Provinces

ALBERTA

Responses below were provided by Alberta Orthopaedic Society in 2023.

What are the current issues that need to be solved/addressed in orthopaedic care in Alberta?

• Shortage of human health resources, especially in nursing and anesthesia. In Calgary and Edmonton, there is also a shortage of clinical associates and surgical assistants.
• Excessively long wait lists. The government has a mandate to resolve this problem with various initiatives (ASI – Alberta Surgical Initiative, FAST – Facilitated Access to Specialized Treatment)) to get patients access to surgeons.
• Burden of trauma. All zones are seeing an increase in trauma, with associated lack of trauma resources.
• Burn out, practice pressures and emotional fatigue are evident.

What can government do to push change forward on a provincial or territorial level?

• New government policies and initiatives are affecting healthcare overall, not just orthopaedics. It is unknown how the purging of Alberta Health Services and realignment of decisions of health policy will affect orthopaedics.
• The initiation of privately-run, publicly-funded surgical centres will have an impact on an already-depleted anesthesia and nursing resources.
• Negotiations with longstanding, established, effective orthopaedically-run initiatives and Alberta Health Services have been difficult.

In 2022, COA leadership and membership met with the Alberta Minister of Health.

Responses below were provided by the British Columbia Orthopaedic Association in 2022.

It has been just over one year since the BCOA began an extremely active campaign to bring awareness to British Columbia’s citizens, media and the B.C. Government on the significant wait times for orthopaedic surgeries in the province. While we have had some success securing meetings with the ministry of health, there are still unacceptable patient wait times and few solutions to improve orthopaedic patient care in the province including:

• Up to more than two years wait for knee, joint and hip surgeries in some areas of B.C. with people becoming depressed and addicted to opioids and facing loss of work while they wait – major physical and mental health deterioration.
• 2000 people on a waitlist for orthopaedic surgery in Prince George. Major backlog for surgeries in Northern B.C.
• An estimated one million British Columbians waiting to see a Specialist, emphasizing the importance of global system investment and change.

What can government do to push change forward change on a provincial level?

• Improvements to Health Care Workforce and Work Environment for all Health Care Workers – Fair workload, Safe workplace, mental health support, validation.
• Decisions on healthcare funding need to be evidence based – not based on politics. HCW need a seat at the table. There is no place for a to down approach that is seen across many provinces.
• Research & Evaluation (DATA) needed to tell us how to improve delivery of health care. We need leadership collecting workforce data. Need research to inform solutions.
• Test different models of care. Share results with other hospitals. Collaborate.

In 2023 COA leadership and membership met with MP Todd Doherty (Prince George), MP Richard Cannings (Trail), MP Mark Strahl (Chilliwack-Hope), MP Ed Fast (Abbotsford), MP Tako Van Popta (Langley-Aldergrove)

Responses below were provided by Manitoba orthopaedic surgeon representatives in 2022.

Overview of Orthopaedic care in the province, current issues that need to be solved/addressed.

• Specialist Orthopedic Care in Manitoba is mainly centred in Winnipeg with 2 rural centers providing general orthopedic care
• Access to orthopedic referral is above recommended wait times in all areas. Total joint replacement consult is 6-12 months from referral. All other specialities have 4-24 month long waits.
• Access to orthopedic surgery is above recommended wait times in all areas. Total joint replacement surgical wait times are 6-18months from time of consultation. All other specialities have 6-24 month long waits for surgical care from consultation.
• As a result of the long wait times and insufficient human resources, Manitoba has developed Out of Province options for Spine and Hip/Knee Arthroplasty. Options for other orthopedic subspecialties are being developed.

What can government do to push change forward change on a provincial level?

• Increase human resources to improve access to care including orthopedic surgeons, OR nursing, ward nursing, health care aides, extended health care providers
• Decant day surgery procedures to private operating rooms to increase throughput

NEW BRUNSWICK

Responses below were provided by New Brunswick orthopaedic surgeon representatives in 2023.

