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Ontario Government Enlarges Role of Ambulatory Clinics

The government of Ontario, Canada’s most populous province, will expand the capacity of ambulatory clinics to shorten wait times for various procedures. The private clinics will receive public funding to deliver services such as cataract surgeries, hip and knee replacements, and CT and MRI imaging. Some healthcare officials, however, express concern that these clinics will drain resources and expertise from public hospitals.

“This plan will boost the availability of publicly funded health services in Ontario, ensuring that Ontarians currently waiting for specialized surgeries will have greater access to world-class care where and when they need it,” said Ontario Health Minister Sylvia Jones at a news conference on January 16. “Bold solutions are necessary to improve the healthcare system as we know it today.”

Publicly Funded Care

Describing the status quo with respect to wait times for cataract surgeries and hip and knee replacements in Ontario as “unacceptable,” Ontario Premier Doug Ford underlined that the services to be offered at the ambulatory and diagnostic clinics will be covered under the public health plan.

“Ontarians will always access healthcare with their OHIP [Ontario Health Insurance Plan] card, never their credit card,” Ford said at the same news conference.

The three-part plan will initially involve investments for cataract surgeries and plastic surgeries, followed by a focus on increasing the number of colonoscopy and endoscopy procedures and continuing cataract surgeries. The third step of the plan involves the passage of legislation in February 2023 that will permit these centers to perform hip and knee replacements at the beginning of 2024.

OMA Seeks Involvement

There is no disagreement among stakeholders in Ontario healthcare that there is a backlog of surgeries, along with unacceptable wait times, said Rose Zacharias, MD, president of the Ontario Medical Association (OMA).

The average wait time for cataract surgery in Ontario is 35 days. But some patients wait as long as 111 days. Factors that are taken into account are need and access to healthcare providers, according to the Ontario health ministry.

Zacharias emphasized that the OMA is not against having surgeries and procedures performed in ambulatory settings but wants reassurances about how the clinics will operate.

“This announcement of bringing those surgeries and procedures out of the hospital and into the community into these focused, dedicated ambulatory clinics is something that the OMA has been recommending for some time,” Zacharias told Medscape Medical News.

Questions remain, however, about how connected these centers will be to the hospital system, where more emergent and higher-acuity procedures will still be performed. Other questions include whether the centers will take resources away from hospitals and what follow-up care will be offered to patients who are treated at the centers, according to Zacharias.

“These [ambulatory centers] need to be connected to hospitals and the broader Ontario health regions in order to protect patients’ safety and quality” of care, said Zacharias. “We also need a health human resources strategy. We are dealing with such a critical doctor and nursing shortage, so we need to ensure that these centers don’t take those resources away from hospitals or exacerbate our existing doctor and nursing shortage and ensure hospitals are still staffed appropriately.

“With the implementation of these models, Ontario’s doctors want to be at the table,” said Zacharias. “What we’re currently not seeing a commitment to is an implementation plan that would include all the stakeholders, including doctors, nurses, the Ontario Hospital Association, and our college [the College of Physicians and Surgeons of Ontario (CPSO)], which would regulate the professionals that will be working at these stand-alone clinics. This key group of external stakeholders needs to be part of the government’s implementation plan. And that’s what we are asking for.”

Continuity of Care

The CPSO, which regulates the practice of medicine in Ontario and is responsible for investigating complaints from members of the public about doctors in Ontario, has also expressed concerns.

“I recently met with senior officials from the [Ontario Health] Ministry and the Minister’s Office regarding the premier’s announcement,” CPSO Registrar Nancy Whitmore, MD, told Medscape. “We reiterated our position that complex procedures such as hip and knee joint replacement surgeries should remain connected to the hospital system to ensure continuity of care and patient safety.”

Whitmore added that the CPSO supports augmenting access to diagnostic procedures and standard surgical procedures. It is concerned, however, about the potential for the ambulatory clinics to siphon off healthcare staff.

“The CPSO is supportive of expanding access to diagnostic procedures and less complex surgical procedures in community settings,” wrote Whitmore. “However, we emphasized our ongoing concern about creating further strain on the present healthcare provider crisis, particularly in skilled operating room nurses and anesthesiologists. We will continue to work hard to help address the substantial healthcare issues Ontario is facing.”

Zacharias and Whitmore have disclosed no relevant financial relationships.

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