Faced with a previously lengthy waiting list for hip and knee replacements made even longer by the pandemic, Dr. Eric Bohm and other orthopedic surgeons would like to perform more surgeries — but the province won’t let them.
At least not yet.
It's all because, for budgeting purposes, the province caps the number of hip- and knee-replacement procedures surgeons can perform.
Bohm, an orthopedic surgeon at Concordia Hospital, a professor of surgery at the University of Manitoba and the medical adviser for the Winnipeg Regional Health Authority's orthopedic wait list, said procedures in the four places hip and knee surgeries are mainly performed at — Concordia and Grace hospitals, the Health Sciences Centre and the Boundary Trails Health Centre in Winkler and Morden — have been capped at 4,000 for a few years.
But three years ago, with a growing wait list that showed no signs of decreasing, the province agreed to raise the number to 5,000 surgeries per year.
And then COVID-19 arrived.
"Three years ago there was a lucid, rational decision to increase the volume based on the continuum we had, and that was just torpedoed by the pandemic," Bohm said.
"We've got to clear this backlog to get back to a normal state, and that is going to take a lot of work... certainly all the surgeons I know would be happy to do more cases."
Before the pandemic, Bohm had a list of 175 patients waiting for surgery. It now sits at 350.
Surgeons could each do between 400 to 500 per year, he said.
"Three years ago there was a lucid, rational decision to increase the volume based on the continuum we had, and that was just torpedoed by the pandemic." ‐ Dr. Eric Bohm, orthopedic surgeon at Concordia Hospital
"I do about 350 or 375 per year," he said. "I also do probably 25 emergency cases a year. I've got exactly a year's worth of work on my waiting list if we started back up at the same rate we were doing before."
The only way to clear the backlog is, not surprisingly, to do more surgeries, he said. And that means the province will have to lift the cap even higher.
"Manitoba patients deserve better health care sooner, and that includes reducing the time they wait for priority procedures," then-health minister Cameron Friesen said in November 2018 during an announcement of the bump in surgery numbers.
A Shared Health spokesman said because the number of surgeries are budgeted, hospitals schedule them "to ensure a consistency and continuity of service that lasts throughout the year.
"If a site gets behind or ahead on their predicted volumes, the regional health authority will work with the side to determine how best to manage."
But the spokesman said special consideration will be given because of the pandemic's disruptions in surgical activity and the backlog.
Bohm said tackling and clearing the backlog will not be a quick undertaking; he expects the province, Shared Health and others will have to sit down again, as they did in 2018, to figure out how many surgeries will have to be done annually to catch up in a post-pandemic world.
"It is a lot longer than you think it is going to be because you can't double your surgical volume," he said. "You're probably looking at a 30 per cent increase for three years to clear that backlog."
At least one of Bohm's patients — former travel agency owner Max Johnson — told the Free Press recently he was not willing to wait a long time for his knee-replacement surgery. Johnson opted to fly to a surgical centre in Lithuania, where he will pay about $16,000 Canadian for the procedure and two weeks of rehabilitation.
"It is a lot longer than you think it is going to be because you can't double your surgical volume. You're probably looking at a 30 per cent increase for three years to clear that backlog." ‐ Dr. Eric Bohm, orthopedic surgeon at Concordia Hospital
And Johnson is not alone. At least two other Manitobans told the Free Press they went to a surgical centre in Calgary to pay to have their hips replaced at a cost of about $50,000 in total.
"I understand why people go to the states," said Bohm. "I understand why people go to Lithuania to have their procedures done. They don't want to wait."
But that doesn't mean that he wants to see a private system set up to reduce the size of the wait list.
"I'm a very strong supporter of a universal publicly funded health-care system," he said. "You look at the data and it is the most cost-effective and high-quality way of providing health care. If you have a private parallel system, you will start siphoning off resources, human resources, from the public system.
"You'll simply spend more money doing what you are doing in the public system."
For now, Bohm said Manitobans should make sure they are vaccinated so they are ready for elective surgeries.
"I've had one patient who has refused to be vaccinated and is quite upset he can't have his hip surgery," said Bohm. "There are some people (who are) very anti-vaccine and it is hard to understand the reason.
"They will trust me to cut them open and to permanently alter them for the rest of their life, but they won't trust me when I tell them having the vaccine is the single most important thing they can do.
"It puzzles me."
Kevin Rollason is one of the more versatile reporters at the Winnipeg Free Press. Whether it is covering city hall, the law courts, or general reporting, Rollason can be counted on to not only answer the 5 Ws — Who, What, When, Where and Why — but to do it in an interesting and accessible way for readers.