Pressure mounts as sixth orthopaedic surgeon quits Canberra Hospital

Canberra’s orthopaedic surgeons are ramping up the pressure on Health Minister Rachel Stephen-Smith’s planned care reforms at Canberra Hospital with a sixth resigning in protest at their loss of autonomy.

Head of orthopaedics Professor Paul Smith led the walkout last month, saying the changes to how surgery is managed, involving a pooled list and the Operations Centre, would not be more efficient and compromise patient care, and five more have followed at various intervals.

It is understood that the sixth surgeon is Dr Alexander Burns, a colleague of Professor Smith at Orthopaedics ACT in Phillip.

The surgeons, all Visiting Medical Officers, want to retain their own lists and are also upset at proposed contract changes from fee per service to fee per session, which has been adopted in other jurisdictions to save Canberra Health Services money.

According to its 2023-24 annual report, CHS paid out $7,289,498 to 17 orthopaedic surgeons that financial year, ranging from $53,921 to $1,146,671.

In the meantime, Canberra Health Services is confronting a daunting challenge to cover such a loss of expertise and experience in the future.

All of the departing surgeons have many years of experience, with the latest to go believed to have been working at the hospital for two decades.

Health Minister Rachel Stephen-Smith acknowledged that this expertise could not be replaced overnight but reassured the public that CHS still had a committed orthopaedics department and was still providing timely, safe, emergency-based care.

Ms Stephen-Smith said CHS was working through what impact these departures would have on elective orthopaedic surgery wait lists.

“We will also work with patients who may be affected by this to minimise the impact this may have on the care they receive,” she said.

“This could include reallocation to a different surgeon within the unit or an alternative arrangement.”

Ms Stephen-Smith said CHS was continuing to plan to recruit more surgeons for the orthopaedics team.

“In addition, CHS leadership will continue to engage with all surgical teams to work through any concerns about implementation of the Operations Centre,” she said.

“CHS continues discussions with its VMO workforce about the need to phase out fee for service contracts to ensure the sustainability of our public health service into the future.”

However, there are signs that the surgeons’ walkout is working, with both the minister and CHS CEO Dave Peffer saying the hospital was stepping back from the changes and taking a slower approach to negotiating with clinicians while still being committed to the reforms.

Australian Medical Association ACT president Dr Kerrie Aust said she still hoped the surgeons would return, but they had tendered their resignations, and it would require addressing their concerns for them to come back to the table.

Dr Aust said the planned care system being introduced had not worked elsewhere, such as in the US or the UK.

“Where is the evidence that the process that they put in has actually been successful in other jurisdictions?”

Dr Aust said the AMA supported moves for more transparency in surgical lists, but clinicians needed to retain their autonomy and individual care for patients.

“When we look at planned care and managed care models overseas, where each time a doctor wants to do something they have to ask permission from the administrative staff, reducing the clinical autonomy causes significant changes in the health system,” she said.

“And while it might feel like it’s going to be more efficient, it actually becomes less efficient over time because doctors spend less time looking after their patients and more time advocating for standard care.”

Dr Aust said it was important that triaging was left to the particular surgeon who knew the patient history, even if another clinician would be the decision maker.

“These are clinical decisions that really need to be made by a person who is trained in that area,” she said.

“So when they talk about clinical making the decisions, my question is, which clinical staff? What level are they at? What kind of training and background do they have?”

Dr Aust believed costs could be reduced and efficiencies made without interfering with doctor autonomy.

She did not believe the surgeons were turning their backs on the public system.

“I think they’re advocating for quality processes to ensure good outcomes for patients,” Dr Aust said.

Dr Aust acknowledged that change was needed to make the hospital more sustainable, saying the AMA backed taking a look at evidence-based processes working in other jurisdictions.

“We’re very supportive of looking at innovative ways to improve things,” she said.

“We just want to make sure that they’re evidence-based and they don’t have unintended consequences for efficiency and effectiveness of patient care.”