Doctor quits public health system
Surgeon frustrated over long waits for care
Frustrated watching patients wait too long for medical care, a prominent Calgary orthopedic surgeon is taking the unusual step of opting out of the public health-care system — a move that will allow him to charge patients for privately delivered procedures.
Dr. Robert Hollinshead is set to become the only Alberta doctor providing patients medically necessary care not paid for by the Alberta Health Care Insurance Plan.
The physician said too many young surgeons can’t find work in the province, meanwhile, patients are waiting months and years too long for hip, knee and other surgeries because the government isn’t properly funding the public system.
“I feel that governments do not have the stomach to put the kind of money into the system that would help it go from long, long waiting lists to timely access,” Hollinshead said in an interview on Thursday.
“If the public system isn’t prepared to step up for Canadians and provide the resources so they can get timely access, then maybe we have to have an adult discussion about considering other options. And that other option is allowing the private sector to participate in providing the resources so we can match waiting times to patient need.”
Hollinshead, 65, said he has advised Health Minister Fred Horne of his intentions to leave the public system on July 1, 2014 after a surgical career of more than three decades.
Provincial legislation provides terms for doctors who choose to opt out of the Alberta Health Care Insurance Plan, including notifying the minister of health, publishing a notice in a local newspaper and alerting patients, all at least 180 days before they opt out.
Hollinshead, past president of the Alberta Medical Association and former clinical chief of orthopedics in Calgary, said access has worsened since he started his career in 1979.
While about seven years ago, Canada struggled to find enough surgeons and boosted medical school
We need to do something. We just cannot continue the way we are now DR. ROBERT HOLLINSHEAD
enrolments, governments of today aren’t providing the infrastructure for the new crop of recruits to actually get work even as wait lists grow, said Hollinshead, a shoulder subspecialist.
Today, it takes up to 18 months to see a shoulder surgeon in Calgary, then between six months and a year to book the procedure, he said. Some family doctors struggle to get their patients in to see surgeons, leaving them “just swirling around” waiting for care, as their conditions deteriorate, said Hollinshead.
He criticized the Alberta government for playing shell games with hospital beds for years, closing some down when new ones opened and delaying new capacity, such as at South Health Campus and McCaig Tower at Foothills Medical Centre.
Private health care has provided fodder for thorny debate in Alberta over the years, but just one physician in Red Deer has previously chosen to opt out of the public system and the decision was short-lived, noted University of Alberta health policy expert John Church.
While the concept of straddling both systems — publicly funded care provided in private facilities — has gained more traction, the either/or option of opting out hasn’t proved attractive, said Church, noting doc- tors are given a steady supply of work and a guarantee their bills will be paid by government.
“There is no sweeter deal on the Planet Earth than what doctors in publicly funded health care are getting,” Church said.
“When a doctor sits down and thinks through the implications of having to set up their own system for going after clients to get paid, I think the hassle of doing that and the potential cost of doing that will outweigh any perceived benefits of being free of government constraints.”
While Church said he generally believes injecting private care into the system doesn’t make sense if it starves public resources, “there may be merit on a case-by-case basis” in allowing some patients to pay cash for faster care.
In Calgary, Hollinshead will be breaking new medical territory and is still working out some of the logistics of his new practice.
The physician said he plans to operate at a private facility in the old Grace Hospital.
He’ll charge the same fee he received from the Alberta government, roughly $700 to $1,500 per shoulder procedure, though the final bill will run a patient between $8,000 and $10,000 once the fee for implants, nurses and the facility is factored in.
Hollinshead acknowledged his move could reopen the debate about private health care in Alberta, but noted queue jumping is already taking place through medical tourism when patients book in with surgeons outside of Canada, or head to the Cambie Surgery Centre in B.C., for example.
Further, Hollinshead said, some patients fly with their Alberta surgeons to Turks and Caicos for hip, knee and shoulder surgery.
He insists while his decision may allow some patients faster access to surgeries, he’s only in it to improve care.
“This is about a principle of me trying to help the public health system get better for over 30 years and being frustrated that patients still languish on waiting lists for months and months and sometimes years to get surgical care for many conditions,” said Hollinshead. “We need to do something. We just cannot continue the way we are now.”