‘Ottawa’ Reevely: Cutting Doctors’ Fees a Risky Strategy For Ottawa’s Eye-Surgery Backlog
Children who need eye surgery in Eastern Ontario wait an astonishingly long time compared to elsewhere in the province, according to our regional health authority, and the problem begins with long waiting times for the procedures the provincial government wants to pay doctors less to do.
Cataract surgeries are the symbolic central battle in Health Minister Eric Hoskins’ current war with the Ontario Medical Association. Replacing a cloudy lens in an old eye is easier than it used to be and Hoskins wants to pay ophthalmologists less to do it.
A couple of weeks ago, Hoskins brought out the story of a single ophthalmologist who billed the province for $6.6 million in procedures last year to illustrate the point that a doctor can make a mint doing routine work.
The argument is that we should pay less for these things, and Hoskins isn’t necessarily wrong. It’s just that that comes at a cost, which is coincidentally spelled out in a brand new report for the Champlain Local Health Integration Network.
The waits for routine cataract surgeries for adults here — much of the total eye-surgery caseload — are longer than they should be but only a little worse than the provincial target of having 90 per cent of them done within six months.
That’s OK. It’s also where the good news ends.
We can expect the wait times to get massively longer over the next 10 years, as more old eye lenses wear out. Just thanks to aging, Eastern Ontario’s health region can expect the volume of cataract surgeries to increase from about 14,000 in 2014 to 20,000 by 2025. Well, in theory: Somebody has to do all those surgeries and we need places for the surgeons to work and that costs money we don’t want to pay.
The wait time to get strabismus (cross-eyedness) surgery if you’re an adult is 370 days. That condition didn’t get special government attention and it shows.
Worse, grownups are getting their cataract surgeries at the expense of children. If you’re a kid, strabismus surgery takes nearly 450 days, vastly out of whack with the rest of the province. While you wait, there’s a good chance you have worsening vision problems, developmental delays, and sometimes social problems that can grow into psychological ones.
Many ophthalmologists won’t treat children even if they’re qualified to. They don’t have to, with cataracts keeping them busy. Another problem: the eye clinic at the Children’s Hospital of Eastern Ontario is antiquated and inefficient and it’s been hard to recruit new surgeons to work there.
“Plans were drawn up to renovate this space but recent fiscal challenges have put this on hold, challenging our ability to recruit,” the LHIN report says.
Many of the region’s 420 optometrists, who can do some of the same tests and treatment as ophthalmologists, resist taking on kids because they don’t want to be stuck holding the bag when they refer a child for more advanced treatment and then he or she can’t get it. “This has become self-perpetuating and the cycle needs to be broken,” the report says.
Rising demand is, of course, an argument for paying less for cataract surgery. More surgeries at higher prices will bust the budget and it would be great to get more work for less spending. It’s just that usually, if you want more of something, you expect to spend more on it.
The LHIN report doesn’t specifically take up the issue of fees but it does talk about spending more in just about every other way.
We can squeeze some efficiency out of the system, the LHIN report says. We need to get more optometrists doing things instead of ophthalmologists, and we need more efficient transfers of patients information from one office to the next, it says. But we also need more pediatric ophthalmologists, at a minimum. We’ll need extended operating-room hours, Saturday and Sunday surgeries, more space in existing hospitals and more surgical centres run by doctors. More work, more work, more work.
Yes, maybe if we pay ophthalmologists less, some of them will work more to try to maintain their incomes. Maybe that’ll more than make up for the docs who decide to work less. Maybe if cataracts aren’t as lucrative, ophthalmologists will decide to do more strabismus surgeries. Maybe they’ll decide to mix more children in with the adults.
Those are best-case scenarios. Most of them involve fewer cataract surgeries getting done right as demand for cataract surgery roars