Doctor examining the x-ray of a hip joint replacement patient with osteoporosisiStockphoto/Getty Images/iStockphoto
One of Canada's leading orthopedic surgeons, Allan Gross, would rather be performing joint replacements on patients who have waited weeks and months but instead he will take holidays he doesn't want.
Dr. Gross, and others in the Toronto Central Local Health Integrated Network, is facing a cut in operating-room time to do hip and knee replacements - his has been reduced by about half - after government money to fund the surgery started to run short.
"All three of us will be taking some time off," said Dr. Gross, who along with two other Mount Sinai Hospital orthopedic surgeons will collectively be doing 10 joint replacements a week, down from about 20. "We just came back from our big Christmas break; the last thing we need is a holiday."
At issue is the way joint replacement operations are paid - through incentive funds provided by the province, part of a $5.5-billion federal fund to reduce waiting times in five areas. The incentives - $6,882 for each hip or knee patient at community hospitals and $8,930 for those at teaching hospitals - have helped whittle down waiting times, with patients viewed as sources of revenue.
With many hospitals hitting or nearing their target number of operations before the end of this fiscal year, March 31, 2011, joint replacements - costing $10,000 to $12,000 - are now seen as a financial drain as the money to fund them must come out of a hospital's global budget.
To compound matters, the Toronto Central LHIN received funds to do 232 fewer joint replacements this year compared to last, as the provincial government wanted to encourage patients to receive care closer to home and spread the money to outlying areas.
As orthopedic surgeon Rod Davey, co-chairman of the Toronto Central LHIN Joint Health and Disease Management Committee, pointed out: "No one has enough money; health care is expensive."
And yet, the federal government has high hopes for the fund, initiated in 2004, to cut waiting times in five designated procedures: hip and knee replacements, cataract surgery, heart operations, diagnostic imaging and cancer radiotherapy.
While some provinces, such as Ontario, have made huge progress in reducing waits for joint replacement, others such as Nova Scotia have continued to have lengthy queues. And federal waiting-time funding is slated to evaporate in 2013-2014.
NDP Health critic France Gélinas called the short-term situation ludicrous.
"We have highly trained skilled professionals, we have ORs, we have hospital support," Ms. Gélinas said in a telephone interview from Sudbury on Tuesday. "And all of this will go idle."
At Mount Sinai Hospital, Dr. Gross said operating rooms will be filled with other cases; he hopes to do cartilage transplants.
When April 1, 2011, rolls around and new funding comes in, Dr. Gross hopes to be able to get the number of joint procedures up again. In the meantime, he may have to fill his hours with some time off he doesn't want.
"Our time could be used replacing joints," said Dr. Gross. "We don't need a holiday right now."