Fact-checking and misinformation

Not all stories you read are accurate. Here, we address misleading claims about eye surgery and provide the facts, backed by experts and research. Learn how to separate myths from reality.

CUPE advocacy against physician‑owned clinics: what you need to know

The Canadian Union of Public Employees (CUPE) has been campaigning against community-based, physician-owned surgical centres by framing their opposition as “protecting public healthcare.” In reality, their position prioritizes maintaining high wages and lower-productivity union environments, at the expense of patients who need timely care.

Unlike physician-owned facilities, where surgical teams are flexible and focused on patients, unionized hospital environments often create unnecessary barriers:

• Rigid work rules that cancel surgeries if the day runs past 4:00 p.m., leaving patients – who are already prepped – sent home, disrupting families and delaying care. Surgeons in these environments often plan light surgical days (finishing by 2:30 p.m.) to avoid this problem, leading to wasted capacity and poor use of physician time.
• Lower productivity and limited incentives for excellence. In physician-owned facilities, staff are paid overtime to ensure all surgeries are completed and rewarded for outstanding service or efficiency. These motivators are absent in unionized hospital settings.
• Seniority over skill. Unionized environments prioritize pay and advancement based on seniority alone, rather than rewarding skill, compassion, efficiency, or initiative. This can discourage younger workers and limit innovation in patient care.

The result is clear: while CUPE presents its position as protecting the public system, the real effect is limiting productivity and putting union interests ahead of patients’ needs. Physician-owned surgical facilities, by contrast, prioritize patient care, efficiency, and fairness.

Setting the record straight: 
a response to the 2021 Toronto Star critique of community-based surgical facilities

This response addresses key claims made by Dr. Sherif El Defrawy and Dr. Bob Bell in their 2021 Toronto Star article opposing community-based surgical facilities (CSFs). While the authors present their views as fact, many of their statements are misleading or unfounded. Given the potential impact on public opinion and policy, it is important to set the record straight.

Government initiatives to reduce wait times

The article criticizes Ontario’s plan to use community facilities to reduce surgical backlogs. Yet since 2021, all ten Canadian provinces have adopted this approach, and it has proven highly effective at shortening waitlists and relieving pressure on hospitals. Suggesting that this would harm patients, leave hospitals without services, or threaten training programs is alarmist and unsupported.

Community surgical facilities, which are physician-owned in over 90% of cases in Ontario, train their own staff, freeing up hospital personnel for more complex surgeries such as cardiac, orthopedic, and cancer procedures. Far from weakening the system, this model strengthens it.

As of 2023, 70% of cataract patients in Canada receive surgery within the 16-week benchmark, up from only 45% in 2020. (CIHI).

Upselling is alive and well in the “non-profit” sector

The article contrasts Kensington Eye Institute (KEI), a not-for-profit center, with physician-owned facilities, implying a moral or quality difference. In reality, not-for-profits still generate surpluses and often distribute them through salaries, bonuses, and expansion projects rather than dividends.

Financial statements show KEI earns millions annually in excess revenue, charging patients out-of-pocket fees that far exceed their costs. A 2023 Toronto Star investigation confirmed that roughly half of KEI’s patients pay extra charges beyond OHIP coverage. For example, KEI routinely charges patients $200 or more for a monofocal aspheric lens that costs under $50. Non-profit status does not shield patients from upselling or unnecessary charges.

Training programs

The claim that moving cataract surgeries to CSF’s would threaten university training is also inaccurate. Ophthalmology residents across Canada—including at University of British Columbia, University of Calgary, University of Manitoba, McGill University, and University of Ottawa—regularly train in CSFs. Even KEI, where University of Toronto residents train is itself a CSF. Suggesting that CSFs jeopardize residency training is misleading; in fact, many provide residents with higher surgical volumes than hospital settings.

Countries like the UK, Australia, and several European healthcare systems actively use ambulatory surgical centres or CSF equivalents for high-volume cataract surgery. These facilities deliver equal or better outcomes, higher throughput, and strong training environments—without compromising quality.

Quality and ethics

The article implies privately managed centers compromise quality or avoid complex patients. All CSFs in Ontario, including KEI, undergo the same accreditation as hospital-affiliated facilities and are led by licensed physicians who carry full professional and ethical obligations. To suggest that surgeons would avoid complex cases to maintain “assembly lines” maligns colleagues without evidence.

Ironically, KEI emphasizes its efficiency and high throughput—precisely the characteristics it criticizes in physician-owned centers. Furthermore, KEI garnishes part of surgeons’ professional fees as a condition for OR access, which is not done in Ontario’s hospitals and other publicly funded facilities.

All CSFs in Ontario, including KEI, are accredited under the same provincial frameworks (CPSO, Accreditation Canada) and bound to the same ethical and quality regulations.

Suggesting physician-owned clinics avoid complex cases or prioritize volume undermines the professionalism of those practitioners without evidence.

Misrepresentation of consensus

Finally, the article claims the government acted “despite strong objections from eye surgery leaders.” While some academic leaders who may gain from maintaining status quo opposed the initiative, this was not the position of the Eye Physicians and Surgeons of Ontario (EPSO), which represents all eye surgeons in Ontario. EPSO supports equitable, high-quality care for all Ontarians regardless of where this care is delivered.

ACCESS' perspective on the issue

The 2021 Toronto Star article by Drs. El Defrawy and Bell relies on rhetoric, selective comparisons, and unsupported claims to discredit physician-owned community surgical facilities. In reality:

• CSFs have reduced wait times across Canada, particularly in cataracts.
• These facilities have maintained and expanded training opportunities for residents, consistent with both Canadian and international practice.
• They meet the same accreditation and ethical standards as hospital sites.
• They provide equitable, timely access to patients closer to home.
• International models confirm their success in delivering safe, efficient care.

Meanwhile, Kensington Eye Institute, though structured as a non-profit, has generated large, retained earnings, levied patient charges well above cost, and positioned itself as the alternative while employing many of the same practices it criticizes.

The real debate should not be framed as “for-profit versus not-for-profit.” The measure that matters most is whether Ontarians receive timely, safe, and transparent care under public funding. On that metric, community surgical facilities are not just succeeding—they are indispensable.