As long as I’m working it’s ok, but let’s say it’s starting to get rough [financièrement]
says Dr. Marie Gdalevitch.
The latter has been an orthopedic surgeon for a few years at the Verdun Hospital, in the center-south of Montreal.
Dr. Marie Gdalevitch, orthopedic surgeon, Canadian specialist in limb lengthening and correction of deformities.
Photo : Ivanoh Demers
She and her sister, who specializes in plastic surgery, have invested two million dollars to set up two operating theaters in the Town of Mount Royal. They expected to obtain a permit in the months following their application in November 2021 to perform medical procedures covered and not covered by the RAMQ.
However, for the moment, even if everything is ready, they cannot carry out any surgery there.
Our goal was to have a center to make cases of the waiting list to the public
says Marie Gdalevitch.
This Canadian limb lengthening and deformity correction specialist alone has close to 300 patients on her orthopedic waiting list.
And it’s not just his list that explodes. This is the case almost everywhere in Quebec, a phenomenon that appeared in a pandemic and that the public network is unable to reduce.
According to data from the department, nearly 40,000 orthopedic patients are on waiting lists across Quebec, including more than 6,300 for more than a year. This specialty is by far the one with the most patients waiting, whether for a hip or a knee, for example.
In plastic surgery, the specialty of his sister, it is regarding 30% of the 8265 patients who have been waiting for more than a year. Plastic surgery covers essential interventions, including breast reconstruction following cancer, the correction of deformities in patients who have been victims of road accidents or the numbness of a hand.
The Minister of Health had presented a plan in June 2021 to reduce the lists to the pre-pandemic level for March 2023. The shortage of nursing staff changed the plans.
To date, private surgery centers perform 10% to 15% of the volume of surgery.
Support from their associations
As soon as they received the refusal letter from the Minister of Health, the two sisters immediately prepared a request for review.
They count on the support of their professional associations.
Orthopedists want to operate and there is nothing more frustrating than seeing patients who just want to know when they are going to have surgery.
says the new president of the Quebec Orthopedic Association, Véronique Godbout.
Dr. Véronique Godbout, president of the Quebec Orthopedic Association.
Photo : Radio-Canada
Dr. Godbout, who practices in the public network at Notre-Dame Hospital in Montreal, believes that Quebec must make more room for private health care.
« We are not the first in the world to want to integrate private with public. I think we are there in Quebec, I think we are even late! »
As for the president of the Association of specialists in plastic and aesthetic surgery of Quebec, Dr. Eric Bensimon, he believes that the licensing process raises questions.
We would like a transparent process, that we know what it takes to obtain a CMS [centre médical spécialisé]
claims Dr. Bensimon.
Dr. Eric Bensimon, president of the Association of Plastic and Aesthetic Surgery Specialists of Quebec.
Photo : Radio-Canada
« We cannot build a CMS of good will, of good faith, and at the end of the day being told that maybe we’ll give you the permit, maybe not. These are major investments. »
According to our information, two plastic surgeons acquired a building on a commercial street in Westmount at the start of COVID, in addition to setting up six operating theaters there. A multi-million dollar investment. A web page in English promotes the cosmetic surgery services that would be offered there.
Two years later, the two entrepreneurial surgeons had to raise their mortgage to $15 million in addition to juggling legal mortgages in the construction industry.
According to a source familiar with the scene, the two doctors took a bold financial risk. They preferred not to grant an interview.
Six operating theaters have been set up in a building in Westmount. The two owner surgeons are trying to obtain a license from the Ministry of Health.
Photo : Radio-Canada / Davide Gentile
A cut public network?
Minister of Health Christian Dubé has already mentioned in an interview that he was not in favor of new private aesthetic surgery centers, given the shortage of nurses in the public network.
In the letter of refusal received by the Gdalevitch sisters, it is specified in particular that a situation of labor shortage and a lack of medical availability are present in the same administrative sector
.
Marie Gdalevitch says she understands these concerns. But the nurse who is going to leave the hospital, she’s going to leave, it doesn’t matter, and if you close the private sector, she won’t stay in the hospital because you have closed the private sector.
she argues.
Most of the nurses who would work with her and her sister would come from other CMS private or nursing staff placement agencies, according to a document submitted to the ministry.
At the Order of Nurses of Quebec (OIIQ), which compiles data on the nursing workforce in Quebec, we do not have specific data on the number of nurses in CMS.
At best, it is stated that more than 9% of the 76,000 nurses who have a job in Quebec work in the private sector
including in agencies, pharmacies and CMS.
Called to react last week to the CAQ’s private hospital projects, the president of the CSNCaroline Senneville, supported that the vast majority of the staff who will work in these new hospitals will necessarily come from the public network, which is already struggling with serious labor shortages
.
According to the group Médecins québécois pour le régime public, the subcontracting of surgeries paid for by the RAMQ must remain a short-term solution.
If we want to avoid further strengthening a two-tier health care system, it is essential, in the short term, that the granting of permits go first to the CMS who support surgeries from the public network wait list, it is a harm reduction approach
says its president, family doctor Mathieu Isabel.
« In the medium and long term, it is the very existence of CMS that must be questioned. By continuing to develop a parallel network of CMSwe risk reviving, with these companies, certain problems similar to what we currently see with private employment agencies. »
In addition to the debate around nurses, others also fear that hospitals are stripped of their medical specialists.
Dr. Perry Gdalevitch, plastic surgeon.
Photo : Ivanoh Demers
Perry Gdalevitch explains that he left the public network a few years ago for personal reasons.
I was the only plastic surgeon at the Saint-Eustache Hospital
she says. I was not allowed to have a vacation, I was always on duty, I had no more life.
She explains that she had no choice but to resign.
Today, she is free from her schedule and rents operating time in other private surgery centers to receive her clients. I love breast reconstruction, it’s my passion
she says.
Au CISSS des Laurentides, spokesperson Dominique Gauthier writes that the planned recruitment of new medical specialists in 2023 will certainly allow us to increase our service offer to the population
.
The latter also cites an agreement with a new CMS which should allow increase the number of technical platforms dedicated to day surgery in the Lower Laurentians
.
Aesthetics to finance equipment
According to the plan of the two sisters, 25% of the operating time of their surgery center would be devoted to medical procedures not covered by the RAMQ.
The demand is huge for aesthetics and people come and want their surgery tomorrow morning
says Perry Gdalevitch.
According to her, there is a market
which otherwise fuels overseas medical tourism.
boost on the public side that can’t afford the beauty of the new equipment”,”text”:”All that equipment costs money and the private comes to fund the public, give a little boost on the public side that can’t afford the beauty of new equipment”}}”>All this equipment costs money and the private sector finances the public, gives a small boost on the public side that can’t afford the beauty of the new equipment
she concludes.
