91原创

Mingay, then 66, expected to wait months 鈥� maybe even a year 鈥� to have joint replacement surgery.

But Mingay, among the first patients referred to a 91原创 hospital collaboration that performs joint replacement surgeries on weekends, only had to wait four weeks for a new left hip.

鈥淚 was prepared for a much longer wait,鈥� said Mingay, who underwent joint replacement surgery last April at Sunnybrook Health Sciences Centre. It was a Saturday, a day that operating rooms are typically vacant. 鈥淚 know people living outside 91原创 who are waiting more than 12 months.鈥�

The provincial backlog of surgeries, which soared during the COVID-19 pandemic, has prompted hospitals across the province to tackle the problem, but in different ways.

Two of their approaches offer a contrast that speaks to the heart of a raging debate over how health care in this province should be delivered.

Mingay is among hundreds of patients who had joint replacement surgeries on weekends through the (TRAC).

The initiative, launched last April, started as a collaboration between orthopedic surgeons at Sunnybrook and Michael Garron Hospital with the goal of slashing the number of people waiting for hip and knee replacements in the region by 25 per cent. TRAC uses existing hospital resources, taking advantage of unused operating room space, and participating surgeons travel to Sunnybrook鈥檚 Holland Centre, which has hired additional nurses to help staff the weekend and after-hour ORs.

鈥淲e鈥檝e been very efficient in getting our procedures done on weekends in this team approach,鈥� said Dr. Markku Nousiainen, medical director at the Holland Orthopaedic & Arthritic Centre and TRAC鈥檚 orthopedic surgical lead. 鈥淭he key message here is that we made this work through a publicly funded health-care system in collaboration with multiple hospitals.鈥�

In the nation鈥檚 capital, The Ottawa Hospital has gone a slightly different route, renting out unused operating rooms at its Riverside Campus on Saturdays to a group of surgeons operating privately as the Academic Orthopedic Surgical Associates of Ottawa (AOAO). The arrangement, which began in February 2023, has prompted criticism from health policy experts, politicians and unions for a lack of transparency and the use of publicly funded operating rooms by a private entity. The hospital says the initiative is creating capacity so it can tackle more complex operations, such as neurosurgery, cancer and spinal surgeries.

Despite the different approaches, both the 91原创 and Ottawa initiatives report success, each pointing out that more patients are now able to get joint replacements in their regions, reducing wait times for these surgeries.

When the TRAC program began in April 2023, there were 4,001 joint replacement cases on the wait list in the 91原创 region. During its first year, TRAC surgeons completed 1,120 hip and knee procedures, representing 28 per cent of the backlog. Hospital leaders say they aim to do another 1,519 surgeries through TRAC in the 2024-2025 fiscal year.

In its first fiscal year, AOAO performed about 600 surgeries, said Cameron Love, CEO of The Ottawa Hospital. This year, the group is aiming to complete 1,000 surgeries 鈥� which will bring the hospital鈥檚 total output to 2,500 joint surgeries 鈥� by offering procedures on both Saturdays and Sundays.

Cutting wait times is at the top of the agenda for the听provincial health ministry and the Conservatives, prompting听Bill 60, the Your Health Act, which aims to reduce wait lists by expanding the provision of some publicly funded procedures, including joint replacement surgeries, in private clinics.

But with Ontario currently recording the shortest surgical wait times in 91原创听鈥� a point often raised by the government听鈥斕�health policy experts are questioning the need to open the doors to private interests. They argue gains are being made within the public system and that in many cases hospitals could be funded to do more surgeries.

In an interview, Love said his hospital is 鈥渄oing the same thing鈥� as the hospitals involved in the TRAC program, stressing that AOAO is completely publicly funded and overseen by The Ottawa Hospital. The AOAO surgeons, he said, 鈥渏ust happen to have a corporation鈥� that is planning to build a surgical centre in the community 鈥渋n partnership鈥� with The Ottawa Hospital, once the government opens applications for community surgical and diagnostic centres 鈥� some of which are expected to be private 鈥� as part of its plan to offer more surgeries outside hospitals, expected in late summer.

Health policy experts point out that the model employed by The Ottawa Hospital differs from the TRAC program in that AOAO rents operating rooms from the hospital, hires its own nurses, and supplies its own equipment.

鈥淭his is not business as usual,鈥� said Andrew Longhurst, a PhD candidate and health policy researcher at Simon Fraser University. 鈥淕roups of surgeons don鈥檛 go into these ventures just because they want to perform more surgeries. It鈥檚 often the case that these ventures are more lucrative than operating through a standard contractual relationship working fee-for-service through a hospital.鈥�

A lawyer representing AOAO offered no comment, but Love defended the arrangement, noting that for every procedure AOAO does, the hospital receives about $8,000 from the province, of which about $6,000 goes to AOAO. The remainder, he said, is reinvested in the hospital to grow a diverse range of other surgical programs.