• Overview of orthopaedic care in the province/current issues that need to be solved or addressed:
• Inadequate recruitment and retention efforts have resulted in high turnover rate among nursing staff, posing challenges in maintaining a skilled and experienced nursing workforce.
• Geographic challenges – The province’s large size and scattered population may make it difficult for patients in remote or rural areas to access orthopaedic care. This can lead to disparities in healthcare delivery and limited resources in the region.
• Lack of centralized referral processes as well as the absence of surgical efficiency and Operating Room utilization efficiency models.
• Lack of operating room resources for schedule Daytime Fracture care, leading to long in hospital waits for surgical fracture care.
• Insufficient orthopaedic surgery person power/human resources to meet patient demand, leading to long T1 and T2 wait times.

What Government can do to push forward change on a Provincial level:

• Implementing strategies for nursing retention, healthcare organizations and policymakers can work towards retaining nurses in New Brunswick and improving nurse job satisfaction, ultimately leading to better patient care outcomes.
• Implement strategies to reduce waiting times for orthopaedic consultations and surgeries. This may involve streamlining referral processes, optimizing surgical scheduling and improving efficiency in hospital workflows.
• Recruit more nursing staff and create “Scrub Technician” positions for the OR to address staff shortages and increase OR access.
• Fund primary care MSK physicians to see and treat non operative orthopaedic conditions to decrease T1 wait times to see orthopaedic surgeons.

In 2022, COA leadership and membership met with the New Brunswick Department of Health.

Responses below were collected via ReCOAnnect meetings held in 2020-2021 with Newfoundland and Labrador-based orthopaedic surgeons.

• Access to care disparity, growing patient waitlist especially for hip fractures from aging population.
• Orthopaedic departments blamed for inefficiencies on ground level. • Nursing shortages and burnout.

Responses below were collected via ReCOAnnect meetings in 2020-2021 with Nova Scotia-based orthopaedic surgeons.

• Lack of primary care physicians poses logistical and ethical challenges later when addressing specific health issues related to orthopaedic care.
• Early career surgeons not able to train effectively, make connections and collaborations from being in virtual environment.
• Care team fatigue.

In 2022, COA leadership and membership met with Tanya Penney, Sheila Macleod, Cindy Connolly and Dr. Greg Hirsch (Nova Scotia Health and Department of Health and Wellness) and in 2024, COA leadership and membership met with MP Dr. Stephen Ellis (Cumberland-Colchester), Vice-Chair of the Standing Committee on Health.

Responses below were collected via ReCOAnnect meetings in 2020-2021 with Ontario-based orthopaedic surgeons.

• Job scarcity. Surgeons are foregoing retirement, creating job shortages. • Disparity in resource allocation, both regionally and specific to specialty.
• Orthopaedics deemed a low priority.
• Nursing and anesthesia shortages.

COA leadership met with the Ontario Ministry of Health (2022), MP Marcus Polowski (Thunder Bay), MP Lloyd Longfield (Guelph), MPP France Gelinas (Nickel Belt), MPP John Jordan (Lanark-Frontenac-Kingston), MPP/PA Dawn Gallagher Murphy (Newmarket-Aurora), MPP Jamie West (Sudbury) in 2024.

Responses below were collected via ReCOAnnect meetings in 2020-2021 with Prince Edward Island-based orthopaedic surgeons.

• Allocation and prioritization of resources.
• Orthopaedic care considered low priority.

COA leadership and membership met with the Deputy Minister of Health, Assistant Deputy Minister of Health, Chief Medical Officer of Health PEI, Chief Operating Officer of Health PEI and Opposition Health Critic (2023).

Responses below were collected via ReCOAnnect meetings in 2020-2021 with Quebec-based orthopaedic surgeons.

• Prioritization of orthopaedic procedures, while breaking perception that these are lifestyle surgery or elective (optional, by choice) procedures.
• Critical shortage of nurses and ancillary staff, impedes hospitals to perform outpatient orthopaedics.
• Surgeons have successful models that improve efficiencies, but many are not implemented by administration.

Responses below were collected via ReCOAnnect meetings in 2020-2021 with Saskatchewan-based orthopaedic surgeons.

• Strained healthcare practitioners during COVID-19.
• General discouragement and confusion how to advocate for better access to care in orthopaedics.
• Nursing shortages, both on the floor and operating rooms.