Cardiologists and heart surgeons in Quebec are warning about a shortage of staff, particularly perfusionists, saying the lack of workers who help keep patients alive during heart surgeries is contributing to delays and even deaths.
“Eighty people have died in the last year, year and a half, waiting for their surgery,” said Dr. Bernard Cantin, president of the Quebec Association of Cardiologists.
“That is awful,” he said. “It’s unbelievable.”
The job is not well-known, but perfusionists play a crucial role in the operating room during cardiac surgeries across Canada. They run the cardiopulmonary bypass, or heart-lung machine, which does the work of the heart and lungs during hours-long procedures. The machine diverts the patient’s blood supply from the heart, oxygenates it, then returns it to the patient throughout the surgery.
There are about 375 perfusionists in Canada right now, around 40 vacancies and more than 60 retirements expected over the next five years, according to the Canadian Society of Clinical Perfusion.
Quebec’s associations of cardiologists and cardiovascular and thoracic surgeons said of the 92 perfusionist positions in that province, only 70 are currently filled. The associations said they have been warning the government about the shortage and growing surgical waitlists since 2019. Now, they plan to file a complaint to the province’s ombudsman.
“We started working with this hoping the government would take action and nothing has happened,” said Cantin.
The latest data available in Quebec shows as of Aug. 23, more than 1,300 patients were waiting for cardiac surgery. Nearly 65 per cent had been waiting longer than what is medically acceptable according to the province’s timelines.
Quebec’s Health Ministry said in a statement to CBC News that the number of deaths noted by the cardiologists and surgeons should be “interpreted with caution.”
“Patients awaiting cardiac surgery often have multiple co-morbidities. The cause of death may therefore be related to a condition other than cardiac disease.”
The ministry said the shortage of perfusionists specifically is responsible for just one per cent of cancelled surgeries in the province.
Staffing issues across Canada
Other provinces are dealing with staffing challenges, too.
“We’re a very under-the-radar profession,” said Naresh Tinani, a senior cardiovascular perfusionist in Regina and acting president of the Canadian Society of Clinical Perfusion. He said that’s partly what makes attracting new people to the job difficult, along with on-call schedules and overtime.
“You’re essentially working on a cardiac surgeon’s schedule,” he said. “It becomes a challenging position to maintain over time.”
Tinani said the staffing crunch is also linked to wages — with higher salaries and other incentives in the U.S. drawing perfusionists away — an aging workforce, and the intense demands of the job.
Quebec faces the most strain, said Tinani. “They do lose perfusionists to other provinces and to the U.S.”
Yannick Pinard, a perfusionist in Quebec City and president of the Quebec Perfusionists Association, said it’s getting harder to recruit and retain people for the job.
“We see more and more people leaving the province of Quebec for better work conditions outside of the province,” he said.
Santé Quebec, the government corporation in charge of health services, said it is aware of the recruitment and retention challenges.
“Santé Québec remains committed to attracting, training, and retaining new graduates to ensure continuity of services,” it said in a statement.
Some provinces are trying to boost the number of people training for the position, which is offered at three sites in Canada — the Université de Montréal, the British Columbia Institute of Technology and the Michener Institute in Toronto.
Michener principal Dr. Michael O’Leary said the school is working with Ontario’s Health Ministry to increase the number of students it trains each year — from 16 last year to 38 by the fall of 2027.
“We do have a concern around the recruitment of individuals into the profession,” O’Leary said. “The importance of this role within the operating room is significant and we believe that there’s an opportunity here to meet that demand.”
Died on the waiting list
In Quebec, the cardiologists and cardiovascular surgeons said they’re worried about keeping people on waitlists — and losing patients as they wait for surgery. The associations track the number of deaths on waitlists for each cardiovascular surgical centre in Quebec and found nearly 80 died while waiting for surgery last year. The associations say that is in part due to staffing shortages which prevent surgeries from being scheduled, and leads to some being cancelled.
In Manitoba, Debbie Fewster was added to that province’s wait list for cardiac surgery in August of last year. She was 69, and needed a triple-bypass surgery, but her son Daniel Fewster said it was never scheduled.
She died of a heart attack a year ago, after Thanksgiving dinner. She had been on the list for two-and-half months.
“When the ambulance showed up they did their best to revive her. They threw everything they had at her, but she was gone,” said her son in an interview from his home in Niverville, Man.
Fewster says he doesn’t know why his mother’s surgery was not scheduled, or if the delay was linked to a shortage of perfusionists or other staff. Still, he has been calling for more transparency around wait times — regardless of the reasons behind them.
He and his family want the Manitoba government to pass “Debbie’s law” — which would ensure patients are informed about expected wait times for their surgery, and what their other options are if the wait time is longer than what is medically recommended.
“If we’d have known that my mom was going to be on a list for two-and-a-half months and she needed surgery in three weeks, we’d have done something about it,” said Fewster.
In the meantime, the Manitoba government said in a statement, “the Minister of Health, Seniors and Long-Term Care directed cardiac services to provide all patients with a letter giving them an expected timeline for their surgery (based on their acuity).”
Pinard, the perfusionist in Quebec City, wants Quebec to improve salaries and working conditions. He remains committed to the job, and hopes things will improve.
“I believe in it. I think it’s just a matter of time,” he said.
