Entrepreneurial doctors eager to find their scalpel

Doctors from the public and private sectors believe that the opening of new private surgery centers must be accelerated to reduce the lists of expectations that remain at peaks.

Surgeons Marie and Perry Gdalevitch.

When they received at February the response from the Minister of Health informing them of his intention to refuse their request for a permit for a private surgery center, Marie and Perry Gdalevitch were startled.

As long as I working, that's okay, but let's say it's starting to be difficult [financially], says Dr. Marie Gdalevitch.

The latter has been an orthopedic surgeon for a few years at the Hôpital de Verdun, in south-central Montreal.

Dr. Marie Gdalevitch, orthopedic surgeon, Canadian specialist in limb lengthening and deformity correction.

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 perform any surgery there.

Our goal was to have a center to make cases of the waiting list to the public, says Marie Gdalevitch.

On her own, this Canadian specialist in limb lengthening and correction deformities has nearly 300 patients on its orthopedic waiting list.

Two million dollars have been invested to develop two new operating theaters in the town of Mount Royal.

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 ministry, 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 its sister, that's about 30% of the 8,265 patients who have been waiting for over 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 by March 2023. The shortage of nursing staff changed the plans.

To date, private surgery centers perform 10% to 15% of the volume of surgery.

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 Association d'orthopédie du Québec, Véronique Godbout.

Dr. Véronique Godbout, president of the Quebec Orthopedic Association.

Dr. Godbout, who practices in the public system at Notre-Dame Hospital in Montreal, believes that Quebec must make more room for the private sector in health.

“We are not the first in the world to want to integrate the private sector with public. I think we are there in Quebec, I think we are even late! »

— Véronique Godbout, president of the Quebec Orthopedic Association

As for the president of the Association of Plastic and Aesthetic Surgery Specialists 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 [specialized medical center], claims the Dr. Bensimon.

Dr Eric Bensimon, president of the Association of Plastic and Aesthetic Surgery Specialists of Quebec.

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“You can't build a CMS out of good will, good faith, and at the end of the day be told maybe we will give you the permit, maybe not. These are major investments. »

— Eric Bensimon, President of the Association of Plastic and Aesthetic Surgery Specialists of Quebec

According to our information, two plastic surgeons acquired a building on a commercial street in Westmount in addition to fitting out six operating rooms. 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 construction mortgages.

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 permit from the Ministry of Health.

Health Minister 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 will leave, it doesn't matter, and if you close the private sector, she will not stay in the hospital because you have closed the private sector, she argues.

Most of the nurses working with her and her sister would come from other private CMSs or nursing placement agencies, according to a document submitted to the ministry.

To the College 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 agencies, pharmacies and CMS.

Called reacting last week to the CAQ's private hospital projects, CSN President Caroline Senneville maintained that the vast majority of the staff who will work in these new hospitals will necessarily come from the public network, already grappling with serious labor shortages.

According to the group Médecins québécois pour le régime public, the outsourcing of surgeries paid for by the RAMQ must remain a short-term solution.

If we want to avoid further strengthening a system of two-tier health care, it is essential, in the short term, that the granting of permits go first to the CMS which take on surgeries from the public network wait list, it is a harm reduction approach, declares 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 CMS, we risk reviving, with these companies, certain problems similar to what we currently see with private employment agencies. »

— Dr. Mathieu Isabel, President of Quebec Doctors for the Public Regime

In addition to the debate around nurses, others also fear that hospitals will be stripped of their medical specialists.

Dr. Perry Gdalevitch, plastic surgeon.

Perry Gdalevitch explains that he left the public sector 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 call, I had no more life. She explains that she had no choice but to resign.

Today, she is free to schedule and rents operating time from other surgery centers private to receive its customers. I love breast reconstruction, it's my passion, she says.

At the 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.

This last also mentions an agreement with a new CMS which should make it possible to increase the number of technical platforms dedicated to day surgeries in the Lower Laurentians.

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.

There is a huge demand for aesthetics and people come and want their surgery tomorrow morning, says Perry Gdalevitch.

According to her, there is a market that otherwise fuels medical tourism abroad.

All this equipment costs money and the private comes to finance the public, to give a little boost on the public side who can't afford the beauty of the new equipment, she concludes.