Doctor leaving prompts much-needed discussion

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Wendy Elliott Column

The departure of a talented surgeon, Dr. Andrea Veljkovic, has prompted much discussion locally and provincially of late. And that is a very good thing.

Veljkovic is leaving for a new job in Toronto at the end of February. Her patients in western Nova Scotia, where she has been practicing orthopedic surgery, have been speaking out against her loss.

Dr. Andy, as she’s known, has a unique specialization in the foot and ankle. Only two other surgeons in the province have this focus and one is close to retirement.

“I’m sad that we’re losing her,” said patient Lolita Crosby of Avonport. “We can’t afford to lose her.”

Patients who seek this kind of surgery, who are often diabetic, can wait an entire decade to see a specialist.

Veljkovic came to Kentville temporarily to fill in for another surgeon, but folks found out how good she was. Veljkovic was unwilling to speak to the media, but I understand the couple had wanted to settle here.

According to Dr. Lynn Harrigan, who is the chief of medical staff for Annapolis Valley Health, another orthopedic surgeon had already been selected to fill in the fifth slot in the orthopedic department when Veljkovic came on a locum.

“Dr. Murphy was already hired,” she told me, pointing out that Dr. Andy was recognized as a wonderful surgeon. She added, however, that aging hips and knees are the biggest issue for orthopedic surgeons.

On Feb. 4, in response to an e-mail from another patient of Veljkovic’s, Health Minister Dave Wilson indicated funding was not the issue that is causing her departure. He suggested that all the current orthopedic slots province-wide are filled.

So what’s going on that Nova Scotia is losing such a needed specialist? It’s complicated when you consider almost half our tax dollars - $3.9 billion - go toward health costs.

Harrigan said that the province has been following a Physician Resource Plan since last May. For the first time, the government has been trying to improve planning and management of the province's physician workforce.

The province's initial actions in this 10-year plan included making commitments to: 1) investment in four new collaborative primary care teams in communities of need and provide additional support to existing teams; 2) provide additional incentives for doctors practicing in communities of need; 3) working with Dalhousie University's medical school to increase the number of family doctors; and 4) strengthening efforts to recruit and retain physicians where they are needed most.

We have many competing needs when it comes to health care. In fact, I think you’d need the wisdom of King Solomon to make everyone happy. Earlier this month, a school fundraiser for a New Glasgow girl with diabetes snowballed into a drive to urge the province to cover the cost of insulin pumps. An online petition accumulated over 3,000 signatures and opposition politicians got busy deriding the government.

In January, there was a call for terminally-ill patients at home to have tube-feeding supplements paid for. These needs are very real, but as Harrigan pointed out, the province can’t keep throwing money at the loudest issues. Planning is required.

Her advice was for patience until the health system is under control. I also learned that Dr. Eric Howatt, a well-known local orthopedic surgeon, is vice-chair of the planning group, so the message should be loud and clear about feet and ankles.

When the budget came down last spring, then-Finance Minister Graham Steele said, “Nova Scotia needs a health-care system that is well planned and managed. We need a system that is sensitive to the needs and priorities of local communities, and that acknowledges the hard work of our health-care professionals.”

That is political rhetoric at it’s best; however, he did include a promise to “make investments this year to reduce the time Nova Scotians wait for receive orthopedic surgery.” If that’s part of good planning, then we have to make the Dexter government live up to that promise.

