Alberta’s general surgery is at a tipping point, with lives on the line: AMA

By Mia Parker, Local Journalism Initiative Reporter

According to a July 8 Alberta Medical Association news conference, Alberta’s general surgeons are facing increasing human resources shortages, which are limiting their ability to provide urgent, life-saving care to patients.

This news conference marked the start of the AMA’s general surgery information campaign, seeking to inform the public of the issues faced in their hospitals.

“General surgeons, to put it succinctly, are essential and the lifeblood of surgery in our hospitals,” said AMA president Dr. Paul Parks in the conference. “Hospitals simply cannot function without having general surgeons available.”

“These are the patients that need timely, lifesaving care,” he said.

According to a pre-meeting briefing, every full-service hospital requires general surgeons to function and provide safe, timely care.

“The vast majority of the emergency conditions treated by general surgeons, if not rectified promptly, lead to serious outcomes such as sepsis, long-term complications and sometimes death,” read the briefing.

According to the AMA, patients are waiting too long for care, and the province has seen an increase of diversions, situations when patients are transferred to other facilities due to a lack of available services.

“We need to get ahead of this problem,” said AMA Section of General Surgery president Dr. Lloyd Mack. “It’s not safe and clearly a poor use of resources shipping patients around the cities.”

AMA is also calling for more transparency from Alberta Health Services on the full impact of these diversions.

Delays and diversions in care are serious issues, which Mack said could be resulting in patient deaths.

Growing staffing shortages is at the heart of this issue, and according to the AMA, it’s unprecedented in North America and has now reached a tipping point.

“The chronic shortages of health-care professionals that you’ve been hearing about are hitting general surgery patients particularly hard,” said Mack. “Hospitals just can’t run without general surgery care.”

The capacity to provide adequate general surgery relies on more than just surgeons; it also involves other health-care professionals and house staff, from administration to housekeeping.

To tackle the growing issue, the AMA is highlighting the need for adequate anesthesia support, surgical nurses, more hospital beds in cities, review of information systems that have been offloaded onto surgeons, increasing trained housekeeping for faster turnovers, and surgeon incentives.

Mack also noted that making sure the public understands the issue is essential, and investment must be made to ensure the province can become attractive to the workforce of the future.

“We need focus and a plan for investment on the workforce,” he said, noting general surgery has not been growing with the population or adequately replaced as professionals retire or leave.

“I personally think this is a crisis,” said Mack. “It’s only going to get worse if we don’t start taking action now.”

Pincher Creek’s surgeon, Dr. Jared Van Bussel, highlights that Pincher Creek, too, is affected by these gaps in surgical coverage.

“In order for an OR to run effectively, it requires the combined skills of several OR-trained registered nurses, certified OR cleaning technicians, surgical instrument processors, surgeons, anesthetists, surgical assists, as well as a supportive administration and a facility to bring it,” he said in a statement to Shootin’ the Breeze.

Being able to have these resources requires funding, training and hiring.

“Pincher Creek has suffered incremental losses to many of these areas,” said Van Bussel, highlighting loss to local instrument cleaning facilities, on-call OR nursing and resultingly several OR-trained nurses.

“We previously had three surgeons and three anesthetists in our small community and we are down to one of each,” he said. “More than that, we’ve lost vision.”

Workforce planning and the breaking down of barriers have not been prioritized, which has come with a lack of adequate training in the province and significant barriers within the privileging process of visiting surgeons.

“Visiting surgeons have faced significant barriers to working in Pincher Creek, with the privileging process for two of our recent surgeons taking longer than a year to complete,” he said.

The Pincher Creek hospital has also faced gaps in its capacity to provide maternity care, which Van Bussel describes as a keystone in rural health care.

“In order for this to change, decision-makers need to speak in specific, measurable, achievable targets and the system has to correct the currently insurmountable barriers for rural surgery,” said Van Bussel. “Otherwise we will see further loss in the OR services provided in Pincher Creek.”