Ontario hospitals optimistic health-reform bill will prevent drain of workers

Ontario hospitals are optimistic the province's new healthcare reform legislation will protect against the drain of workers to expanding private surgical clinics. 

The province's hospitals told the government last month their top concern was losing doctors, nurses and other staff to the new system, said Ontario Hospital Association chief executive officer (CEO) Anthony Dale.

“We have confidence in the knowledge that we're being heard because it's included in the legislation,” Dale said. 

“So that is reassuring, but it's all in the practical implementation of the initiative.”

Health Minister Sylvia Jones introduced a healthcare reform bill that will allow more private clinics to offer certain publicly funded surgeries and procedures. Cataract surgeries and diagnostic imaging and testing will be expanded while the government will create an entirely new system to perform hip and knee replacement surgeries.

There are about 900 private clinics currently operating across the province, the vast majority of them for diagnostic imaging and testing. There are 25 private clinics that perform surgeries, largely for cataracts, Dale said.

Last year, hospitals performed nearly 37,000 hip and knee replacements. Jones has not set a target on how many of those would be done under the new system. 

It's all part of the government's plan to decrease wait times and reduce a growing backlog of surgeries, which stands at more than 200,000 procedures.

The hospitals wanted, and received, protections written into the legislation.

New clinics must apply for a licence to operate. Those clinics must provide a detailed staffing plan “to protect the stability of doctors, nurses and other healthcare workers at public hospitals” as part of their applications.

“At the end of the day, this will be something that is worked out between hospitals and organizations at the local level and that's good,” Dale said.

One other issue the hospitals fought for is to have physicians at those clinics have hospital privileges.

Those privileges mean doctors will be accountable to a hospital and must be on its regular on-call team, Dale said.

“This is absolutely necessary in order to ensure stable operation of hospitals,” he said.

“The only way a hospital can make sure that its patients have ongoing access to the services it needs is if specialized health-care practitioners in a hospital setting are able to come in and provide services even when it's off hours because of an emergency.”

Kevin Smith, the CEO of the province's largest hospital network, the University Health Network, said he has “no anxiety whatsoever” about the expansion of cataract surgeries, colonoscopies and diagnostic imaging and testing in private clinics.

There are 5,000 people waiting for surgeries at UHN, which runs several hospitals, long-term care homes, rehab clinics and home care.

“We have to do something because that grows if we aren't rapidly meeting the needs of the new people coming on our referral list,” Smith said.

He and his colleagues are calling for two independent expert panels to advise the government as it implements and operates the new hip and knee replacement clinics.

“We need expert panels and some tables to solve problems as these get up and running, especially to figure out unintended consequences,” Smith said.

Guarding against poaching of staff is even more important in small-town hospitals, said Huron Perth Healthcare Alliance CEO Andrew Williams.

The collective of four hospitals in southwestern Ontario has had to deal with some temporary emergency department closures over the summer and one hospital's emergency department is still not running 24 hours a day due to staffing shortages, Williams said.

“If there's a parallel system expanded without a detailed plan, it has the risk of very much destabilizing the system that we have,” he said.

Williams said he wants his hospital network to be a part of the new system. 

“As the government is investing net new resources into improving access – whether it's for cataracts or scopes or hips and knees or diagnostics – (I hope) that those opportunities also extend to the hospitals where we have the physical capacity currently, but perhaps not the resources or the staff,” Williams said.

The province has said it still hasn't decided on the regulating body for the new clinics.

Both Dale and Smith said they are not concerned about that.

The College of Physicians and Surgeons said last month that stand-alone surgical centres needed to be connected to hospitals and that the proposed changes were not the solution to the health-care crisis in the province.

The college said it is reviewing the proposed legislation.

Dale said the college has oversight on existing independent health facilities and “will carry on its responsibilities until there's an alternative developed.”

His main concern is that the government figure out the oversight situation soon if they have any hope of launching the new hip and knee replacement clinics by next year.

Smith had a different idea for oversight.

“I think it's actually a great opportunity for public hospitals to work with these sites to monitor their quality,” he said. 

This report by The Canadian Press was first published Feb. 22, 2023.