The Yukon’s health system has many ailments, but two stand out as particularly big and systemic: operating room capacity and family doctors.
Both are fixable, but will take more money and focus than the Yukon government has been willing to give to them so far.
This week, we’ll look at the operating room crisis. This has been documented for a long time. Back in 2018 over a six-month project, consultants with Cornerstone did a 190-page report entitled Whitehorse General Hospital: Surgical Services Renewal Project.
It is full of hospital floorplan analysis and charts about the number and type of operations Yukoners required at the time. Did you know that back in 2017/18 the hospital delivered a baby with a Caesarean section 110 times, and that 54 per cent of these deliveries involved nurses and doctors working outside normal working hours?
The report also has surgical projections out to 2037 based on a growing and aging population.
Way back then, in 2018, Cornerstone said the Whitehorse hospital’s “Surgical Services will already outgrow its space as of 2018.”
As in, there was already a problem the year the report was written.
The consultants said that the hospital in 2018 had the equivalent of 2.36 operating rooms (ORs). The .36 is a “Flex OR” that is the “size of a small procedure room.” A doctor described it to me as a “closet.”
By 2024 the Cornerstone estimated the hospital would need 3.3 ORs. It is hard to tell how that forecast compares to demand today, since the government does not release granular weekly data. Another doctor, whom I am not naming to allow them to avoid governmental repercussions, told me that in any case the data collected internally sheds limited light on capacity since it tracks the number of procedures but not their complexity. A quick 30-minute procedure is treated the same as a complex 6-hour major surgery.
The doctor estimated that actual surgical demand from our growing and aging population has significantly surpassed even the Cornerstone growth projections.
I looked into the Cornerstone report’s population growth forecasts. The report does not include the detailed numbers, but says it used Statistics Canada forecasts available in 2018. I looked up Statistics Canada’s 2018 population report for the Yukon. For the Yukon’s 2018 population, it had 40,500 Yukoners. Its medium growth population forecast had that growing to 52,300 over the following 25 years to 2043.
Actual population growth has been much faster than that. By 2024, only six years into that 25-year forecast, our population was at 46,704 and already over halfway to the forecast for 2043. As an annual growth rate, we have more than doubled the Cornerstone projections.
However, no new ORs have been built since the Cornerstone report came out.
The pandemic disrupted health operations, of course, but the Yukon government managed to start a $55 million health care centre in Old Crow in 2021 and complete it this year. It also started the mental health wing at the hospital.
It’s not clear why they decided not to fund an OR expansion too, given the number of Yukoners from the communities and Whitehorse that the ORs serve.
As mentioned in my recent “Yukon, we have a problem” column, the Yukon government put out a press release in September trumpeting how “system improvements” and “recent optimization” thanks to government support had increased surgical capacity at the hospital. One doctor told me this was “untrue and perhaps actual gaslighting” and another described it as “blatant lying.”
All of this gets us to the situation you may have experienced in recent years if you or a loved one ended up in surgery in Whitehorse General.
One doctor told me they were “constantly above census,” which is health jargon for crammed over planned capacity. This is apparently now routine, happening every week, and getting worse.
Overflow patients from Emergency get put into pre-operating spaces, which disrupts surgical operations and raises infection risks. Others end up in hallways.
I was also told that the Operating Rooms, especially the “closet,” are not up to modern codes.
From my interviews, I got the sense of doctors and nurses working hard to serve Yukoners in a facility that was close to being overwhelmed. And, even worse, that they felt neglected and unheard by government leaders. One of the doctors said it would be good if policymakers made an occasional visit to see what was really happening on the frontline.
While some system improvements like those mentioned in the government press release may be possible, the scale of the problem is such that you shouldn’t expect the surgical situation to be fixed until the hospital gets those new ORs the Cornerstone report flagged back in 2018.
In the meantime, we all need to worry that the situation will get worse. The doctors I spoke to painted a picture of stress and low morale at the hospital. The Yukon’s orthopedic surgeons are maxed out and not taking new patients for some kinds of surgeries. Nurses and doctors are talking about retiring early or moving elsewhere.
I have to admit that I found my interviews about the hospital crisis much more alarming than my usual conversations with economists or mining engineers. One of the doctors I interviewed said they worry that in 10 or 20 years they will find themselves alone and neglected on a stretcher in a Whitehorse General Hospital hallway, in pain and with a dirty diaper. You and I should probably be worried too.
On that gloomy note, let’s take a break until next week when we will move on to the other mega problem: family doctors.
Keith Halliday is a Yukon economist and the winner of the 2022 Canadian Community Newspaper Award for Outstanding Columnist. His most recent book Moonshadows, a Yukon-noir thriller, is available in Yukon bookstores.
