If your family doctor decides you should have a colonoscopy for cancer screening, you may feel anxious thinking about the potential health issue. You may also worry about the procedure itself, and if you’ll feel much discomfort.
But for one Nova Scotia patient, that’s nothing compared to the frustration he felt when the referral letter arrived in his mailbox, within the week, announcing that he was looking at a wait time of 12 months.
Canadians are famous for ignoring an issue until it strikes a chord with us, personally. Wait times for diagnostic services are getting longer and longer, and we know they remain significantly higher than in most leading industrialized countries.
So how long are you expected to wait for a service? It seems to depend on where you live.
The Canadian Medical Association (CMA) works with other national medication organizations to lobby for implementation of wait-time commitments. They co-founded the Wait Time Alliance, and run annual Taming of the Queue conferences.
According to the Wait Time Alliance, 90% of patients in Newfoundland and Labrador received their hip replacement within six months compared to only 37% of patients in Nova Scotia.
In 2004, the Canadian government committed $5.5 billion to a 10-year plan to reduce wait times in five key areas: cardiac care, cancer care, diagnostic imaging, joint replacement, and sight restoration. However, 11 years later, we haven’t seen much progress in shortening these wait times.
The Wait Time Alliance designed benchmarks for these five key areas:
- Cardiac care: An acceptable wait time ranges from within 24 hours (for consultation in most emergency situations) to within three months (catheter ablation).
- Cancer care: An acceptable wait time ranges from within 24 hours (for emergency radiation therapy) to within 10 days for scheduled consultants and treatments).
- Diagnostic imaging: An acceptable wait time ranges from within 24 hours (for Priority 1 MRIs and CT scans) to 60 days (for Priority 4 cases).
- Joint replacement: An acceptable wait time ranges from within 24 hours for emergency cases, within 30 days for urgent cases, and scheduled treatment should be done within six months of consultation.
- Sight restoration: An acceptable wait time for a scheduled case is within 16 weeks.
Then the Wait Time Alliance went a step further – rather, seven steps further – and devised wait-time benchmarks in 12 other areas of care:
- Arthritis care: An acceptable wait time ranges from 7 days (for a patient with Systemic Onset Juvenile Idiopathic Arthritis) to three months (for a patient with potential inflammatory back pain).
- Chronic pain: An acceptable wait time ranges from 14 days (for cancer patients who do not have access to palliative services) to six months (for types of chronic pain that do not include nerve damage, disc problems, cancer pain, or exacerbations/flare-ups).
- Digestive health: An acceptable wait time ranges from within 24 hours (for urgent cases of gastrointestinal bleeding, esophageal food bolus, ascending cholangitis, severe acute pancreatitis, severe decompensated liver disease, and acute severe hepatitis) to six months (for Chronic gastroesophageal reflux disease for screening endoscopy, screening colonoscopy, or persistent unexpected abnormal liver enzyme tests).
- Emergency rooms: An acceptable wait time for an initial assessment by a physician is one hour, and an acceptable length of stay ranges from two to eight hours.
- Family doctors: The majority of appointment slots are open for patients who call that day for routine, urgent, or preventive visits.
- General surgery: An acceptable wait time for urgent cases is two weeks (six weeks for semi-urgent cases, and 16 weeks for scheduled cases).
- Nuclear medicine: An acceptable wait time for all emergency cases is immediately or within 24 hours. An acceptable wait time for an urgent bone scan or fluorodeoxyglucose positron emission tomography (FDG-PET) is within seven days (within 30 days for schedule cases), and an acceptable wait time for urgent cardiac nuclear imaging is within three days (within 14 days for scheduled cases).
- Obstetrics and gynaecology: Acceptable wait times range from one week (for a consultant with a pregnant woman who risk factors for adverse perinatal outcomes) to 12-24 weeks (for uterine prolapse surgery).
- Pediatric surgery: Acceptable wait times range from 24 hours (for Priority I cases) to within 12 months (for Priority VI cases).
- Plastic surgery: Acceptable wait times range from less than three hours (Necrotizing fasciitis, ahdn replanations) to 12 months (cleft palate).
- Psychiatric care: Acceptable wait times for access to a psychiatrist range from within 24 hours (emergency cases of first episode psychosis, mania, postpartum severe mood disorder or psychosis, and major depression) to within four weeks (scheduled cases).
Take Nova Scotia, for example. The current wait time for a hip replacement ranges from an average of 119 days (four months) in Sydney (at the Cape Breton Regional Hospital) to 366 days (just over a year) in Dartmouth (at the Dartmouth General Hospital).
The Wait Time Alliance says an acceptable benchmark for a hip replacement is within 24 hours for emergency cases, within 30 days for urgent cases, and scheduled treatment should be done within six months of consultation. Patients waiting for a hip replacement at the Dartmouth General may wait double the acceptable wait time — or even longer.
Nova Scotia’s current wait time for a knee replacement ranges from an average of 172 days (almost six months) in New Glasgow (at the Aberdeen Hospital) to 516 days (one year and four months) in Dartmouth (at the Dartmouth General Hospital).
The Wait Time Alliance says an acceptable benchmark for a knee replacement is within 24 hours for emergency cases, within 30 days for urgent cases, and scheduled treatment should be done within six months of consultation. This means that only a single hospital in Nova Scotian has an average knee replacement wait time that squeaks in within the recommended benchmark.
According to a study on the cost of wait times in Canada, there’s a high cost to our excessive waits for medical care. Long wait times for just four procedures (joint replacement surgery, sight restoration, coronary artery bypass graft surgery, and MRI scans) cost the Canadian economy an estimated $14.8 billion in 2007.
Cost aside, wait times also take an emotional, physical, and financial toll on patients and their families.
When a patient has to wait for a procedure, their condition may worsen — putting the patient at risk for complications, and possibly needing a more invasive treatment.
Long wait times do not automatically go hand-in-hand with having a universal health care system. Canadians are suffering from excess wait times, and something needs to be done.
For more information on wait times in Canada, please visit http://www.waittimealliance.ca/for-professionals.
