Wait times for hip and knee replacements may have dropped dramatically in the Horizon Health Network, but it's come at the expense of other types of surgeries, say some Fredericton doctors. 

It's a "rob Peter to pay Paul" situation, said Dr. Chris Goodyear, a general surgeon at the Dr. Everett Chalmers Regional Hospital and a former president of the New Brunswick Medical Society.

"The ripple effect is that our wait times have gone up," he said. 

"So when I see a new patient in my office with breast cancer, for example, instead of telling them they're going to have their surgery in two to three weeks, it's now four to six weeks."

Wait times for cancer surgeries are now double pre-2023 waits, he said, but they're still within the national benchmark of six weeks. 

"We are meeting those targets still, but it means a four- to six-week wait. So if you're the patient being told you have cancer, you are waiting twice as long. However, you are still within that safe area."

   Dr. Chris Goodyear, a former president of the New Brunswick Medical Society, said the 'ripple effect' of focusing on hip and knee replacements has meant increased wait times for other surgeries, including for cancer. (Rachel Cave/CBC)

But to prioritize cancer surgeries, "a lot of our other elective surgeries like gallbladder surgeries are now waiting much longer," Goodyear said. 

And that means patients are presenting at the emergency department in worse condition and often require after-hours emergency surgery, which is more expensive than a regularly scheduled, relatively routine one, said Goodyear. 

Before 2023, he said the wait time for gallbladder surgery would have been two to three months. 

"Now that's over seven months to a year to wait. And again, the longer you're waiting, the more chance that you're going to end up in the emergency department with a more acute episode."

Horizon boasts of waitlist win

Last month, Horizon Health Network said it had eliminated the waitlist of patients waiting a year or more for hip and knee replacement surgery. The list had previously ballooned to 700 people. 

Patients are now waiting less than 300 days, according to Horizon. 

Wait times were reduced largely by adding hip and knee surgeries to the Upper River Valley Hospital and running operating rooms a bit later than usual in Saint John, said a spokesperson for the health authority. 

About 1,500 hip and knee replacements were performed just in the last year.

Horizon was asked about the doctors' claims, but spokesperson Kris McDavid said no one was available for an interview on Tuesday.

In an emailed statement, Dr. Patricia Bryden, co-lead of surgical services for Horizon, said Horizon has been able to reduce wait times for hip and knee replacements "without impacting wait times for urgent procedures such as cancer surgeries."

"Across Horizon, most patients are receiving cancer surgeries much more quickly than in previous years, with 90 per cent having their surgery completed approximately 10 per cent sooner during fiscal year 2023-24 than in fiscal 2022-23."

Ripple effect

While he's "thankful" the system was able to reduce the wait times for replacement surgeries, he doesn't want to see one type of surgery benefit at the expense of others. 

Neither does Dr. Christa Mullaly, an obstetrician and gynecologist at the Chalmers. She said there's been a similar effect on wait times in her department. 

About a year ago, just over a third of gynecological patients at the Chalmers were waiting longer than national targets for surgery, Mullaly said. Now almost 80 per cent of them are waiting longer than national targets, she said.

"And we've gone from almost no one waiting a year for their gynecologic surgery to almost six per cent of our patients waiting more than a year."

   Dr. Christa Mullaly, an obstetrician and gynecologist at the Chalmers, said a focus on joint replacement surgery has meant an increase in wait times for her patients. (Submitted by Christa Mullaly)

Like Goodyear, Mullaly said her time in the operating room at the Chalmers has been drastically reduced — in part because of a long-term shortage of anesthesiologists but made worse because of the focus on joint surgeries over the last 15 months. 

Mullaly, who has been at the Chalmers almost 20 years, said that for the majority of her first 15 years, she usually had two or three operating days a month. 

"And now our entire department has been reduced to about one day per month [per doctor]," she said.

As a result, the number of patients waiting for surgery has almost tripled, she said.

Bryden said operating room time is based on "overall waitlists and historical data for higher acuity surgeries.

"As such, some surgeons and surgical specialities have more OR time than others."

She said surgeries are "prioritized in accordance with New Brunswick's Surgical Access Registry Policy criteria: acuity of patient, surgery recommended date, length of time waiting, clinical judgment of the surgeon, and other operational factors such as length of case and equipment required."

Bryden said surgeons can modify their patient lists based on that criteria. 

Shortage of anesthesiologists a factor

Goodyear said part of the solution is tied to fixing the shortage of anesthesiologists — something he said the province has made progress on rectifying. 

He said the Dr. Everett Chalmers Hospital is "operating overall at 50 per cent capacity because of our anesthetic shortage right now. Last month there were 60 days of OR time that were not used at the DEC hospital because of that. So if we could fill that, this would take care of this problem to a great extent."

He said the numbers weren't as bad before 2023, and "the only thing that's changed really is this rob-Peter-to-pay-Paul approach that they've taken at our local hospital."

Toll on doctors

Mullaly said having to watch patients suffer while they wait longer for surgery is taking a toll on doctors. 

"There's this moral injury, meaning it's really challenging to be constantly surrounded by people who are suffering, who I have the skills to help, but don't have the resources to help in a timely fashion," she said.

Goodyear agreed.

"Yeah, I've been here for 22 years and I've never seen morale lower," he said.