While the AOAO partnership may not necessarily be cheaper for The Ottawa Hospital, Love said it has made surgeries more efficient.

鈥淚f I do joints in the main OR today amongst every other procedure, I get through four. When I do them with AOAO, in a half an hour of less time in an eight-hour day, we do six or seven,鈥� Love said.

The show that in February, on average, 76 per cent of people needing a hip replacement got it within the target time (as measured from specialist’s decision to surgery). For knee replacements it was 73 per cent.

Across 91原创, wait times for patients needing hip and knee replacements are longer than before the pandemic, according to . Still, compared to other provinces, patients in Ontario face the shortest waits, the data shows.

David Urbach, professor of surgery and health policy, management and evaluation at the University of 91原创, said about three-quarters of the patients who need a joint replacement in Ontario receive it within the target time, making it 鈥渃urious鈥� that these particular surgeries are at the top of the province鈥檚 plan to grow private clinics.

鈥淥ne could legitimately ask because we鈥檙e almost there with hip and knee replacements in Ontario, why is this the sword to die on for private hospitals?鈥� said Urbach, also head of the department of surgery at Women鈥檚 College Hospital.

He noted Ontario hospitals, including his own, can and want to perform more joint replacements.

Hannah听Jensen, a spokesperson for Health Minister Sylvia Jones, said wait times for surgeries and diagnostic tests 鈥渉ave been increasing year after year.鈥�

鈥淲e are not OK with the status quo and know more work needs to be done,鈥� she said, adding the government is 鈥渆xcited鈥� to see partners such as The Ottawa Hospital 鈥渆mbracing innovation to provide more publicly funded procedures, reducing the surgical backlog and reducing patient wait times.鈥�

The expansion of publicly funded procedures outside hospitals, she said, is about 鈥渆xpanding capacity within our publicly funded health system to connect more people to the care they need, when they need it.鈥�

Funded by the province, TRAC has expanded to include Sinai Health and Unity Health 91原创. About 15 orthopedic surgeons 鈥� with the potential for more to join 鈥� offer weekend operations at Sunnybrook鈥檚 Holland Centre, Nousiainen said.

He said patients referred to TRAC by a primary care provider see their surgeon within four to six weeks. And while the province鈥檚 goal is to have non-urgent joint replacement surgeries completed within six months, TRAC patients often get theirs sooner 鈥� sometimes within a month 鈥� because the program offers greater flexibility, Nousiainen said.

鈥淭here鈥檚 variation, depending on the urgency, but the bottom line is the flexibility that TRAC provides the partner surgeons decreases wait times for patients.鈥�

Staffing the Holland Centre on weekends was one of TRAC鈥檚 main challenges. Barbara McArthur, operating room manager at the Holland Centre, said flexible staffing models based on input from nurses helped 鈥渂uy-in,鈥� as well as the knowledge that their weekend efforts are helping patients.

Collaboration among partner hospitals to pool resources and specialists is a key reason for TRAC鈥檚 success, and can be a model for tackling other wait lists in the health system, said Dr. Carmine Simone, an executive member of TRAC and vice-president of medical, strategic and clinical partnerships and innovation at Michael Garron.

Before TRAC, more than 15 per cent of patients at his hospital were waiting longer than the recommended window for joint replacement surgeries; as of March, that number had dropped to 8.7 per cent, Simone said.

Right now, TRAC mainly serves north and east 91原创 but Simone said hospital partners from across the GTA can join, increasing access to more patients and further cutting wait times.

Mingay, who has since had her second hip replaced, said she鈥檚 grateful to have had two joint replacements within nine months. For her right hip, Mingay waited just four weeks from seeing her surgeon 鈥� Sunnybrook鈥檚 Nousiainen 鈥� in November to when she had the procedure the following month, a few days before Christmas.

Four months later, Mingay said both new hips 鈥渨ork great鈥� and that she is slowly getting back to her favourite activities, including walking, riding her bike and volunteering at a 91原创 food bank, where she helps organize听donations.

鈥淒r. Nousiainen says 鈥榢eep moving, don鈥檛 sit,鈥� so that鈥檚 what I鈥檓 doing,鈥� Mingay said. 鈥淚 can walk easily for 40 or 45 minutes 鈥� one day I did over 14,000 steps 鈥� and I can walk with no pain after. It鈥檚 been a new lease on life.鈥