Ontario facing critical shortage of neurosurgical specialists

Ontario could soon face a severe shortage of neurosurgeons and related specialists unless important changes are made immediately, says a new report from the Institute for Clinical Evauative Sciences (ICES).

“The neurosurgical sciences are a small and often overlooked part of our healthcare system. The few dozen physicians providing these services experience heavy workloads and resource limitations. Many are leaving Ontario for other provinces and the United States,” said report lead author and ICES associate scientist Dr. Joshua Tepper.

“Over the past few years, Ontario’s neurosurgical services have been stretched to capacity, and, in some circumstances, beyond capacity. This report provides workable recommendations for the province to reverse the current trends so we can meet the needs of patients for these important services,” said Tom Closson, chair of the Provincial Neurosurgical Task Force, and president and CEO of University Health Network.

Researchers used a variety of research methods, as well as a literature review and expert panels, to identify system-level medical staff and technology issues that impact access to the following neurosurgical specialties: neurosurgery, complex spinal surgery, and interventional neuroradiology.

The various analyses showed that:

• Ontario’s neurosurgeons are barely keeping up with demand and are doing so at very high academic and personal costs. Neurosurgeons have among the highest levels of on-call hours of service of all physician groups, and work between 73 to 81 hours per week;
• Although 6 new neurosurgeons graduate in Ontario each year, only about 1 or 2 begin to practice here due, at least in part, to a lack of opportunities in Ontario hospitals. Previous research has shown that 5 years following their graduation, approximately 50% of Ontario neurosurgery graduates have left to practice in other provinces or the U.S.;
• There are large and growing waiting lists for even a first assessment by complex spinal surgeons;
• Timely access to interventional neuroradiology is limited because of the low number of centres providing the service;
• There will likely be an expanding need for complex spinal surgery and interventional neuroradiology, which will be difficult to meet with current physician numbers and allocated resources (including diagnostic and treatment equipment); and,
• Access to care for complex spinal surgery and interventional neuroradiology is unequal across the province.

“Demand for neurosurgical science services is predicted to increase with an aging population and the introduction of new surgical procedures. At the same time, the current workforce is an older group that will probably want to start reducing their high workloads and ultimately consider retiring,” said Dr. Tepper.

In order to sustain and strengthen this critical provincial resource, the report makes a series of recommendations that the Ontario Ministry of Health and Long-Term Care should consider. These include:

• Recruiting 10 additional neurosurgeons over the next 2 to 3 years;
• Capitalizing on changes in U.S. regulations that will make it much harder for Canadian-trained neurosurgeons to work in the U.S.;
• Creating an attractive system that will improve retention of Ontario neurosurgeons;
• Implementing new models of compensation for neurosurgeons; Stabilizing funding for new evidence-based neurosurgical technologies to provide state-of-the-art care for Ontarians; Improving access to care and reducing workload by establishing multidisciplinary teams (including advanced trained nurses, family physicians, and physiotherapists) to provide many of the services, particularly initial assessments, for complex spinal surgery; and
• Establishing a province-wide strategy for interventional neuroradiology to address provincial variations in timely access.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

FOR FURTHER INFORMATION, PLEASE CONTACT:

• Julie Argles
• Media Relations Officer, ICES
• (416) 480-4780 or cell (416) 432-8143