As the Ford government prepares to take the next step in its expansion of private medical clinics this fall, one Canadian philanthropist is finishing work on a massive surgical centre north of Toronto.
Walter Schroeder, a Manitoban who made hundreds of millions of dollars as the founder of the DBRS credit rating agency, has been building the Schroeder Ambulatory Centre since 2021 and vows to run it as a non-profit with a mission to shorten surgical wait times.
The 300,000-square-foot medical building in Richmond Hill is intended to house surgical suites and recovery rooms, an eye surgery unit, a diagnostic imaging clinic, primary care and specialist clinics, pharmacy and reception spaces, and more, according to filings by the charitable entity Schroeder has set up to run it.
But it will not be able to perform any procedures without being licensed by the provincial government.
“(The) Schroeder Ambulatory Centre is currently working through the Government of Ontario’s comprehensive Integrated Community Health Services Centre’s licensing process, which will play a large part in determining the specific services provided at the facility,” wrote Schroeder Foundation treasurer Michael McConnell, who’s involved with the ambulatory centre project, in an email to The Trillium.
The Ford government’s expansion of government-funded procedures performed in private clinics is structured in three stages, with three calls for proposals from which the government is selecting proponents to fund to perform the procedures. The first call was for diagnostic imaging. The second was for gastrointestinal endoscopy procedures and remains open.
The third call for proposals will be for orthopedic surgeries and is on track to begin “this fall,” according to a spokesperson for Health Minister Sylvia Jones.
“As this process is still ongoing, we cannot yet confirm which services will be offered or how they will be distributed across the facility,” said McConnell when asked to confirm what kinds of medical services will be performed in the Schroeder Ambulatory Centre once it's complete.
Still, Schroeder has poured a fortune into it.
By the end of last year, The Schroeder Foundation — the charity he and his wife formed in 2014, the year he sold DBRS — had moved $175 million to the Schroeder Ambulatory Centre Foundation. The latter charity, which he created in 2021, paid $55 million for what was then a partially finished medical building at 9355 Leslie Street, in Richmond Hill. It had put almost all of the rest of its funds toward completing the hospital-like facility, its financial statements show.
The Schroeder Ambulatory Centre Foundation estimated in its 2023 financial statement that it would spend another $120 to $140 million completing the work, which it intends to do by sometime in 2025.
Even though the licensing process for orthopedic surgeries is yet to open, the Schroeder Ambulatory Centre — a third charity, which was established to run the centre — employed 23 total employees last year, including three full-timers and 20 part-timers, according to its tax filings.
John Tory has also joined the cause.
A year ago, the former Toronto mayor joined the Schroeder Ambulatory Centre Foundation’s board to help oversee “the management of facility assets and fundraising efforts in line with the Schroeder Ambulatory Centre’s charitable mission,” according to McConnell.
The time, money and effort Schroeder has poured into his centre is not available to all groups who are seeking to set up a private clinic under the province’s new regime.
The provincial government has yet to release details on the funding structure for the orthopedic surgery clinics. Without it, many would-be clinics are on hold or have given up completely, according to Brian Rotenberg, an ear, nose and throat surgeon who works both inside and outside of Ontario's public hospital system and has established a consulting firm that helps physicians set up out-of-hospital surgical centres.
“There's been nothing official announced by the ministry for months and months and months now, every project that I know of has stopped,” Rotenberg said. “And the reason they have stopped is because it's not enough for the ministry to say, 'Here's a request for proposals,’ but the ministry has provided zero clarity on the funding of cases.”
While the surgeries will be OHIP-funded, that is not enough to pay for a surgical centre, and while the government has said there will be facility fees paid, it hasn’t said how much. Without that information, it’s not possible — for most — to create a business plan, Rotenberg said.
Schroeder’s plan is particularly large. He’s previously said about 8,000 surgeries a year could be completed there.
It would also require dozens of doctors and over 100 nurses to be fully operational, according to a source connected to the project.
Ontario’s shortage of nurses and doctors — anesthesiologists, in particular — has been one of the chief concerns raised about the Progressive Conservative government’s plan to expand the kinds of procedures performed in private out-of-hospital premises. The thinking is that health-care workers could opt for potentially higher paid, or less demanding, work in a private facility, hurting staffing in the public system.
The Ontario Hospital Association (OHA) is broadly supportive of the government’s decision to expand the use of these private clinics, known as community surgical and diagnostic centres. It “has the potential to address health system capacity challenges, alleviate pressure on public hospitals, and improve access to care,” Anthony Dale, OHA’s CEO, said.
Dale expressed some reservations about the orthopedic surgeries expansion, saying it must be undertaken with close collaboration with the hospital system to be successful.
“Additionally, consideration should be given to leveraging existing capacity in hospitals, maximizing the use of scarce health-care resources, and ultimately focusing on improving access and providing high-quality care,” he said in a statement.
While the province has asked each potential private clinic to provide information about how it will manage health human resources and the potential impact on the public system, it hasn’t made any requirements of them in this regard.
“The delivery of orthopedic surgery in community settings is novel for Ontario, and it brings a new level of uncertainty than previous calls for applications for new community surgical and diagnostic centre licences,” Dale said.
“Additional work is needed to identify how these centres may indirectly impact staffing challenges, particularly for anesthesia, and how surgical complications will be managed in partnership with local hospitals.”
Asked about the impact the centre will have on health human resources, McConnell said the Schroeder Ambulatory Centre is also “partnering with educational institutions to support a robust health human resources strategy.”
“These partnerships aim to address labour shortages by expanding education and training opportunities for students, encouraging them to pursue careers in the field and ultimately increasing the number of skilled professionals in the health-care system,” McConnell said.
Schroeder had been working with Unity Health Toronto for a few years before the hospital network backed away from the Richmond Hill project in the summer of 2023. A couple of years before — prior to the Ford government’s law changes setting the stage for the expansion of private clinics — Schroeder was planning to eventually turn the facility over to Unity Health Toronto after operating it for a few decades.
In a 2023 statement, Unity Health Toronto said that while it’s not involved with the project, it “will continue to look for new ways to collaborate with government and partners to get patients the care they need when they need it, including future opportunities to integrate ambulatory surgical centres into Ontario’s health care system.”
A spokesperson recently said the hospital has nothing more to add to that.
In 2023, a spokesperson for UHN said the hospital network had discussed Schroeder’s project and shares the view that “we must experiment with new models and locales of care so that more patients might be rapidly treated — while ensuring we don’t compromise staffing in the hospitals who care for our sickest patients.”
When The Trillium canvassed other major hospitals, a couple expressed interest in being involved in the private clinic expansion in some way. Trillium Health Partners, for instance, called it “an important opportunity to help further expand access for our community.”
“We are focused on partnerships that are grounded in innovation and help us create better health outcomes for the community we serve,” said spokesperson Priyanka Niranjan Nasta.
The chief opponents of the government’s plan are unions and public health care advocates, who’ve dubbed it the Trojan horse of two-tier health care.
McConnell, meanwhile, wrote of Schroeder’s facility, “It’s important to emphasize that this initiative is a philanthropic commitment, focused on reducing long wait times and improving health care efficiency across the province.”.
“Schroeder Ambulatory Centre operates as a fully charitable organization, working closely with government and health-care partners to make a lasting, positive impact on Ontario’s health care system,” he wrote.
