New premium for doctors aims to encourage more surgeries on evenings, weekends

The Progressive Conservative government is taking another step to extend operating room hours in Nova Scotia, but it's not clear if it will cut into a stubborn backlog of surgical cases.

A contract the government recently signed with doctors extends a premium already paid for emergency surgeries to scheduled surgeries outside normal hours and on weekends and holidays. The premium would be available for surgeons, anesthesiologistsand surgical assistants.

"I'm hopeful that this is going to result in more output and more surgeries for Nova Scotians who have been waiting but, you know, ultimately at the end of the day we're asking a lot out of a lot of people," Grayson Fulmer, the senior director of medical affairs for Nova Scotia Health, said in an interview.

"I think over time we're going to see much, much more success, and in the short term we're going to try everything within our power to coordinate and get as much access to Nova Scotians who need and deserve it."

Fulmer said a continuing challenge in reducing the backlog is an overall lack of staff. Along with needing enough doctors, additional surgeries requirenurses, technicians to sterilize surgical instruments and people to clean and prepare operating rooms.

Premiums range from 35 to 50 per cent

As recruitment efforts continue, Fulmer said the new premium will come into play when hospitals have enough staff to take on the extra work, while recognizing thatmost doctors who couldparticipate are already putting in full-time hours.

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He compared the premium to overtime that unionized employeesreceive for putting in extra hours.

"It's about acknowledging their time, it's about acknowledging that we're already dealing with a busy cohort of people and we're asking for a little bit more out of them in certain cases."

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According to guidelines obtained by CBC, cases that start between 5 p.m. and 11:59 p.m. on weekdays or from 8 a.m. to 4:59 p.m. on Saturdays would be eligible for a 35 per cent premium. Cases starting between 12 a.m. and 7:59 a.m. on weekdays, from 5 p.m. to 7:59 a.m. on Saturdays, or cases started anytime on Sundays or holidays would get a 50 per cent premium.

Surgeriesscheduled for regular hours cannot be bumped to gain a premium and the cases occurringoutside regular hours must result in demonstrable additional surgical activity to be eligible for the premium.

Level of interest yet to be determined

Fulmer said there willeventually be a change to the fee code system for doctors doing additional work, but at first the premiumswill beauthorizedinternally.

The premiums became available on Aug. 1, so it's too soon to know how many doctors are willing to take on additional cases, saidAlexandra McNab,aspokesperson for Doctors Nova Scotia.

"What we do know, however, is that physicians are always willing to be a part of the solution," McNab said in an email.

"But it is of course difficult to ensure they are keeping that work-life balance and providing safe and sustainable care for patients."

Fulmer said it would be up to individual doctors to decide whether they will perform more surgeries. And doctors would follow regular safety standards using the professional judgment they already exercise to monitor for fatigue and burnout.

Change at some hospitals will be easier than others

Implementing the change could be easier at some hospitals than others, he said. Some sites have more resources than others, although the new contract for physicians also allows for travel-related payments for doctors willing to go certain distances for work.

"Making sure that all the right people are there at a particular site at a given time to enable this is going to be very, very challenging and our perioperativeteams [whodeal with patients before, during and after surgery] locally are trying their best to make sure that all of this aligns and moves forward."

A health authority spokesperson said that although the incentive applies to specialists' pay, the collective agreements for other health professionals such as nurses and medical device processing staff may allow for overtime in these settings. If other professions such as diagnostic imaging and laboratory services are required for surgeries, they may also be eligible for additional payments.

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