A new report highlights Canada’s major drop in surgeries during the early years of the pandemic, but those pains were felt unequally across the country’s patchwork provincial health-care systems — with the largest decrease in procedures seen in Newfoundland and Labrador.
The findings were released Wednesday by the Canadian Institute for Health Information (CIHI), an independent organization which compiles and analyzes health system data.
The CIHI team found roughly 743,000 fewer surgeries were performed in Canada during the first 2½ years of the pandemic — a drop of about 13 per cent compared to 2019.
“It takes a long time to catch up when you have to cancel a large number of surgeries,” said Kathleen Morris, CIHI’s vice-president of research and analysis.
Despite the drop in surgeries, overtime hours in Canada’s public hospitals from 2020 to 2021 increased by 15 per cent over the previous year — a “stark example” of the pressure COVID-19 put on health-care workers, the CIHI report noted.
The findings also shone a spotlight on other health-care issues, including staff shortages and burnout, levels of access to personal health information, and the roughly one in 10 Canadians who say they don’t have a regular health-care provider.
The report is part of a sweeping effort to change how the country handles Canadians’ health data. The federal Liberals have offered the provinces and territories billions in new spending over the next decade to address the country’s health-care crisis and, in exchange, the regions must commit to improving how health data is collected and reported.
All provinces and territories have signed on, except Quebec, which did not provide any figures for CIHI’s new report — leaving out health information for a population of roughly 8.8 million.
Surgeries decreased most in Newfoundland
On the surgery front, the new data offers an up-to-date look at the impact of paused surgeries across Canada.
There was no change in the numbers of surgeries performed in P.E.I. from 2020 to mid-2022, compared to the year before the pandemic started, and only single-digit drops in Yukon, Northwest Territories, British Columbia and Nova Scotia.
Other provinces’ declines in surgical volumes ranged from 13 to 18 per cent, while Newfoundland experienced the largest decrease at 21 per cent.
As CBC News has previously reported, the wait-list for hip and knee replacements alone in Newfoundland has remained stuck at 1,900 patients between 2022 and June of this year, despite provincial efforts to make orthopedic procedures more available.
Surgeons also warned Newfoundland’s health authority that doing more surgeries each year won’t actually help the province tackle its backlog as its population ages. “Projections show that completing 1,100 cases annually will still result in wait-list growth to 4,500 people by third quarter 2029,” reads a surgeons’ letter, acquired through an access-to-information request.
To reduce their surgical backlogs, provincial and territorial health systems will have to increase their surgeries above pre-pandemic levels, CIHI noted in its new report.
The analysis suggests only modest increases in surgeries among the regions — between one to nine per cent — were achieved across several months between March 2021 and June 2022.
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CIHI’s report also touched on another issue with surgeries in Canada: the drop in procedures during the pandemic was “more pronounced for those living in lower-income neighbourhoods.”
When asked for more specifics, a CIHI spokesperson said the organization has previously looked at trends by income level and found pronounced differences between the most affluent and least affluent neighbourhoods when analyzing the data by procedure. There were larger differences for cardiac surgeries, for instance, followed by hip and knee replacements and cataract procedures.
“This was a general pattern across the country,” Morris said. “We know that COVID impacted more in low-income neighbourhoods, so it’s possible [some patients] had to delay their own surgery because they — or someone in the household — had COVID and were not eligible to have their surgery done at the scheduled time.”
That ripple effect, further exposing the pandemic’s disparities, came as no surprise to Dr. Danyaal Raza, a family physician with Unity Health in Toronto.
“If you’re from a low-income, working-class community, you’re even further behind in terms of accessing surgery than other people in Canada,” he said. “And unfortunately this is not a new pattern.”
18 million overtime hours worked
As hospitals struggle to catch up on surgery backlogs, health-care workers remain in short supply, teams are overstretched and staff keep fleeing the sector after years of pandemic pressure and burnout.
“The 18 million overtime hours worked in Canada’s public hospitals [between 2020 and 2021] is the equivalent of more than 9,000 full-time jobs, which gives a sense of the increased workload during the pandemic’s first year,” CIHI’s report notes.
“The pressure contributed to burnout and illness, which can have long-term implications for the health of workers and for health-care systems. Some workers changed jobs and even careers.”
That’s been particularly evident among nurses. While the number of nurses in most regions has gone up, the number of those actually working in certain health-care settings has dropped, CIHI figures show.
There was a roughly two per cent decrease in the number of registered nurses providing direct patient care in long-term care homes between 2020 and 2021, for instance.
Many nurses now face unsafe workloads, said Doris Grinspun, head of the Registered Nurses’ Association of Ontario, which represents registered nurses, nurse practitioners, and nursing students across the province. One-to-one ratios of nurses to patients in many intensive care units shifted to one-to-two or more during the pandemic — and stayed that way, she said, leading to “cognitive stress, exhaustion, and also moral distress.”
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Burnout is a real phenomenon, echoed Toronto-based trauma nurse Eram Chhogala. “It’s something that we’ve all encountered just by the workloads, the lack of staffing,” she said.
In Chhogala’s case, the toughest stretch of the pandemic was when she was juggling 12-hour days at her job while her father was being treated for COVID-19 at her own hospital. “Those were definitely moments where I nearly felt like I was going to break down,” she recalled. Her father later passed away from his illness.
Amid that “pressure cooker,” many nurses ended up shifting to private agencies, or leaving the industry altogether, Grinspun said.
“That creates a cycle where the more people who leave, the more people who complain about burnout, the worse it gets.”
A lack of health-care staff also applies to primary care providers, with Canadians reporting varied access to regular care in the early years of the pandemic, ranging from just 24 per cent of people living in Nunavut to 90 per cent of those living in Ontario or New Brunswick. (Other provinces fell somewhere between 80 and 89 per cent, though CIHI cautioned the numbers were self-reported and only estimates.)
People in rural and remote areas have more challenges finding regular providers, CIHI noted. Young adults — those aged 18 to 34 — were also the least likely to have a regular provider.
Overall, 88 per cent of Canadians aged 12 and up reported having access to a regular health-care provider.
“The flip side to that stat is that there are more than 3½ million people in Canada that don’t have access to a family doctor,” noted Raza.
Gaps in data
The CIHI report also highlighted other pressing health-care issues in Canada, including how many Canadians don’t feel mental health care services are meeting their needs. And less than 40 per cent of the population — not including Quebec — reported ever having access to their own health information online.
While the lack of data from Quebec undercuts the report’s countrywide figures, a spokesperson for the province’s Health Ministry told CBC News via email that the province has been reporting its own health data publicly in an online dashboard since May 2022.
“We have always said that we must be more transparent with Quebecers and that is what we are doing,” said the statement, translated from French.
CIHI’s report also lacks data specifically about First Nations, Inuit or Métis people.
The challenge now is actually tackling chronic, systemic failures in the health-care system with sustained funding, ongoing data collection and a clear set of outcomes to hold governments accountable, said Dr. Andrew Boozary, executive director of social medicine at Toronto’s University Health Network.
Pandemic pressures, layered on top of staff shortages and existing disparities, created a “perfect storm” that exposed the system’s flaws, long before CIHI’s new report, he added.
“If we don’t ensure that we keep the accountability and transparency in place — but also investments in areas that we know can truly ameliorate some of these real divides — then we’re going to continue to collect this data, with no real promise of reducing the suffering and premature death in certain communities,” Boozary said.
“So I think all of this has to happen in tandem.”