Our Orthopedic team has developed a new model of care called the Shoulder Centre. This is a big addition to my skill set, in addition to inpatient care and consultations. Gratefully, I have been assisting in the development and implementation of the Shoulder Centre Program. We have 6 providers at our Ajax/Pickering Shoulder Centre with 1 champion Medical Doctor in Port Perry. Shoulder care is very underserved in our communities. There is a gap between primary care practitioners and Orthopaedic specialists, in terms of shoulder treatment. Specifically when we need to see patients and what we need from primary care practitioners. Often times there are so many patients in the community that suffer for years with shoulder pain and bounce back and forth between x-rays, ultrasounds, MRIs and doctors without any sound diagnosis or treatment plan.
Our surgeons created an Intelligent e-referral tool so we can obtain the information we need from primary care to triage the patient to the right provider at the right time. The referrals come into a central referral and they are reviewed by our shoulder surgeons and coded appropriately. Between the six providers, the coded referral goes to the appropriate provider. Referrals that have a high likelihood of requiring surgery go to the three Orthopaedic Surgeons and wait less time. The referrals that likely do not require surgery or need further testing are divided amongst the PA and two Non-surgeon Medical Doctors.
In preparation for seeing and assessing patients at the Shoulder Centre, the Orthopaedic Surgeons trained me quite extensively. This was a 3-6 month training period with direct supervision, workshops, injection clinics, and learning labs. We created a very thorough and complete set of medical directives to encompass all my shoulder centre skills.
I now see a certain subset of non-surgical shoulder patients completely independent if their conditions are covered by the umbrella of medical directives that we have established. These are cases that I am comfortable managing, and are often seen repetitively. I perform AC Joint injections, subacromial and glenohumeral injections, prescribe anti-inflammatories and physiotherapy. I spend a lot of time teaching the patients about their condition and they are often so happy to have a better understanding. Yet mostly they are happy to be heard and have somebody that wants to help them. I spent approximately 16 hours per week at the shoulder centre.
Common conditions I see at the shoulder centre include:
- Adhesive capsulitis (frozen shoulder)
- Subacromial impingement
- Rotator cuff tears, acute and subacute
- Periscapular pain
- Rotator cuff and biceps tendonitis
For the patients that I see independent of my supervising physician, there is no Orthopaedic Surgeons fee billed to OHIP for this patient. The patients I see are solely charged the hospital visit. Therefore, my care is a 25% saving the health care system. The disconnect is that I am employed by the hospital, and the hospital does not perceive this cost savings.
This system has really helped cut down wait times significantly for surgery. Previous wait times to see a surgeon specialist for a shoulder condition went from 3 month or more wait to 2-4 weeks for a surgical consultation. With the start of the Shoulder Centre, the hospital has opened more OR time, which also improves wait time to date of operation by 4-6 weeks.