His praise for the world-renowned private hernia clinic, one of Ontario’s few hospitals allowed to operate for profit, also raised the question of whether it was a model that could be replicated or would lead to the erosion of medical care and in creating a two-tier system. The hospital, in Thornhill, just north of Toronto, sits on 20 acres of country grounds, with gardens and walking trails – making it feel more like a spa – 89 licensed beds and five operating theatres. The menu includes dishes such as rainbow trout with hollandaise sauce, baked potatoes and French beans, or coconut curry chicken with Singaporean noodles. A former patient recently quipped on Facebook that he keeps checking for “another hernia so I can take another mini vacation.” However, the hospital’s main claim to fame is the number of hernia operations it performs, around 7,000 a year. That means, according to the hospital, its surgeons repair more hernias in a year than most others do in a lifetime. The hospital’s main claim to fame is the number of hernia operations it performs — about 7,000 a year. (Shouldice/Facebook) “Our surgeons and surgical team are second to none,” John Hughes, CEO of Shouldice Hospital, said in an email to CBC News. “Since our surgeons only do hernia repairs … they’re just great at what they do – the more you do the better you get.” Shouldice also claims that its model allows it to perform at a lower cost per case than public hospitals and that wait times are a fraction of those in the public system. The hospital also says the infection, complication and recurrence rate is less than 0.5 percent for primary inguinal hernia repair, the lowest on record in the world. The surgeries themselves are covered by the Ontario Health Insurance Program. Besides that “we charge for a semi-private room at a price corresponding to the rest [Toronto-area] hospitals,” Hughes said. “There’s no extra charge for other services — for example, medical, food, medicine.” But because of the hospital’s policy that most patients must stay at least three days or more after surgery, those room fees generate significant revenue, critics say. “A lot of people who go there, they go there because they have very good private insurance,” Ontario MPP France Gélinas, the NDP’s health critic, said in a statement.
It was founded in 1945
The hospital was founded in 1945 by Dr. Edward Earle Shouldice, who performed hernia operations on servicemen during World War II, according to his grandson Daryl Urquhart. “At the end of the war, there was this line of people who wanted and wanted to have their hernia repaired. And there was a shortage of beds in the hospitals. And so my grandfather decided that the best way to handle that was to open a hospital,” said Urquhart, who is also a former co-owner and former director of business development for Shouldice. Its first location was in downtown Toronto, but as it became more popular, it moved to Thornhill, the estate of George McCullagh, a millionaire miner and newspaper publisher, who bought the Globe newspaper and the Mail and Empire, merging them to create the Globe and Mail. The main residence of the estate was converted into a hospital. In 1971, the province’s Private Hospitals Act was amended to prohibit any new private hospitals, but those already operating were grandfathered. There are only three private, for-profit hospitals in Ontario and one is Shouldice. His patients include notable politicians and personalities such as former Prime Minister Joe Clark, US Consumer Advocate Ralph Nader and US Senator Rand Paul. NDP Leader Jack Layton, a critic of private health care, was accused of hypocrisy after admitting he was a Shouldice patient in the mid-1990s. (Tom Hanson/The Canadian Press) In 2006, it caused controversy for NDP Leader Jack Layton, a critic of private health care, who was accused of hypocrisy after admitting he was a patient there in the mid-1990s. (Layton said he didn’t know it was a private hospital. ) Urquhart says Shouldice’s specialization model has created an efficiency and skill set not available anywhere else. “You just can’t achieve a higher level of efficiency in a general plant that you can achieve in a focused plant,” he said.
The model can be reproduced
He says the model could be replicated, but would require a focused initiative by specialist doctors. “It has to be a concerted effort between professionals and administrative and bureaucratic people. And that kind of action usually happens in the private sector, not the public sector,” he said. However, Dr. Hasan Sheikh, vice-president of Canadian Doctors For Medicare, said there are “great examples” of not-for-profit surgery centers doing high-volume surgeries for specific conditions. NDP MPP health critic France Gélinas says public hospitals can perform hernia operations just as well at no charge to patients. (Mathieu Gregoire/CBC) “And without that profit motive, they are able to provide extremely efficient and high-quality care,” he said, citing the Kensington Institute in Toronto, which specializes in eye surgery, as a “great example.” “There’s a comfort in sending people to a place that does one thing and one thing only. And I think, you know, there’s no reason for that to happen in a for-profit delivery model.”
The patient’s stay was questioned
Sheikh also questions whether hernia patients really need to stay on Shouldice for a few days after an operation. “One of the big concerns I have is the fact that for a hernia repair – which is a fairly simple operation and in most public hospitals it’s a day procedure – at Shouldice, these patients stay for three nights. “Keeping people longer to do the same procedure doesn’t sound particularly innovative to me,” he said. “And I think when you have that profit motive … it raises the question of whether those decisions are being made based on what’s best for the patients.” Gélinas, the NDP health critic, says thousands of hernia operations are performed in hospitals across the province by hundreds of general surgeons. “And everyone recovers and everyone is satisfied.” Gélinas also says that, with only a limited number of general surgeons in the system, more going to private clinics means fewer “are available for the rest of us.” “Private for-profit clinics will cost us dearly,” he said. “It is deeply troubling that Mr. Ford has cited the Shouldice as a model to look at.” However, Urquhart defends the hospital’s three-day policy, saying it reduces patient stress and leads to fewer potential complications. “You’ll find people who say, ‘They don’t have to stay. Shouldice just needs to make money and so on.’ And that’s not true. If Shouldice sent patients home the same day or the next day, they would just put more patients through the system.” “It makes no difference. The most important thing about the model has always been what’s best for the patient.”
