Last week, I got in the back of a SUV to go to Buffalo to meet neurosurgeons.

Why go to Buffalo? The team at RCM Health finds it challenging to find spine surgery for our patients throughout Canada.

Non urgent cases can wait 2 or more years for access. Causing harm to patients and denying their right to timely care which is unethical?

So when I learned that 21 neurosurgeons at the University of Buffalo had built an ambulatory neurosurgical centre, I was intrigued.

When I arrived at the neurosurgical centre which is focused on day surgery, I was very impressed.

The centre is a brand new 75,000 square foot modern design with four full neuro operating rooms, an angiography suite for stroke patients,

a gamma knife and sterotaxic radiosurgery.  It is wonder to behold. I was humbled by the accomplishment of this team of neurosurgeons.

They had no regulatory barriers to overcome. No regulatory or licensing issues stopping the project. They found the private funding to build the centre.

And now they are open for business. They take US health insurance for payment for the surgeries. They also take self pay patients from Canada.

The role for RCM Health is to triage appropriate patients to this centre for surgeries and procedures, if there is funding available from either the patient or a sponsor such as an employer.

Compare this with the efforts of four orthopedic surgeons in Toronto who attempted to develop an ambulatory orthopedic surgery centre outside of a hospital.

They had to pay a team of healthcare lawyers billing $1000 per hour for 2 years of legal work to overcome regulatory barriers.

There is no question about the need for more capacity with hip and knee replacements.  They would accept OHIP patients and possibly private pay patients from other provinces.

After 2 years, the regulator allowed them to limit their work to arthroscopy. Not knee or hip repairs or replacements.

Ironically, they could do a look and see at the inside of joints ( ankle, knee, hip and shoulder) but could not repair anything.

Once they found the cases needing joint repair, then those patients could join the public sector waiting list for repairs.

So the Toronto surgeons failed in their efforts to privately fund new capacity because of regulatory barriers.

I found the comparison of the neurosurgical centre in Buffalo that I visited and the failed orthopedic centre in Toronto of utmost interest.