Vitalité wants to open thoracic surgery 'centre of excellence' in Moncton

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

The Vitalité Health Network wants to open a thoracic surgery "centre of excellence" at the Dr. Georges-L.-Dumont University Hospital Centre in Moncton.

It's part of Vitalité's strategic plan, said vice-president of medical services Dr. France Desrosiers.

"Really, we should have a multi-disciplinary team that would include thoracic surgeons, oncologists and respirologists," she said.

"This would ensure a critical mass of specialists and patients, and allow for efficient and high-quality health service, [and] sufficient volume of surgery to maintain excellence and competency for the province."

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.

New Brunswick is currently dealing with a thoracic surgery coverage crisis.

Moncton's only certified thoracic surgeon, who works for the Horizon Health Network, has been on unexpected leave for about a month, "undergoing treatment," officials have said.

And a Horizon general surgeon in Saint John, who has thoracic fellowship training, has also been on unexpected medical leave since late February, with no word of when he'll return to work.

Horizon's only other certified thoracic surgeon, who is based in Fredericton, is covering the entire province, with help from two of Vitalité's general surgeons in Moncton and Edmundston who have some thoracic expertise.

Horizon also hopes to consolidate

Vitalité hasn't discussed the centre of excellence idea with the Department of Health yet, said Desrosiers, and it's too soon to discuss any details.

But she did say the Dumont already has a sufficient number of oncologists and respirologists for a centralized service.

For thoracic surgeons, "maybe [the Dumont and the Horizon Health Network's Moncton Hospital] should be together on that project," she suggested.

Horizon, however, may have plans of its own. It has been trying to recruit a second thoracic surgeon for the Moncton Hospital for about a year, but changed the job posting just last week from a fee-for-service remuneration model to an "alternate funding plan" [AFP], which typically involves a base salary.

"The department at present consists of five and a half general surgeons, one thoracic and two vascular surgeons," the ad states.  

Horizon also recently posted an opening for a thoracic surgeon at the Saint John Regional Hospital with AFP remuneration.

Dr. Edouard Hendriks, Horizon's vice-president of medical, academic and research affairs, has said the regional health authority has been reviewing its thoracic surgeon staffing levels and distribution, and discussing the situation with the New Brunswick Medical Society and medicare.

"Our hope is to eventually get some kind of approval and agreement to consolidate the services in at least our major centres," Hendriks has said.

Some provinces successfully regionalized

Other provinces, such as Ontario and British Columbia, have already consolidated thoracic services through regionalization with success, according to Dr. Andrew Seely, the vice-president of the Canadian Association of Thoracic Surgeons.

Concentrating care in one or two centres with multiple surgeons working together, along with related multi-disciplinary support services, is safer for patients and surgeons alike, said Seely.

"It is our recommendation that thoracic surgeons work in teams," he said.

The model, similar to the one used for cardiac care at the New Brunswick Heart Centre in Saint John, ensures a support system if any surgeons get sick or need time off, said Seely.

It also increases patient volumes, which fosters expertise and leads to better outcomes, studies have indicated, he said.

Health minister urges patience

Health Minister Victor Boudreau said talks are ongoing between the department, both regional health authorities and the surgeons involved to find ways to "improve the overall situation."

"We see what can happen when you have just a few specialists and for various reasons, one or two end up on leave, it does cause pressures and stress on the system." said Boudreau.

"There's no question that being spread over multiple facilities does cause particular challenges, but you know I'm certainly not prepared to say consolidation is something that's going to happen," he said.

"We want to be able to make sure that we're able to continue to provide a sustainable service to New Brunswickers. That's obviously what's important here."

"But until we get there and actually have a concrete solution, I don't think I'm going to start speculating through the media what that could look like," he said.

Boudreau said he sympathizes with the patients who are waiting for thoracic surgeries, but urges them to "be patient and to have confidence that we are doing everything we can to try to improve the situation."