Search for Saint John thoracic surgeon underway

Thoracic surgery services won't leave Saint John, medical staff leader insists

The Horizon Health Network has posted a job opening for a new thoracic surgeon for the Saint John region amid a staffing shortage in New Brunswick.

Horizon's only two thoracic surgeons, located in Saint John and Moncton, have both been on unexpected sick leave for about a month and there is no word on when either of them will return to work.

The Saint John Regional Hospital is now recruiting a second full-time thoracic surgeon "to begin practice immediately" under an alternate funding plan, or AFP, remuneration model, says the online job posting dated March 15.

The estimated pay would be between $450,000 and $475,000 annually for 40 hours per week, according to the Canada Job Bank website.

The Moncton Hospital has been trying to recruit a second thoracic surgeon under a fee-for-service remuneration model for nearly a year.

Thoracic surgeons are specialists who deal with structures of the chest, such as the esophagus, lungs and diaphragm muscle, but not the heart.

They treat diseases ranging from cancer to gastroesophageal reflux, remove benign tumours, perform chest reconstruction after major traumas and handle lung transplants.

National shortage

There is a national shortage of thoracic surgeons, according to Dr. Christian Finley, a thoracic surgeon in Hamilton, Ont., who is leading a federal initiative to put together a national standard for thoracic surgery.

There are approximately 10 vacancies across the country, said Finley, who works at St. Joseph's Healthcare Hamilton and is an assistant professor at McMaster University.

Only about 75 thoracic surgeons are  in practice in Canada and only a handful graduate each year, he said.

It's unclear when the Saint John region was approved for a second thoracic surgeon.

Dr. Edouard Hendriks, Horizon's vice-president of medical, academic and research affairs, made no mention of the job opening during a news conference about the staffing shortage, held on March 17 — two days after the position was posted online.

"At this point in time … in New Brunswick we have, I would call it, an adequate number of surgeons providing this service to the province," Hendriks had said.

He did say Horizon was reviewing patient volumes and meeting with the New Brunswick Medical Society and medicare to discuss whether more thoracic surgeons are needed, given the aging population and high cancer rates, where they should be located, and what the best remuneration model would be.

"The discussion has been going very positively in the past few months so we are expecting potentially good news in the very near future," Hendriks had said without elaborating.

Remuneration changes not yet approved

Although the job posting states remuneration is "based on New Brunswick medicare's alternate funding plan for thoracic surgery," the "final AFP has not yet been approved," Hendriks confirmed in a statement to CBC News on Friday.

"However, we are very optimistic this funding model will be approved and there was an agreement to use it in our posting to ensure candidates would understand that New Brunswick offers a competitive remuneration for this position," he said.

"It was our intention to post early so that Horizon does not miss the opportunity to recruit upcoming new graduates that are currently looking for positions. Once the final details on the remuneration model will be determined, they will be communicated to the candidates."

The medical staff organization for the Saint John region had been trying to negotiate for a second thoracic surgeon and a change in the remuneration model for the past four years, according to president Dr. Patti Forgeron.

But the plan had been "stonewalled at a number of different stages for different reasons and now we have a crisis," Forgeron told CBC News last week.

Moncton surgeon 'undergoing treatment'

Doctors at the Moncton Hospital say they are "very much aware" of the "difficulty" patients are having obtaining thoracic surgery in the province, but they are limited by their resources in providing care.

"Working with the Medical Society of New Brunswick as well as the province of New Brunswick and Horizon Health Network, we are hopeful that we will be able to recruit two new thoracic surgical providers, one each to both Saint John and Moncton in the near future to alleviate the stress on our already overworked thoracic surgeons," Moncton medical staff said in a statement on Friday.

The Moncton region's thoracic surgeon, who has provided about one-third of thoracic surgeries for patients in New Brunswick, Prince Edward Island and northern Nova Scotia for more than 30 years, is "undergoing treatment," according to the statement.

Staff wish him a "speedy recovery" and are "extremely optimistic" he will be back on duty "in the near future."

The Saint John thoracic surgeon is off for "an undefined period of time," Hendriks has said.

"Notwithstanding these difficulties, we are doing our utmost to provide the care as needed," with assistance from other "thoracic surgical providers" in New Brunswick and Quebec, the Moncton medical staff said.

Some general surgeons perform some thoracic surgeries.

"Unfortunately, our Halifax colleagues are unable to assist us."

Patients are also being referred to oncology and respirology experts in New Brunswick and Quebec "to ensure access to care," the statement said.

"We … are hopeful that with the potential ability to hire two new thoracic surgical providers we will be able to avoid a similar issue in the future if it so arises."