Removing barriers to healthcare
Regulatory standards have long been developed to meet the specific needs of hospital settings where clinical and surgical needs are broader than the needs of community surgical facilities.
These standards are creating unnecessary barriers to healthcare access. In return, patients wait longer for care, and some lose access entirely. Every unnecessary barrier adds strain to a system already struggling with surgical backlogs.
Outdated anesthesia rules
Alberta remains the only province where anesthesia providers are utilized for routine cataract procedures, despite the use of topical anesthetic and mild oral anxiolytics (sedation) in Non-Hospital Surgical Facilities. Eliminating anesthesia involvement in these routine cases would enable the redistribution of specialized resources back to hospitals, potentially saving the province an estimated $6 million annually and increasing anesthesiologist availability for more complex surgical cases with longer wait times.
ACCESS continues to advocate for greater government and public awareness to support more effective utilization of anesthesia resources, replacing them in community settings with other qualified personnel, and promoting alignment with the national standard of care.
Clinical requirements beyond an accreditor’s role
Proscriptive accreditation standards put in place by provincial non-hospital surgical accreditation programs created clinical requirements which are not standard of care. The practice of medicine is already regulated by the provincial colleges of physicians and surgeons, therefore regulating clinical practice should not be included in the scope of accreditation programs. Accreditation Canada’s independent medical/surgical accreditation program is a leader in standards development to support inclusive patient care.
Examples:
- Requiring dilated fundus exams for corneal laser vision correction.
- Imposing one-week delays for refractive lens exchange.
- Enforcing unjustified BMI limits for patients seeking refractive and cataract surgeries in British Columbia.
- Applying size requirements to non-surgical rooms with no impact on safety. Accreditation must support safe surgical environments without interfering in clinical judgment or creating barriers to care.
Short-cycle sterilization regulation
Regulators have prevented the use of a safe, efficient short-cycle sterilization process that is well suited to low-risk ophthalmic surgery. Blocking this option increases the cost of care through longer sterilization cycles, higher energy and HVAC demands, greater instrument inventory needs, and the staffing required to manage them. ACCESS members are actively engaging with regulators to remove these barriers and enable safe, cost-effective sterilization practices in Canada.
Qualified surgeons, unfair barriers
Across the country, dozens of trained eye surgeons are unable to practice fully because hospitals restrict privileges based on internal politics. This leaves surgeons underutilized, forces some into non-surgical environments, or pushes them to move abroad (typically the United States) or into private settings where patients must pay out-of-pocket.
Conflict of interest in hospital‑based surgical privileging
A conflict of interest occurs when individuals in positions of authority have a personal or professional interest that may compromise – or appear to compromise – their objectivity in decision‑making.
In some hospital settings, the process of granting surgical privileges to new graduates is influenced by existing ophthalmologists who may also be competing for the same operating room time.
While peer review is an important element of professional oversight, allowing those with a vested interest to control public OR access can unintentionally lead to:
- Barriers to entry for new surgeons
- Delays in care delivery to the public
- A lack of transparency in access to publicly funded resources
- This structural issue can discourage early-career ophthalmologists from practicing in Canada and may result in underutilized surgical capacity in a system already strained by long wait times.
In some cases, these dynamics have led to legal challenges and growing public concern about fairness in hospital privileging and equitable access to publicly funded surgical infrastructure.
Removing BMI screening
To help remove accessibility barriers for patients seeking refractive and cataract surgery in British Columbia, members of ACCESS provided feedback on the inappropriate use of the BMI screening tool. Clinicians were regulated to use BMI as tool to determine patient candidacy for surgical procedures limited to the eye, which only require topical anesthesia and mild anxiolytics.
ACCESS’ advocacy
We believe eye surgeons ability to access operating room facilities to care for their patients should be based on their competence and participating in clinical care in the community, rather than on politics.
ACCESS advocates for a transparent and equitable privileging process to be able to operate in surgical facilities, in order for surgeons to do what they were trained to do: restore site and improve lives.
Aligning staffing requirements
Appropriate staffing credentials ensure patient safety and an efficient health care system. Nursing shortages have been a long-standing concern in British Columbia, especially for nursing specialities such as post anesthesia and critical care.
Currently the CPSBC is requiring nurses with these specialities to be staffed in community surgical settings where topical anesthesia and mild oral anxiolytics are administered which in turn draws these nursing specialities from the hospitals and procedures requiring general anesthesia. ACCESS is working to sensitize the CPSBC on the national standards of care related to topical anesthesia and mild oral anxiolytics to ensure staffing resources are aligned with the national standards of care.
Emergency over‑preparedness
Emergency preparedness in health care settings is critical to patient and staff safety but when accreditation standards mandate medications for emergency carts beyond the CSF’s scope of practice it can contribute to medication shortages and create barriers to effective healthcare when those medications are urgently needed during medication shortages.
ACCESS is working to sensitize provincial regulators on the national standards of care related to emergency preparedness ensuring medications are allocated to more appropriate sectors of healthcare and remove barriers that contribute to medication shortages.