The lack of a specialist ear, nose and throat surgeon on the island could cost lives, according to the Bermuda Medical Doctor’s Association.

The organisation, which represents Bermuda’s physicians, also warned that deficiencies in the system to compensate doctors for on-call work would result in additional strain to the healthcare system and access to 24/7 care.

“ENT is not the only specialist missing,” the BMDA said. “Other Bermudian specialists, with essential skills, have opted to resign their Bermuda Hospitals Board privileges, as they do not feel supported by this institution.

“The reduction of the elective operative time seems to be the implemented strategy used by BHB to save costs, now that their expenses are capitated by the Government. In contrast, there has been no obvious reduction in the cost of the administration at BHB.

“What is the hospital mission, if patient’s care and offering a workplace for the medical doctors is not their priority?”

Capitated payments – in which payments are made based on the number of people enrolled with their provider – is intended to simplify the process of administrating care and control expenses.

The comments came months after the departure of ENT specialist Philip Bell, who left Bermuda earlier this year because of medical issues. It is unknown if or when he will be able to return to his practice.

A statement from the BMDA executive said: “This is an essential field and not having a specialist on the island will cost lives.”

The BMDA called Dr Bell an “excellent surgeon and a remarkable human being” who offered the island outstanding service.

However, they said his departure had highlighted some of the challenges facing doctors in Bermuda’s healthcare system.

“Physicians and particularly surgical specialists offer 24/7 service that is indispensable to cover surgical emergencies,” the BMDA said. “Most surgeons in our island practice privately, but need hospital privileges in order to perform their job.

“They have been offering these services 24/7 at no cost to the Bermuda Hospitals Board. For years, physicians have been providing their services, often receiving no compensation or recognition.

“Physicians assume this responsibility, often as their duty to contribute to our society, and patients in need.

“Nevertheless, this task is becoming economically impossible, as BHB continues to reduce the elective operating time offered to patients and physician surgeons. Lacking elective operating time and having to be on call 24/7, makes the surgeon's job an impossible and heroic mission.”

The BMDA said it had become increasingly difficult to find good physicians to work on call 24/7, particularly without a “clear line of compensation”.

The organisation added that healthcare decisions were being made without the input of private and independent physicians.

“Independent physicians do not have the opportunity to advise the Government about important healthcare matters,” the BMDA said.

“BHB capitation was the initial step for the planned healthcare reform. The results can't be ignored or hidden.

“The increasing waiting time for elective procedures and the lack of medical specialists, are only examples. Unfortunately, this may be also the beginning of what is to come.”

The group praised the work of doctors on the island and urged the Minister of Health to include representatives from the BMDA on healthcare boards as the future of the island’s healthcare system was being decided.

“Our sleepless nights studying or keeping patients alive will bring knowledge, courage and compassion to your team,” the group added.

ENT specialists and other medical specialists have historically come to the island through private practices.

A BHB spokeswoman said the body was also concerned about the lack of ENT specialists on the island.

“All ENTs have been private doctors, not employed by BHB,” she said.

“Currently, for BHB, Wesley Miller, BHB chief of staff, is covering emergency ENT surgeries as these patients come through our emergency department, but we certainly hope that there will be replacement ENT specialists hired within the private healthcare system in the near future.”

However, the spokeswoman denied that elective operating time had been reduced.

She said surgeries might be postponed because of capacity issues and that the pandemic had caused elective surgeries to be ceased for health reasons but the BHB had been working to catch up.

“We certainly appreciate the services of our surgeons,” she said.

“Unlike many countries, BHB does not charge private physicians for the use of its facilities, staff or supplies for their surgeries. Surgeons separately bill and are paid directly by their patients or the patients’ insurers for their elective and emergency surgeries.

“We are all impacted by the pressures and challenges of the current economy. As healthcare providers we need to work together to deliver the best possible care to our patients, which is at the heart of all we collectively do.”