Alberta health authority rejected $240K proposal to resolve orthopedic surgery disruption, documents show

The withdrawal of University of Alberta resident physicians from on-call shifts at the Royal Alexandra Hospital in July resulted in a major disruption that saw scores of surgeries cancelled or postponed, increased wait times for many, and had a cascading effect across health-care facilities.

A proposal, sent in August to Alberta Health Services and Alberta Health, would have allowed in-patient surgeries to resume at a cost of $240,000 per year, according to documents obtained by CBC News.

But that idea was rejected by AHS leadership "based on a preference for 'cost-neutral' solutions," according to a document prepared for Alberta Health by the working group of physicians who developed the proposal.

Six months since its start, the disruption has not been fully resolved. The hospital's Orthopedic Surgery Centre (OSC), previously a 24-hour in-patient facility, remains closed at night. At the same time, the number of hip and knee replacement surgeries in the Edmonton health zone has fallen by half, according to data collected by the Alberta Bone and Joint Health Institute.

"At the end of the day, 'revenue neutral' usually means that sacrifices have to be made on one side or another," said Dr. Paulose Paul, the AHS head for orthopedic surgery in the Edmonton zone and one of the physicians who developed the proposal.

"And when you're talking about the acute care of medical patients and overnight coverage, you never want to talk about sacrifice," he said in an interview with CBC News.

This story is based on interviews with numerous current and former health-care workers and officials, as well as documents obtained by CBC News, including more than 900 pages of AHS emails obtained through freedom of information.

Resident physicians are qualified doctors who have graduated from medical school and are training in a specialized area. During the five-year residency program for orthopedic surgery at the University of Alberta, residents gain supervised real-world experience in various subspecialties.

In Edmonton, different types of orthopedic surgery are concentrated at different facilities, which residents rotate through for several weeks at a time. They were also required to work regular on-call shifts, including overnights, to help provide physician coverage at the University of Alberta Hospital (UAH) and Royal Alexandra Hospital (RAH).

An internal review of the university's orthopedic surgery resident program conducted in December 2021 found concerns from both residents and instructors about these on-call rotations.

Covering two busy trauma centres with a total of 15 to 20 residents resulted in the residents being stretched too thin, raising concerns about their workload as well as their ability to provide reliable support, according to multiple people who have seen the review. These include Paul and Dr. Robert Chan, an orthopedic surgeon who was the residency program director at the time.

CBC News has not seen a copy of that review. 

In their August proposal sent to Alberta Health, the doctors note that a single resident covering an overnight shift was at times responsible for over 100 patients. Multiple people familiar with the situation confirmed this to CBC News.

These longstanding issues finally came to a head in the wake of the internal review, according to Chan.