The chief of cardiology at the McGill University Health Centre is warning access will worsen and wait times will go up under a government plan to cut by more than 10 per cent the number of cardiologists practising at the MUHC.
Nadia Giannetti said with the opening of the MUHC superhospital at the end of April, she was hoping to attract an additional two cardiologists to perform the latest procedures — everything from advanced cardiac imaging to cardiovascular genetics.
Instead, the MUHC will have to reduce through attrition its complement of cardiologists to 31 from 35 within the next five years — even though clinical volumes have been going up for all procedures, and are projected to continue rising with the aging of Quebec's population.
The government had initially planned to cut a total of six positions, but reduced that to four after concerns were raised by the MUHC.
This not the kind of health-care system that we want. We want an efficient health-care system and you need to have cardiologists to do that. It's not sending a right message to our society if we're not going to give these patients access to see the doctors they need to see. — Nadia Giannetti, chief of cardiology at MUHC
"There's certainly a risk for wait times and access to procedures," Giannetti told the Montreal Gazette.
"This not the kind of health-care system that we want. We want an efficient health-care system and you need to have cardiologists to do that. It's not sending a right message to our society if we're not going to give these patients access to see the doctors they need to see."
The MUHC's catchment area serves 1.8 million people from western Montreal all the way to Gatineau as well as the far north of Quebec. Volumes for the implantation of pacemakers and defibrillators have increased steadily, while the number of percutaneous valve replacements has doubled.
The mandate of the $1.3-billion MUHC superhospital is to provide tertiary and quaternary medical services — or super-specialized care — to the sickest patients. Cardiology falls squarely within that mandate, Giannetti said, but the Health Department wants to cut back cardiology services based on a 2007 clinical plan that assumes an overall reduction in the number of hospital beds at the MUHC.
"Frankly, for cardiology, that's completely irrelevant because we're not cutting cardiology beds, we're not cutting cardiology procedures, we're not cutting cardiology tests," Giannetti said.
Ironically, the superhospital will boast the latest in cardiology equipment, with a state-of-the-art hybrid operating theatre where cardiac surgeons and cardiologists will be able to work side by side. But it won't have enough cardiologists.
The "limbo" the MUHC's cardiology department finds itself in has resulted in the loss of some top medical prospects who have decided to take jobs elsewhere because there are no positions for them in Montreal.
This is not about cost-cutting at all. It's really related to the fact that we're transferring (MUHC) patients who live in Laval and the South Shore closer to their homes. — Joanne Beauvais, press attaché to Health Minister Gaétan Barrette
Joanne Beauvais, press attaché to Health Minister Gaétan Barrette, said the cuts have nothing to do with a reduction in the number of hospital beds, but rather a projected reduction in the number of routine cardiology consultations once the superhospital opens.
"This is not about cost-cutting at all," Beauvais said. "It's really related to the fact that we're transferring (MUHC) patients who live in Laval and the South Shore closer to their homes.
"The MUHC will have 12 per cent fewer doctors even though they will be cutting back the number of their consultations by 30 per cent," she added.
Giannetti disputed Beauvais's figures on consultations, saying they apply only to consultations for primary- and secondary-care cardiology and not for complex cardiology. Giannetti maintained that the number of consultations for complex cardiology will keep going up.
On April 1, the MUHC will open a cardiovascular clinic at the Queen Elizabeth Health Complex next to the superhospital for low-risk patients. That's in line with the government's plan, but the reduction in the ranks of cardiologists goes against the MUHC's mission to provide tertiary and quaternary care, Giannetti argued.
Across-the-board reductions
The planned cuts to cardiology are part of across-the-board reductions at the MUHC as the government has ordered the hospital network to phase out a total of 85 specialists by 2020. Among the other services being cut are immunology, endocrinology, ophthalmology, dermatology, obstetrics-gynecology and psychiatry.
In November, Barrette told reporters the government won't back down on its plan.
"There will not be decreased patient care," he said. "Patient care will be provided elsewhere. All governments try to move services to where people are living, and that's what we are doing."
Barrette added the superhospital "was designed to have less people and less services."
Beauvais noted seven cardiologists at the MUHC are at least 65 years old and three are winding down their practices, which prompted the government to revise its cuts from six to four.
Giannetti said a cut of four cardiologists will still hurt, given the MUHC treats tens of thousands of cardiology patients.
Jean Buithieu, a cardiologist who practises at the MUHC, said he will probably have to eliminate his monthly visit to examine patients in Ormstown to make up for the reduction in staff at the hospital network.
"There is a profound irritation among the cardiologists," he said, adding specialists don't even have enough office space in the superhospital to consult with patients.
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