OR utilization. Yep, a several year shortage. We in US have the lack of comprehension about how our specialty is different from surgeons. Our hospital demands we cover 18 lines a day, although on average we only have business for 15. They also demand we staff a rural hospital they purchased, never mind that the practice could never support an MD, much less the two we are to provide. The hospital administration demanded we go to a CRNA based practice (ironic, since they insist the rural hospital with less sick patients, be MD staffed!!). The carrot/stick used to motivate this, is a subsidy. Yes, the administrator runs/ruins our practice in exchange for money. I would rather have my freedom and soul back, if I were still a partner. Since I am an hourly employee, I have retained both. Although I still have to listen to the surgeons take potshot at our "favored" status.

Bleeding Heart said...

Nursing manpower has been up and down ever since I have been in healthcare. The problem is that politicians refuse to commit to long term planning. About 15 years ago a consultant hired for seven figures at the CofE proposed replacing most of the nurse with what she called "smart aides" and what the nurses called "street people".

Every time they lay off nurses in bad times, a certain percentage just decide to retire and nursing school admissions drop so there is a shortage when times are good.

2 years ago we were bringing in nurses from the Philipines, now we are talking about laying off nurses.