Thoracic surgery services won't leave Saint John, medical staff leader insists

Thoracic surgery services will not be leaving Saint John, says the president of the Horizon Health Network's medical staff organization for the region.

Two candidates for a newly posted thoracic surgeon position at the Saint John Regional Hospital are expected to be interviewed "in the near future," Dr. Patti Forgeron said in a written statement issued Wednesday to "reassure" the public.

"The Saint John Regional Hospital remains a vital asset in the delivery in tertiary services within the province of New Brunswick and thoracic surgery is absolutely required" to maintain tertiary services in oncology, the New Brunswick Heart Centre, the trauma program and medical school, said Forgeron.

The statement comes in the midst of a thoracic surgery coverage crisis in the province and a proposal by the Vitalité Health Network to consolidate services with a "centre of excellence" at the Dr. Georges-L.-Dumont University Hospital Centre in Moncton.

•  Vitalité wants to open thoracic surgery 'centre of excellence' in Moncton
• ​Thoracic surgeon shortage offers opportunity to centralize, specialist says

​Horizon's medical staff organization has advocated the centralization of services for the past four years, said Forgeron.

Based on a 2012 internal consultant review, "a proposal was put forth to have two thoracic surgeons in Moncton City Hospital and two surgeons in Saint John, who would then provide a shared on-call service within Horizon Health Network," she said.

"It must be acknowledged that Horizon Health Network provides the majority of thoracic surgery services within the province," she added.

Thoracic surgeons are specialists who deal with structures of the chest, such as the esophagus, lungs and diaphragm muscle but not the heart.

They treat diseases ranging from gastroesophageal reflux to lung and esophageal cancers, remove benign tumours, perform chest reconstruction after major traumas and handle lung transplants.

Moncton's only certified thoracic surgeon has been on unexpected leave for about a month "undergoing treatment," officials have said.

Dr. Brian Johnston, a general surgeon with fellowship training in thoracic surgery, whom Forgeron said has been working "in the capacity of" a thoracic surgeon at the Saint John Regional Hospital for 19 years, has also been on unexpected medical leave since the end of February.

Johnston worked alone for years, responsible for all thoracic patients from Sussex to St. Stephen, on-call 24/7 for thoracic patients and part of the on-call rotation for general surgery.

The 2012 internal consultant review had recommended two thoracic surgeons be posted in Saint John, said Forgeron.

Based on those recommendations and the recommendations of Johnston, the medical staff organization has supported an alternative funding program to replace the current fee-for-service remuneration model to recruit a second surgeon, she said.

Alternative funding programs, or AFPs, typically involve a base salary.

Support quest to build sustainable model

Johnston, a "thoracic surgery specialist," has provided "exceptional" surgical care and has been "instrumental" in pushing for centralization of thoracic services within Horizon, said Forgeron.

The medical staff organization supports his "quest to promote and build a thoracic surgery program that will serve this province long-term" and will continue to work with the department of surgery in establishing a sustainable model of delivery, she said.

On March 15, the Horizon Health Network posted a thoracic surgeon job at the Saint John Regional Hospital "to begin practice immediately" under an alternate funding plan, although the final AFP has not yet been approved.

"We wait in anticipation for the Department of Health to approve the AFP proposal so that our short-term challenges can be overcome," Forgeron said.

Dr. Edouard Hendriks, Horizon's vice-president of medical, academic and research affairs, has said the network is "very optimistic" the funding model will be approved.

"There was an agreement to use it in our posting to ensure candidates would understand that New Brunswick offers a competitive remuneration for this position," Hendriks told CBC News.

The estimated pay would be between $450,000 and $475,000 annually for 40 hours per week, according to the Canada Job Bank website.

Horizon has been trying to recruit a second thoracic surgeon under the fee-for-service model for the Moncton Hospital for more than a year but on March 29 changed the job posting to AFP remuneration.

A certified thoracic surgeon based in Fredericton is currently covering the entire province with help from two of Vitalité's general surgeons, who have expertise in thoracic surgery.