Popularity of Laser Eye Surgery Grows in BC

Docket: 1-5422 Initial: JN Customer: CMAJ 15422 January 27/98 CMAJ /Page 161

News and analysis appear optimistic that agreement will drigue, a spokesperson for the Feder- However, it said midwife-assisted be reached, the obstetricians have ation of GPs of Quebec, says it wants births should not take place more said that if a solution is not found by to encourage GPs to handle births. In than 30 minutes from a hospital. — Feb. 1, all low-risk deliveries will the short term, however, “I think it © Janice Hamilton have to be handled by GPs. Obstetri- would be difficult for GPs to deal cians will be involved only in provid- with the situation” if obstetricians in- Physician numbers ing essential and tertiary services for crease their pressure tactics. hold steady high-risk patients. Meanwhile, a government council Senikas says the insurance issue recently proposed that midwives be The number of physicians in Canada brought the plight of her specialty allowed to practise in hospitals, dropped by 48 — or less than 0.1% into focus in Quebec, where obste- birthing centres and private homes. — in 1996. Figures released by the tricians make $252 per vaginal delivery — less than in any province except Newfoundland. She says an Popularity of laser eye surgery grows in BC obstetricians who handles an average of 120 deliveries a year has a take- Laser eye surgery is thriving to home pay of $20 per delivery. Many such an extent on the West Coast obstetricians outside the cities per- that a Vancouver ophthalmologist form even fewer deliveries, but their says British Columbia may be the insurance costs remain the same. busiest area for the procedure in Malpractice premiums are expected North America. Since the first to reach $40 000 by 2000. private clinics opened here 7 years In recent years, many Quebec ob- ago, says Dr. Hugo Sutton, up to stetricians have become so angry about 30 000 eyes have been treated in the situation that they left for the US Vancouver. Sutton, 1 of about 20 or other provinces; many others began BC ophthalmologists active in the deciding at a younger age to drop ob- field, says these numbers are “ap- stetrics and stick to gynecology. proached in Calgary and Windsor, “There’s no future for our young peo- but not in the US.” He attributes ple here, and they sense it,” Senikas ar- the popularity of excimer laser gues. “We’re doing this for the future photorefractive surgery here to “a of the specialty, before it’s too late and recognition of Canadian refractive people have left or stopped. We’re not surgery for its careful due dili- asking for any increases except for gence as well as high volume and work related to the delivery room.” successful outcomes.” Dr. Michael Berman in the operating Obstetricians are seeking reim- Patients, who can refer them- room at his Vancouver clinic bursement of their malpractice premi- selves, typically pay up to $5000 ums, so that they would pay $4900, for bilateral refractive surgery. volve cutting the cornea, creating with the government paying the rest; Americans account for about 20% a tissue flap and then applying the this arrangement is already in place in of the caseload for Dr. Michael laser treatment, began just last Ontario. They also want the fee for a Berman, another ophthalmologist year; it now accounts for about vaginal delivery raised to $400, an in- with a laser-surgery clinic in Van- 80% of the work in Sutton’s clinic. crease in bonuses for evening and couver. He says Canada’s approval Why have these procedures be- night deliveries, and an agreement process for the second and third come so popular? Sutton says that that any money earned in the delivery generation of laser equipment has eliminating glasses or contact room will not be included in the an- been faster than in the US, and lenses is a “life-enhancing proce- nual salary ceiling of $257 000. this means that American patients dure for many people.” Berman Meanwhile, the general practition- may receive more advanced surgi- concludes that “people seem to ers who perform 42% of deliveries in cal techniques here. want to be free of glasses and con- Quebec think obstetricians have rea- Techniques have been improv- tact lenses,” and laser surgery has son to complain. The 600 GPs who ing. Laser in situ keratomileusis given him “another lease on oph- perform obstetrics pay malpractice (LASIK) procedures, which in- thalmology.” — © Heather Kent fees of $4980 a year. Dr. Jean Ro-

CAN MED ASSOC J • JAN. 27, 1998; 158 (2) 161