Dr. Viren Naik on How Challenges With Anesthesia Human Resources Aren't Just a Small-Town Problem

On October 27, 2023, Ontario anesthesiologist Dr. Viren Naik slipped on his well-worn grey, plastic clogs for what he thought would be his final OR shift at The Ottawa Hospital (TOH). After 14 years, he was leaving his clinical duties at TOH for a new adventure: Chief Executive Officer at the Medical Council of Canada.

Dr. Viren NAik

With a deep passion for and extensive background in medical education, Naik was eager to lead and shape the national organization that assesses and validates the competencies and credentials of new and potential physicians in Canada. In particular, he was excited to simplify and refine processes that would help address the shortage of physicians, including anesthesiologists, that many communities are experiencing.

Then last fall, while busy at the MCC, Naik experienced that shortage first-hand. He received a text from TOH’s then-new-ish chief of anesthesia asking if Naik would “return as available” to work in the hospital’s operating rooms. The department was at risk of not being able to cover some of its shifts and it hoped that Naik, who is greatly respected by his TOH colleagues, could squeeze a few of those shifts into his schedule. 

Naik’s first reaction was surprise. While anesthesia human resource (HR) challenges aren’t uncommon in rural or northern Ontario communities, it seemed unusual that TOH, a major academic centre that attracts talent from around the globe, was suddenly struggling with staffing.

But Naik quickly realized the predicament his old department was facing. Like most anesthesia departments, TOH works with a tight HR model. “It takes so little for that to spin in the wrong direction,” explains Naik. In TOH’s case, “There was a bit of a rapid attrition, a bit of rapid retirements, a couple other things,” he shares, “The Swiss cheese lined up.”

Naik quickly agreed to fill that hole, likely preventing cancelled surgeries. “Anesthesia is a key part of the health-care system; if it has HR challenges then the entire system can fall apart,” notes Naik.

His return to the OR, along with some other staffing changes that created more flexibility in the department, soon improved the situation, reducing what was then escalating burnout among department members by providing support while new anesthesiologists were recruited to the team.

Naik views TOH’s experience as a cautionary tale that other hospitals, regardless of their size or prestige, should pay attention to. “Knowing what I know about the deficiency of anesthesia, it’s probably pretty tenuous everywhere.”

He wants to reassure patients, “Our system isn’t broken for highly acute conditions. If you have cancer or serious trauma, you’re going to get seen and get your surgery.” But he acknowledges that, even though we’ve seen an improvement in the pandemic-induced backlogs for surgeries and other procedures, health care in Ontario is still experiencing delays, including surgeries for some less urgent diagnoses. 

Dr. Naik on what got him back in the OR.

“There’s a risk to not quickly tackling those conditions as well, not just to the patient but also to society. Now that person stops working or contributing to society however they were doing that,” Naik says. 

While the reasons for these delays are multifaceted, a shortage in anesthesia staff plays a role. “Anesthesia is one of four or five medical disciplines recognized as being in need in Canada,” explains Naik. While all medical specialties are essential for health care, anesthesia is what Naik describes as “the lynchpin.” After all, he points out, “If there’s no anesthesiologist, there’s no surgery.”

This shortage has its roots back to the early 1990s when reports claimed that Canada was producing too many doctors, resulting in a reduction of medical student and residency positions. Unfortunately, this modelling turned out to be inaccurate, due in part to changes in physicians’ work/life balance as well as changes in population demographics and the burden of disease. 

Graphic Courtesy of the OMA

At the same time, advancements in medicine have expanded anesthesiologists’ scope of work, for example, neuroradiologic imaging procedures that require sedation administered by an anesthesiologist. There’s also a growing push to use more community surgical centres, which means that anesthesiologists need to be in more places at once. And then there’s the impact of the COVID-19 pandemic, which led to burnout and more than a few physicians leaving the profession or reducing how and where they worked. 

For Naik, there’s no question that Canada needs to produce more doctors. But with training an anesthesiologist taking at least a decade, quicker solutions are needed. Thankfully, they exist and with proper funding and support from governments, they could have a big impact on anesthesia’s HR challenges, and the health of patients.

One of those solutions is expanding the anesthesia care team (ACT) model, in which certified clinical anesthesia assistants (CCAAs) work under the supervision of an anesthesiologist. As we highlighted in our blog post on ACTs, including CCAAs in the workflow can free up a significant amount of anesthesia time, and therefore surgical time. Currently, ACTs aren’t found in every surgical centre in Ontario, in part due to a lack of funding and a lack of trained CCAAs.

But while establishing more ACTs would boost Ontario’s overall capacity for anesthesia and surgical care, this expansion wouldn’t have helped last fall at TOH. There, where ACTs have been in place for around 17 years, what was needed was more anesthesiologists, including some who could be flexible with their schedule, to better support full-time staff. 

In other words, physicians like Naik who have stepped away from full-time clinical work to pursue other opportunities or due to retirement or even burnout. “How do we gracefully bring back those people?” Naik muses. With the right support and planning, these anesthesiologists could help prevent anesthesia care HR challenges from occurring in the first place. 

More use of family practice anesthetists (FP-As) is another potential solution, particularly for rural or northern hospitals. FP-As are family doctors who have received extra training in anesthesia that allows them to administer general anesthesia, epidurals and other crucial procedures. But as the CEO of the Medical Council of Canada, Naik recognizes this solution for anesthesia’s challenges may come at the detriment of family practice care, which is desperately needed across the country.

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Instead, he would like to see more doctors arriving from abroad working in their trained disciplines in Canada, a goal he is actively working towards at the MCC. While he acknowledges that increasing the number of domestically trained doctors is crucial, “In the short-term, there’s going to be an increased dependence on internationally trained physicians (ITPs).” 

As, “the trusted keeper for validation for ITPs,” as Naik puts it, MCC has renewed its focus on the best way to assess foreign credentials that minimizes red tape while maintaining superior safety standards for Canadian patients. 

He explains that increasingly, skills-based competency assessments are being used instead of exams for licensure. In Ontario and several other provinces, American licensure is now accepted without the need for additional assessments. This pathway is a route that potentially could be explored for other countries, he says.

Naik is quick to note that all ITP recruitment must be as ethical as possible. Thankfully, “There are countries that are overproducing doctors for the purpose of migration,” he explains.

Closer to home, Naik says that progress is being made around simplifying the interprovincial movement of doctors, as well as establishing data collection and sharing practices that will help develop a better sense of which doctors are needed and where. While neither of these are overnight solutions, they do have the potential to help ease the shortage of anesthesiologists and other in-demand physicians, especially if adequate funding and support are provided by governments.

Naik is still taking on the occasional shift at The Ottawa Hospital but, “I’m needed less now.” While the situation that brought him back to the OR might have been less than ideal, he is pleased he returned. “I’m an anesthesiologist first, and I’ve always thought that it makes us better leaders in medicine to always have some clinical role,” Naik explains, “It’s important to ground us and continue that patient-centred focus.”