A surgery is performed in the operating room in Toronto's Hospital for Sick Children on Nov. 30, 2022.Chris Young/The Canadian Press
A nationwide shortage of anesthesiologists is forcing patients to wait longer for surgery and putting hospitals in the increasingly difficult position of prioritizing cases, according to several practising anesthesiologists and a national professional association.
Canada is also facing critical shortages of a wide variety of health care workers, including nurses, family physicians and medical technologists, which are making it more difficult for patients to access timely, high-quality care.
But the shortage of anesthesiologists is being singled out because it can have an outsized impact on patients and the ability to delivery medical services.
It’s a problem that medical leaders say is getting worse.
Last summer, Manitoba’s health authority said it had to postpone 300 surgeries because of a lack of anesthesiologists.
This past February, Ontario’s Niagara Health announced that a shortage of anesthesiologists was forcing it to move emergency after-hours surgeries to its Niagara Falls site from its Welland site.
In April, there were no anesthesiologists available for an entire week in Summerside, forcing patients to be diverted to Charlottetown for care.
Anesthesiologists work throughout hospitals to provide comprehensive sedation and pain management, including in surgical and critical care units, obstetrics and diagnostic imaging. Insufficient staffing means patients are waiting longer – a situation that could deteriorate further as the population ages.
“Access to surgeries in Canada will be impacted for years to come,” said Lucie Filteau, president of the Canadian Anesthesiologists’ Society.
Numbers provided by the association show there are 11 anesthesiologists in Canada for every 100,000 people, compared with 23 in Australia, 21 in the United States and 18 in Britain.
Dr. Filteau said the shortage is compounded by the fact the growing cohort of older Canadians increasingly needs surgery.
Many anesthesiologists are also nearing retirement age, according to the association. In 2018, 13 per cent of anesthesiologists in Canada were 65 or older, while 26 per cent were between 55 and 64.
The pandemic made the situation worse, with clinicians still trying to clear the backlog of patients awaiting surgery and lacking sufficient resources to do so, said Kevin Gregg, the president of the Alberta Medical Association’s anesthesia section.
“The reality is we don’t have enough providers to perform all of the surgeries that need to be done,” Dr. Gregg said. “It’s really tough when you’re in a room with a patient one-on-one and you have to say, ‘You’re not a priority right now.’ That’s the reality of our system.”
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Rohit Kumar, a practising anesthesiologist and chair of Ontario’s Anesthesiologists, said the good news is there are ways to address the current shortages. For instance, some hospitals may be understaffed while others have anesthesiologists who are available to work. Finding ways to address those gaps and ensure hospitals are able to work at full capacity would be an important change, Dr. Kumar said.
But if the shortages in anesthesiology aren’t addressed in the near term, he sees it becoming a much more serious problem.
Dr. Filteau notes that anesthesiologists have long been calling attention to the issue, saying it was an entirely predictable problem.
And it can’t be solved overnight. It can take anywhere from 13 to 15 years for an anesthesiologist to complete training, Dr. Gregg said. Other solutions are being looked at, such as using anesthesiology assistants – respiratory therapists who have completed additional training. While they can’t replace anesthesiologists, in specific circumstances they may be one way to contend with the current shortage, Dr. Gregg said.
Other solutions being touted by the professional association include increasing the number of anesthesiology residency positions; greater use of family practice anesthetists – family physicians who have undergone an additional year of training, in order to fill gaps in rural or remote areas; and creating a national licence for physicians that would allow anesthesiologists to go to areas outside their home province that are facing a significant need.