ACREU is engaged in a series of research initiatives to examine orthopaedic surgery in Ontario. Reports of current orthopaedic surgeon shortages, unmet need for services, and long wait times for some orthopaedic procedures, raise concerns about the ability to meet current and future demand in orthopaedics. In particular, access to total joint replacement (TJR) remains a major concern in Ontario. The aging population is bringing with it an increasing prevalence of arthritis, with a concomitant increase in the need for TJR. Orthopaedic surgeons are central to the provision of TJR and long-term strategies need to consider their availability.
ACREU has conducted surveys of orthopaedic surgeons in Ontario in 1997, 2000, and 2006. The results of these surveys highlighted many challenges facing the orthopaedic community: the aging of orthopaedic surgeons; geographic variation in the level of service provision in Ontario; a chronic shortage of women in orthopaedics; and underservicing of the population in comparison with other countries. In the most recent survey (2006), we found that 50% of orthopaedic surgeons’ time was spent in seeing patients in the office, 30% in the operating room, and 20% working on call. These findings indicate that orthopaedic surgeons are already working at full capacity.
ACREU has also examined the workload of orthopaedic surgeons using data from the Ontario Health Insurance Plan and Discharge Abstract Database. The results of this research demonstrated the large volume of care provided by orthopaedic surgeons, which included TJR (25%), arthroscopy (14%), and reductions without fixations (21%). The majority of care provided by orthopaedic surgeons was ambulatory care (86% of encounters with orthopaedic surgeons). Considerable cross-boundary flow for orthopaedic surgery was found, which was most marked in the Local Health Integration Networks in the Greater Toronto area. Our findings indicate that orthopaedic surgeons provide substantial contributions to the management of chronic musculoskeletal conditions including arthritis and trauma with high volumes of ambulatory as well as surgical care.
Our current research builds on our previous work and aims to examine the proportion of patients who see an orthopaedic surgeon in an ambulatory setting that receive surgery by diagnoses (e.g., sprain, fracture), characteristics (e.g. age, sex, comorbidity), and region (e.g. LHIN) of these patients. Linked data will be used from the Ontario Health Insurance Plan database for ambulatory visits and the Canadian Institute for Health Information’s Discharge Abstract Database for data on orthopaedic surgeries. Understanding this further is critical in health system planning to improve the efficient and effective use of highly skilled orthopaedic resources.
This project is funded through the Ontario Ministry of Health and Long-Term Care.
Researchers: Mayilee Canizares, Dr. Elizabeth Badley, Dr. Aileen Davis, Dr. Nizar Mahomed, Crystal MacKay
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