‘Catastrophic’: No clear solution from provinces as surgery backlog crisis continues

As hundreds of thousands of Canadians wait for surgery, provinces across the country have yet to outline a clear plan on how to clear the backlog.

“We’re really concerned about it because the operations that people are waiting for are necessary operations,” David Urbach, surgery department head at Women’s College Hospital and professor of surgery at the University of Toronto, told Global News.

“They’re going to be suffering for long periods of time instead of being able to enjoy a better quality of life.”

During his 22 years as a surgeon, Urbach has never seen a medical backlog like the one Canada is currently facing.

“Right now, we have hundreds of thousands of people waiting for surgery,” he said.

Ontario, Canada’s most populous province, estimates the waitlist has grown to between 225,000 to 250,000 patients. Nova Scotia Health currently has about 27,000 patients waiting for surgery.

In Quebec, the most recent data shows at least 160,000 residents waiting.

At the end of March, Canada’s health minister, Jean-Yves Duclos, said the country’s universal health-care system is “at risk” and announced a $2-billion pledge to help fix the surgery backlog.

“These delays are a burden that can be very hard to bear for the affected patients, their families and their loved ones, as well as for the health-care workers caring for them,” Duclos said at the time.

Ontario’s share of the recent one-time federal funding, announced on March 25, is $775.5 million, the province told Global News. Newfoundland and Labrador will receive approximately $27 million. Saskatchewan’s portion of the federal is roughly $62 million.

However, not a single province could tell Global News what their plans for the money are as of yet.

Ontario said it will have more details in its upcoming budget, to be released April 28, and noted that the federal money isn’t enough.

“One-time funding is not sufficient to address the challenges faced by the provincial and territorial health-care systems,” a spokesperson for the province told Global News.

In the meantime, British Columbia said it is working with regions to increase capacity, specifically this summer, but didn’t explain how.

In 2019, Alberta created a program to tackle the backlogs already bogging down its system, but that was put on hold due to the pandemic. Now, more than 70,000 Albertans are waiting on surgery.

“I think when you’re dealing with something as large and as expensive as the health-care system, when you don’t have a clear plan about what your goals are and data and accountability within the system, you’re going to end up with chaos,” Katharine Smart, president of the Canadian Medial Association, told Global News, speaking from Whitehorse, Yukon.

“I think unfortunately, that’s where we’re finding ourselves right now. These wait times are not reasonable. You have many Canadians who are feeling desperate, not clear when it’s going to be their turn and not really willing to continue to wait in a lineup that doesn’t have a clear end.”

Spending years on a waitlist wasn’t an option for 38-year-old Jana Jones from New Brunswick.

Locally, Jones underwent three surgeries for the treatment of her endometriosis but when she was told she needed a fourth specialist procedure, there were no physicians in the Maritimes who could take her.

After being referred to Ontario instead, she found out the waiting time would be two to three years.

“The scary part about that is that endometriosis is progressive, so chronic and progressive,” Jones said.

“By the time I waited that two to three years, it’s hard to say what other organs would have been damaged.”

To skip the waitlist, Jones took matters into her own hands and underwent the procedure in the U.S. three weeks ago.

“I did a lot of my own research to figure out where I wanted to go,” she said. “I chose Maine because it was so close to home, and I just really felt I was in good hands with the specialist.”

Without transportation, the surgery cost Jones around US$30,000. This included an additional procedure that also cleared endometriosis from her diaphragm.

As for the Canadian health-care system, Jones feels “completely let down.”

“If the health-care system isn’t able to support people like me when they need help, they should be providing funding for the people who have to go outside of the country,” she said.

Failing to change the way the system is currently running when it comes to surgery backlogs would be “catastrophic,” according to Urbach at Women’s College Hospital. “It’s not just about the money.”

“Right now, we have a very stressed and overburdened workforce. There’s a lot of burnout. There’s a lot of exhaustion. There’s not a lot of coordination across the whole health system,” he said.

“People don’t realize how independent a lot of specialized health care is. For most surgical procedures in Canada, you’re referred to a surgeon who’s effectively running their own kind of independent business. They will operate on people when they get operating time at a hospital, but they’re managing their own independent queue or their own independent wait time, not coordinated or integrated with a broader system.”

Urbach’s solution to the backlog is called the single-entry model, a system that implements a centralized hospital approach.

“All the patients who need, say, a knee replacement enter a common queue. The patient who is next seen or next to receive surgery is the patient who’s waited the longest,” Urbach said.

“If you need a knee replacement, your family doctor has to find you an orthopedic surgeon. Ideally, they want to find you a good one and one who’s got a very short waitlist,” he added.

“What would really help them is to be able to provide a system where patients are just directed to the next available provider so that they can get surgery as quickly as possible.”

This approach would also create more equity between surgeons, according to Urbach, who said female physicians tend to get far fewer referrals than men.

“Right now, because there is no coordination across the whole system and you have these very independent and haphazard ways of getting patients to surgeons, it really disadvantages women surgeons,” he said.

“I think we’re at a crucial juncture right now. This is a real precipice for us and not to take advantage of the opportunity of this crisis right now to implement changes that have been necessary in our system for many decades is a squandered opportunity.”

Long waits for surgery and medical treatment cost Canadians almost $4.1 billion in lost wages and productivity last year alone, a new study released Wednesday by the Fraser Institute found.

Preliminary data suggest that an estimated 1.4 million patients waited for medically necessary treatment last year, and each lost an estimated $2,848 (on average) due to lost wages and reduced productivity during working hours.

“While some of this backlog is the direct result of COVID-19 related closures, results from the same survey suggest that almost as many patients (1.1 million) were waiting for treatment in 2019 — before the pandemic started,” said Mackenzie Moir, Fraser Institute policy analyst and study co-author.

Because wait times and incomes vary by province, so does the cost of waiting for health care.

While the highest cost of waiting per patient ($6,343) is estimated to be borne by patients in Nova Scotia, Prince Edward Island and Newfoundland and Labrador reported large decreases in the per-patient cost of waiting, warranting caution when interpreting results.

Outside the Maritime provinces, residents of Manitoba faced the highest per patient cost of waiting ($3,519), followed by Alberta ($3,199) and Saskatchewan ($3,129).

Last year, Canadians faced a median waiting time of 25.6 weeks between referral from a general practitioner and receipt of the treatment, the Fraser Institute said.

“We’ve never seen a backlog like this. This is a big threat to our ability to have public confidence in Canadian Medicare,” said Urbach.

— with files from the Canadian Press