Frustrated Canadian Surgeon Opens Own Clinic

It was frustration over long patient wait times in the public health care system that prompted Dr. Nicolas Duval and his wife Dr. Pauine Lavoie to drop out of the public system and go private in 2002. “I had patients waiting up to two years for a hip replacement, ” said Duval.

The two now own Canada’s only private clinic that offers total knee and hip replacements. On average, Duval performs around 400 hip and knee replacements a year at their clinic in Laval, Quebec, a stone’s throw from Hôpital de la Cité-de-la-santé. Duval owns the clinic jointly with his physician wife who ensures pre-op and post-op patient care, and does the paperwork.

Now Duval exults in the gratitude of his patients. He said, “For me, as a surgeon, the best reward is hearing people say, ‘Thank you for taking the risk of opening this clinic and helping me not lose a couple of years of my life waiting for surgery.’”

“I was very upset, ” recalled Duval, who worked as a surgeon and teacher at the McGill University-affiliated Queen Elizabeth Hospital and the Centre hospitalier de l’Université de Montréal between 1996 and 2002.

The most expensive procedure Duval performs is hip replacement surgery for which he charges $19, 000 a hip. That fee includes the surgery in one of the clinic’s two new cutting-edge operating rooms, pre-op tests, post-op care, and a six-night stay with round-the-clock nursing care in one of the clinic’s five acute or nine convalescence beds. Knee replacements cost $18, 000 with the same package of services.

The patients pay for all of the charges and neither doctor receives fees or deals with the province’s medical health insurance board. Like all doctors in Canada, their professional practice is authorized by and is accountable to Quebec’s college of physicians. “There is an almost endless supply of patients, ” Duval said. “And demand will continue because many people now live into their 90s.”

David Zukor, M.D., FRCSC, chief of the department of orthopedic surgery at the Jewish General Hospital, Montreal, said his hospital is “one of the busiest places” in the province, doing 600 to 700 replacements a year. Two other Montreal hospitals are likely to do as many replacements, said Zukor. At Jewish General, the waiting list for hip and knee replacement is about six months once the patient has been seen by doctors, Zukor said. However, he added that it can take another six months for patients to get that first pre-op meeting.