In 2013 the Ministry of Health and Long-Term Care established a task force to conduct a thorough review of ophthalmic services in Ontario which resulted in a Vision Care Strategy. One issue identified was that of new ophthalmology graduates not being able to secure sufficient operating time in Ontario hospitals.

Ophthalmology education ranges from undergraduate medical school education through to residency and fellowship; more than eight years of rigorous medical and surgical training which is vital to ensuring the comprehensiveness and sustainability of Ontario’s eye-care system.

Maintaining Excellence

For some interventions, surgeon experience with the procedure is essential for patient safety and surgeons must perform a critical annual volume to maintain a requisite skill level and achieve low surgical complication rate.

“Doing surgery is not like riding a bicycle. You can’t just pick it up again after not doing it for a while.” – Recent ophthalmology graduate

Of concern are the new ophthalmology graduates that are unable to secure operating room time and are therefore unable to offer their patients appropriate surgical treatment. This often forces them to practice outside of Ontario or to abandon ophthalmology all together.

In recent interviews with a number of recent graduates; 80% expressed dissatisfied with the amount of surgical time they could access for their cataract patients. More than a third indicated that they performed ZERO surgeries in a “typical month”. 70% of indicated that they had never had the opportunity to perform three (or more) cataract surgeries in a single day. After so many years of education and training, many new ophthalmologists are expressing frustration at the lack of surgical opportunities available, particularly when contrasted against the backdrop of serious wait times issues for patients requiring eye surgery.

While the population of people requiring ophthalmic care has been steadily growing, the same is not true of the number of ophthalmologists practicing in Ontario. Many of Ontario’s ophthalmologists are approaching an age in which many Ontarians would be seriously preparing for retirement, if not retired already. The Provincial Vision Strategy Task Force found that approximately 1 in 5 ophthalmologists were expected to reach age 70 within three years and, over the next ten years, nearly half of all ophthalmologists practicing in Ontario would reach that milestone.

These physicians, as experienced and skilled as they are, cannot be expected to continue to perform surgery indefinitely and, as they exit practice, Ontario needs to ensure that the next generation of eye surgeons has the tools and experience necessary to step into their place as leaders in the profession.

“We need surgeons for the future. If people graduating now lose their skills, we’ll have a big gap in services in ten to fifteen years.” – Ontario ophthalmologist

Ontario’s health care system has a responsibility to successfully link the large cohort of cataract surgery patients with the large cohort of unemployed new graduate eye surgeons to achieve sustainability.  To address this issue, EPSO developed a whitepaper – Ensuring Access and Excellence in Cataract Surgery – and presented the concept to Queen’s Park MPPs and Ministry of Health policy advisors on March 7,2018. It was later presented to Ontario’s Provincial Vision Strategy Task Force on March 23, 2018.

On May 4, 2018 EPSO received a Letter of Commitment from the Ministry of Health committing to an additional investment in base funding for cataract surgeries as well as a further one-time investment to help reduce Ontario’s wait lists. The MOH has committed to work with partners to develop a plan that will link incremental volumes to the recruitment of new ophthalmology graduate surgeons in select hospitals across the province.

More recently, the MOHLTC communicated to EPSO its intent to share EPSO’s report with the Office of the Auditor General of Ontario as an example of the kind of analysis and clinical advice that the Ministry relies on to inform funding decisions for services to address patient wait times, in this case specifically to inform funding decisions for cataract surgery.  As it stands now, EPSO is working with the Provincial Vision Strategy Task Force to develop the policies and procedures needed to roll this program out across Ontario.