“We empathize with patients whose surgeries have been delayed and plans disrupted, even as we’re not able to comment on health-care services or staffing, as those areas are the responsibility of Alberta Health Services”
Scheduled elective hip surgeries and knee surgeries are cancelled through Aug. 11 at the Royal Alexandra Hospital’s Orthopedic Surgery Centre, Postmedia has learned.
An estimated 350 cancellations are linked to a July 1 breakup between the University of Alberta and the centre’s residency program — coinciding with the end of a deal between Alberta Health Services and surgical hospitalists.
The centre’s staff roster was decimated by the University of Alberta Faculty of Medicine and Dentistry’s orthopedic surgery division’s move.
“We empathize with patients whose surgeries have been delayed and plans disrupted, even as we’re not able to comment on health-care services or staffing, as those areas are the responsibility of Alberta Health Services,” said a statement issued by U of A spokesperson Ross Neitz, citing accreditation standards set by the Royal College of Physicians and Surgeons of Canada.
“These standards require our residents to receive proper supervision and appropriate on-call support, as well as sufficient volume and breadth of training. This helps us provide a safe learning environment and high-quality education, ultimately ensuring the best care for patients,” he said.
Shift rotations for orthopedic residents continue during working hours at the centre, touted on the U of A website as a cornerstone of its orthopedic residency, with 17 residents in the orthopedic surgery residency program, offering “high-volume, hands-on educational experience with a high ratio of staff to residents” at the 2010-founded centre, which houses 56 beds and four operating theatres.
Urgent and emergent orthopedic care continue to be provided, but it’s a six-week disruption for scheduled hips and knees at the highest-volume hip-and-knee surgery provider in the province, at an average of 12 surgeries a day, five days a week.
More emergent surgeries are expected to fill the void during the scheduled cancellations, according to AHS.
“Because of the postponements, we are able to utilize our surgical resources for more non-orthopedic surgeries in Edmonton in the meantime. In most cases, this will improve access to Albertans needing other types of surgery,” Tuesday’s statement said.
Funding agreement expires
Also July 1, with a budget squeezed by the province and Alberta Health, another health-care wildfire popped up.
AHS didn’t renew an expiring unique contract with the surgical hospitalists that gave them an alternative relationship plan — a top-up or stipend or alternative funding model — to incent round-the-clock care, including orthopedic surgical care.
“As a result of (the U of A) decision, AHS worked with medical and surgical leadership to help develop alternate models of coverage. Despite the efforts of all parties, the orthopedic surgeons notified AHS that some arthroplasty surgeries at Royal Alexandra Hospital will be postponed due to the reduction in after-hours coverage,” the AHS statement read.
Dr. Paul Parks, president of the Alberta Medical Association, was once a resident at the Royal Alex.
He remembers 100-hour weeks, but in the ensuing decades volumes, complexity and service have spiralled up for residents, pushing aside some teaching for orthopedic rotations, Parks said.
Support for the first-tier team of clinical supports around the surgeons — the clinical assistants and associates and residents helping with the pre-op and post-op — has eroded with the expired funding deal, while populations are burgeoning, he said.
“There’d be a busy surgeon working at midnight, doing an emergency surgery and having to try to respond to all the calls in the emerge department for new traumas and new orthopedic injuries, and respond to calls on the ward, which is just high volumes and really difficult. There’s just no way that, if they’re up all night doing that, that the next day they could do their full elective surgical slate safely,” Parks said.
The AMA gave Alberta Health a plan in December 2023 that could mitigate it all, he said.
“They haven’t moved on it. I think the universities are getting the blame unfairly. They did signal and let everybody know they’re going to change the residency, how the residency is going to work … but at the same time, AHS cancelled that unique funding model.”
On July 4, Alberta NDP released data they said shows the UCP government falling behind in clearing a surgery backlog.
According to the government’s recent annual report, 292,500 surgeries were performed in Alberta in 2022-23, compared to 297,000 performed in 2018-19 — while the Alberta population has increased by 373,000 people over the same time period.
Data shows Alberta falling behind on national benchmarks for performing hip replacements, knee replacements and cataract surgeries, said Luanne Metz, Alberta NDP health critic for emergency and surgery care.
“This data further confirms what we hear on an hourly basis from Albertans — there is a crisis in health care and there is no end in sight.”