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One Surgeon’s Struggles

Sarah Ward

Academic surgeons work incredibly hard under usual circumstances, contributing to high-quality care and also training the next generation of surgeons, who will be providing care for Ontarians in the decades to come.

As a result of having been forced to cease all elective activities (which we understand to be both necessary and appropriate in the fight against this global pandemic), we are now nonetheless in an extremely difficult position. As a result, our income dropped off by as much as 90%. Given current fee structures, the work that we have been able to continue doing (with great difficulty) is not currently being compensated.

I, along with the vast majority of my colleagues, have volunteered to provide care anywhere that I am needed during this crisis. I would work in the ER, ICU or on the ward to care for COVID-19 patients if my help was needed. Happily, due to the broad efforts of Canadians, it appears that our healthcare system is not currently overwhelmed. As a result, most surgeons are not required to be redeployed in order to care for COVID-19 patients.

We have a duty to continue to care for our own patients and to continue providing emergency care within our own specialties. However, our compensation for such care is increasingly insufficient in the context of pandemic responses which cause simple procedures to take at minimum 2-3 times longer than they would under usual circumstances. As proceduralists who are remunerated based on the number of procedures that we perform, we are being disproportionately affected by the current changes to healthcare delivery. Even if we eventually receive payments, phone and virtual clinics are typically far less efficient than in-person clinical care, resulting in far more work for less pay (a typical virtual clinic takes twice as long and allows approximately half the number of patients to be seen).

Surgeries are high-stress and take much longer to perform than they would have previously (due to the additional precautions that must be taken at each step). Administrative duties have ballooned, with most of us being intimately involved in pandemic response planning within our hospitals. However, 2-3 hours of emergency virtual meetings per day and the time spent reorganizing all of our clinical activities and transitioning to virtual models of care is in no way compensated. I can assure you that Ontario’s surgeons are hard at work during the pandemic, it is simply that the work we are now doing is not paid.

Additionally, we must continue to pay fixed overhead to maintain our offices, pay our administrative support staff, etc. We cannot simply close our offices and walk away, without abandoning patients already in our care. Adding insult to injury for academic surgeons is the fact that most of us are not eligible for wage subsidy programs, due to the fact that our staff are technically hospital employees (even though we are fully responsible for paying their salaries). On top of this, we continue to honour our educational commitments, teaching our trainees through virtual rounds and educational sessions, all while worrying about whether or not we will be able to pay our own mortgages or put food on the table next month.

Given that the end of this crisis is nowhere in sight and that we expect dramatic reductions in the surgical volumes to continue for many months to come (even if some restrictions are lifted, there is zero likelihood that we can “ramp up” to typical surgical volumes until such a time as the need for additional PPE and precautions is completely behind us), there is an urgent need to address income stabilization NOW for the surgeons of Ontario. Without some type of support the impact on our healthcare system and, most importantly, on patient care will be devastating.