EXCLUSIVE: Patients waiting a non-urgent appointment in gastroenterology, ENT and urology at CIUSSS Estrie-CHUS must be patient. To see a urologist, wait until an average of 586 days, while 324 days on average waiting are needed to see a gastroenterologist and 394 days for an ENT. No, the number of consultation requests has not exploded in recent years. In any case, it is the lack of doctors that is denounced.
D years each specialty, coded emergent patients (A) and pressing (B) are all seen without waiting below the ministerial target of three days. However, the situation is far from the same for all other patients.
The 10 urologists posted at the CIUSSS of Estrie-CHUS see patients coded A, B and C within deadlines close to ministerial targets. But things go wrong for patients coded D and E who have to wait on average respectively 231 and 586 days while the targets of the Ministry of Health and Social Services (MSSS) are respectively 90 and 365 days.
The difficulties are great also in gastroenterology. Patients coded C (28-day target) must wait 149 days to see one of the 17 specialist physicians from the CIUSSS of Estrie-CHUS, 146 days for a patient coded D and 324 days for patients coded E.
ENT doctors are also in great demand. The 12 physicians in place manage to see the patients coded D and E in average time of 170 and 394 days.
Recruitment of Specialist Physicians
What is the reason for such long delays in seeing specialist physicians? There are too few specialist doctors on duty to meet the demand.
“The problem in urology is provincial: it lacks doctors. There are great recruitment efforts here at the CIUSSS of Estrie-CHUS, but yet, we have two positions out of 10 that are not filled at the moment. We have a recruitment planned for this summer, but a retirement announced at the same time, so it will not change much the situation, “says André Lortie, assistant director of professional services at the CIUSSS of Estrie-CHUS. The next recruitment is planned for 2020.
In Quebec, there are 180 specialist positions in urology; only 162 are occupied.
Otolaryngologists (ENT) are also difficult to recruit. Currently, only 12 of the 14 available positions are occupied. According to MSSS data, there are currently 200 ENTs on the 209 positions posted for all hospitals.
“Recruitment is difficult there too. We have not been able to recruit for 2020-2021, “says Lortie.
There are also two vacancies on the gastroenterology side where there are 17 doctors for 19 positions. In Quebec as a whole, 11 gastroenterologists are missing to fill all positions.
“These are data that do not matter if there are doctors on sick leave, gradual returns or semi-retirement,” says Lortie.
Action plans have been put in place in each service to improve efficiency. An example ? “People who have to go through a screening colonoscopy now meet a nurse before the exam rather than the gastroenterologist, and they meet the doctor at the time of the examination. It allowed us to free up doctors’ time, “he adds.
In all specialties, mechanisms have been put in place to help family physicians, in particular with decision algorithms for several common pathologies related to each of the specialties. “We try to support them before they make the decision to refer to a medical specialist,” says Lortie.
He reminded that patients can go back to their family doctor at any time if there are any changes in their health condition.
“We have mechanisms in place so that family doctors can let them know if the patient’s medical condition is changing,” he adds.
Service corridors are also used when other CIUSSS have more availability, such as patients referred to ENT in Montérégie and Thetford Mines.
Do not blame existing medical specialists, says Deputy Director of Professional Services, because outpatient appointments are only one part of their multiple tasks in university hospitals like CIUSSS of Estrie-CHUS.
“Medical specialists have many other responsibilities outside the outpatient clinic. They are also in charge of hospitalized patients, ENTs and urologists have a fairly important surgery practice. They also have activities in research and teaching. Also, in these specialties, there is no off-premises practice to support doctors in outpatient clinics, as it can be done in other regions, “says André Lortie.