Wait lists for surgery, including necessary cancer operations and nonelective surgery, are soaring in Quebec. The wait list for cancer surgery in October was 4401 patients, which represents an increase from 4160 in January. Wait lists for elective surgery were up by about 2000 patients.
"We are already losing cancer and cardiac patients [among] the 160,000 people on surgery waiting lists," Paul G. Brunet, chair of the Council for the Protection of Patients in Montreal, told Medscape Medical News.
Long wait times affect "all establishments in the province," Annie-Claire Fournier, media relations advisor to McGill University Health Centre (MUHC), told Medscape Medical News. "Here at the MUHC, we regularly reassess all patients awaiting surgery to ensure that the acuity level of their case has not changed. We work assiduously to operate on all patients as quickly as possible. We understand that waiting for surgery is a stressful time for a patient, and we are sensitive to the impact this situation may have on them."
The Quebec government target for surgical wait time for patients with cancer "is that 90% of patients should have their surgery performed within 28 days of the surgeon requesting the surgery, no matter what the severity of the disease or the level of priority of the surgery, and that 100% of patients should have their surgery within 56 days of the request," according to the Rossy Cancer Network, which is affiliated with MUHC.
In September, André Fortin, a representative of the National Assembly of Quebec and a Liberal party health critic, said that the province's government first submitted a wait-list catch-up plan in June 2021, when 353 patients with cancer had been waiting more than 56 days for their surgery. This year, the number of patients with cancer waiting more than 56 days rose to nearly 1000.
Contributing Factors
Quebec Health Minister Christiane Dubé blamed rotating nurses' strikes for the increased delays, estimating that 500 operations have been postponed for each strike day. But Marie-Claude Lacasse, a spokesperson for the Quebec Ministry of Health and Social Services, told Medscape Medical News that while the strikes have led to a "temporary slowdown" of certain activities, only elective surgeries, and not urgent, semiurgent, or oncologic surgeries are affected.
Brunet took a broader view of the current situation. He said that "pandemic sequels, winter flus, and staff shortages" due to staff leaving public health facilities all are contributing to the delays.
Furthermore, he added, "the historical tendency of centralizing healthcare in the hospitals for the past 40 years [and] sending everyone to emergency wards have caused the present crises in Quebec, and probably in other Canadian provinces, as well."
What's Being Done?
On December 9, the Coalition Avenir Québec government adopted Dubé's wide-ranging healthcare reform legislation, Bill 15. In a press briefing held the same day, Dubé said that implementation of the bill included a commitment that a patient who did not receive surgery "within a reasonable time" from their provider could be sent for surgery "elsewhere in the network or even privately for free."
Dubé expects to appoint the CEO of the Santé Québec Crown corporation, which will run the new health system, by spring 2024. He also said that health network employees can expect "significant changes" in the coming months.
To deal with the current wait-list crisis, Brunet recently asked, "Are we doing everything we can to reduce these wait lists? Have we thought of reaching agreements with all the privately authorized clinics to do more surgeries? Have we thought of sending some patients to Ontario [for surgery]? Have we thought of going to the States…?"
For now, it seems that individual health systems may be on their own as they attempt to lessen the wait-list burden. "The MUHC is monitoring the situation very closely to ensure there is no impact on urgent cases," said Fournier. "We are committed to the health and safety of our patients."
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