Canadian health care wait times highest for orthopaedic surgery procedures

Study finds a slight decrease in overall median wait time, but median orthopaedic surgery wait times increased by 2.1 weeks.

Issue: Issue 2 2006

A recent Fraser Institute study found that Canadian health care wait times were a median 17.7 weeks from the time of referral to treatment in 2005. Orthopaedic surgery had the longest median wait time: 40 weeks.

The 15th annual study of wait lists in Canada marks the first overall reduction in Canadian surgical and therapeutic wait times since 1993. Overall median wait times were 17.9 weeks in 2004. Despite this slight decrease, the average orthopaedic surgery wait time jumped 2.1 weeks between 2004 and 2005.

“Non-life-threatening diseases have been underfunded for some time; hence, waiting times have increased for many patients, particularly those with orthopaedic conditions,” Robert Bourne, MD, Canadian Orthopaedic Association president, told Orthopaedics Today. “As a result, the system became overburdened and long waits, both for referral-to-consult and decision-to-surgery emerged.”

Other observers noted that a shortfall in resources could mean too few orthopaedic surgeons or insufficient operating room time for them.

Waiting time 90% longer

The report’s authors, Nadeem Esmail, Fraser Institute Data Health Systems manager, and Michael Walker, senior fellow and Fraser Institute Foundation president, wrote: “Canada-wide total waiting time fell slightly in 2005, but its level is high, both historically and internationally. Compared to 1993, waiting time in 2005 is 90% longer.”

“Unfortunately, waits are much longer than the Fraser Institute average in many academic centers where there is greater competition for scarce resources, [such as in] transplantation, level 1 trauma centers [and] cardiac surgery,” said Bourne, whose patients fall into this group.

Charles Sorbie, MB, Chb, FRCSC, a practicing orthopaedic surgeon with Queen’s University in Kingston, Canada, also believes the Fraser survey underestimates the wait times.

“For example, the city of Toronto is reasonably well supplied with orthopaedic surgeons, so their wait times are not so long. But in smaller academic centers … and in smaller cities, the wait lists are longer,” said Sorbie, a member of the Orthopaedics Today Editorial Board.

Some of Sorbie’s patients have waited as long as 18 months for joint replacement surgery. And specific orthopaedic specialties, such as foot and ankle, have even longer wait times. In Toronto, patients wait a minimum of one year to see a foot and ankle consultant, Sorbie said.

Reasonable wait times

Esmail and Walker collected their data using a survey of specialist physicians between Jan. 10 and April 8, 2005.

They asked specialists to provide their opinions of clinically reasonable waiting times for various procedures. Specialists generally specified a period of time substantially shorter than the actual waiting times. In fact, 85% of the actual median wait times were greater than what specialists claimed to be clinically reasonable.

Again, orthopaedic surgery marked the largest difference between these two values. Actual waiting time is 15.3 weeks longer than what specialists considered reasonable.

Patients experienced not only long wait times between referral and treatment, but access to diagnostic technologies was delayed across Canada: median 5.5 weeks for a CT scan, 12.3 weeks for MRI and 3.4 weeks for ultrasound.

The study also found that patients waited for an estimated 782,936 procedures in 2005. Assuming that each person waited for only one procedure, researchers estimated that 2.48% of Canadians were waiting for treatment in 2005. They found 7.4% of waiting list patients requested to delay or postpone their treatment.

Wait time consequences

Longer wait times cause patients to suffer, while their families have trouble coping, Bourne said. They also carry unrecognized costs: lost work time, decreased productivity because of physical impairment and anxiety, and physical and psychological pain and suffering, according to Esmail and Walker.

“The primary consequence is a lot of unnecessary pain,” Sorbie said. Joint disease patients generally spend a lot of money on anti-inflammatory drugs, anti-arthritis drugs and other pain remedies. In addition, patients are sometimes depressed because of pain and activity limits. In some cases, conditions may worsen over time, potentially complicating surgery, he said.

Still, Canadian patients have been tolerant of the long wait times and inconveniences, Bourne said. They use canes, crutches and hand walkers and wear off-loading knee braces in the meantime, Sorbie said. And initiatives, such as the Arthritis Society home exercise program, assist patients while they wait and provide preconditioning before surgery.

Sorbie added that some patients travel to the United States for treatment – especially wealthy patients. And families sometimes raise money for relatives to receive treatment in the United States.

Not enough orthopaedists

Sorbie said that the long wait times for orthopaedic treatment may be partly related to a lack of orthopaedic surgeons.

“The problem exists because the number of patients demanding treatment for their joint and other musculoskeletal problems tend to overwhelm the number of available orthopaedic surgeons,” he said. “I think the demand will always be just ahead of the ability to meet those demands in good time.”

Although the government contributes money to hospitals, the hospitals continue to have trouble reaching budget targets, Sorbie said. The solution may lie in increased operating room time for orthopaedic surgeons.

“[The government does not] provide more money for orthopaedic surgeons or their secretaries or the other costs of improving the service by cutting waiting times,” he said. “Generally speaking, what additional government money there is has gone to the hospitals to provide more nurses, open more operating rooms or make them work longer hours. So far, nothing [has been done] to improve the number of orthopaedic surgeons in the country.”

According to Esmail and Walker, Canadian governments agreed with the prime minister to establish “evidence-based benchmarks for medically acceptable wait times” in “priority areas,” including cancer, heart, diagnostic imaging, joint replacements and sight restoration. Further, the government will place multi-year targets for each province to achieve these guidelines by the end of 2007.

For more information:
Esmail N, Walker M. Waiting your turn: Hospital waiting lists in Canada, 15th Edition. The Fraser Institute. October 2005. http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=801