 

Organizations: Dalhousie University

Geographic location: Nova Scotia, Toronto, Kentville New Glasgow

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  • Justin
    April 01, 2013 - 12:08

    Sadly, orthopaedic surgery has the longest waiting times of all surgery types in Canada. It might be due to the aging population here, work accidents, sports injuries, and genetic issues, but knee and ankle surgery is needed for many. And NS has been one of the provinces where access takes far longer than in other province. Losing such an eager and skilled surgeon is a real loss and will mean this will continue to be a problem for many years to come. Dr. VeIjkovic was a knee and ankle orthopaedic surgeon who did the type of surgery that few others here provide. Her sub-specialties typically would have the longest of the waiting times in the orthopaedic surgery world. And she was making a significant dent in working through these numbers until the province started putting roadblocks on her access to OR to do her work. In the end she left. I am sure she was very frustrated and disappointed with her treatment in NS. The fact that Dr. Velkovic moved down here in the first place was a coup for Nova Scotians. Once here, and certainly after proving herself to be exceptionally good surgeon, the province should have bent over backwards to find funding somehow. But no. In Nova Scotia there are, at present, 10 000 people on the "waiting list" for orthopaedic surgery. However those that keep this wait list are coy about how they actually tabulate their figures but admit that even that number is an under reporting of the magnitude of need here. When they are pressed (yes I have spoken to the people who tabulate this and asked them about their data) it is clear that even that staggering number underreports the need for orthopaedic surgery here in NS. Why? Fact is many who need orthopaedic surgery are not officially counted in the wait list. This 10 000 figure does not account for people who have fallen between the cracks (lost consult requisitions to see an ortho specialist by unmotivated support staff, unable to get on the waiting list because their condition has been misdiagnosed by their GP, or they have not had the MRI yet hence no visit is scheduled to an ortho surgeon, or maybe they do not even have a GP to go to to start the process.) In reality, just getting to see an orthopaedic surgeon for knee and ankle issues regardless of your age or condition can take 18-24 months--- if you are lucky. Many times it is longer than that. Also, many times a patient is sent by a GP to an ortho surgeon who does not even do the type of surgery they need done (ortho surgeons all specialize, even within joints such as knees and ankles and are picky about who they want to do surgery on) When this happens that patient is then queued, in a non-prioritozed manner (after another 1-2 year wait to another surgeon) to another ortho surgeon. Repeated experiences like this are commonplace in NS... especially in patients who are complacent or confused by the "system". This article quotes a few people at the Department of Health to imply they are actively changing things for the better regarding orthopaedic surgery. This is a ruse. Nothing could be further from the truth. Wait times are increasing but the politicians an bureaucrats at NS Dept of Health have a vested interest in keeping this hidden from the population at large. Bottom line is that Dr Veljkovic was/is a rarity and she is now gone to where she can practise her trade more effectively. We lost a great resource. Dr. Veljkovic is indeed very talented, well trained, and energetic with excellent people skills. She was keen to help and and was willing to go the extra mile for her patients. Case in point she routinely travelled from Kentville to Yarmouth to get operating room time to do surgery for her patients. (Patients travelled form HRM to Yarmouth just to get access to surgery rather than wait enven longer.) I do not other orthopaedic surgeons doing this! A little research will show you that NS has largest per-capita aging population in Canada. Lack of access to orthopaedic surgery is increasing each year. Trauma and sports injuries commonly affect many who are young and in the prime of their lives but need access to timely orthopaedic knee and ankle surgery. When you cannot walk or do the basics of daily living you loose your job, suffer a demoralizing and agonizing wait for a surgery that may never come... or will take years. And then there is the lengthy rehabilitation time after the surgery. You lose years of your life here in NS if you need orthopaedic surgery. This boondoggle and the issues around it is just another example of why people leave Nova Scotia and never return. Despite the high taxation and the feeble promises of each iteration of politicians and the entrenched laziness of those with full time government jobs, things in Nova Scotia only get worse here. There is lots of political posturing and rhetoric bantered about these articles but it is a ruse. The Dexter government campaigned loudly about improving access to care. This has not happened in any meaningful way. The Mister and the Department of Health in NS continue to fail to grasp the real issues in Nova Scotia healthcare and do not seem to care. It amazes me that the Province can come up with tens to hundreds of millions of dollars for convention centers in downtown halifax that many do not want. But they cannot come up with the funding required to keep a proven, talented surgery in the province to help work through the mountain of people waiting for basic surgery. Shame on this province.