Long Wait Times for Specialists: An Inconvenience or a Problem?

By: Nardeen Oweis

An indicator of a good healthcare system in a country is how long individuals have to wait to see a doctor or a medical specialist. Surprisingly, Canada ranks first among many other OECD countries for the longest wait times to see a specialist and to get a medical response from a doctor (2). Although wait times may be dismissed as an inconvenience, it can be serious when prognosis worsens as a patient waits for treatment. It is important to remember that for many medical diseases and disorders, the best course of treatment is early intervention. This includes diagnosing the disease at an early stage of development and then beginning treatment as soon as possible. Long wait times may push diagnosis and treatment to advanced stages of development for the disease which may reduce prognosis. In some cases, a long wait time can be the reason a treatable disease becomes an irreversible or permanent one (3).

As mentioned previously, Canada ranks first for longest wait times (2). More specifically, over 33% of Canadians do not receive a response from their doctor on the same day, and nearly 60% must wait more than a month to see a specialist (2). To put this in context, the United States ranks second for long wait times, but only 27% of Americans have to wait more than a month to see a specialist (2). This huge gap between Canadian wait times and American wait times is significant and points towards a great disparity in the Canadian healthcare system. Switzerland has the lowest wait times with only 23% of people waiting over a month to see a specialist (2). This means that almost 3 times as many Canadians are waiting over a month to see a specialist than in Switzerland. Since Switzerland also has universal healthcare similar to Canada, there must be other causal factors of this problem. There are even some differences in wait times throughout Canada. For example, you can be waiting up to 7 weeks in Alberta for a CT scan or up to 18 weeks in Prince Edward Island for an MRI (3). Currently, New Brunswick has the greatest median wait times where residents can be waiting up to 39.7 weeks to see a specialist (3). This is compared to Ontario that has the shortest median wait time of 16 weeks to see a specialist (3). This demonstrates that there are more disparities within Canada that influence specialist care wait times.

Furthermore, there are many consequences of long wait times. A study shows that nearly ⅕ of Canadians have been negatively impacted by wait times (1). The result of these wait times includes increased anxiety, stress, and pain, worsening of their medical condition (1). Living with a medical condition and waiting for a diagnosis or treatment can take a heavy toll on mental health. It is important to emphasize that poor mental health can exacerbate existing symptoms (4). Worsening mental health due to long wait times can increase the individual’s vulnerability to new physical symptoms (4). Furthermore, anxiety and depression may reduce motivation and these individuals may neglect self-care, which can result in poor health outcomes (4). Thus, long wait times can negatively affect mental health which can, in turn, worsen the physical medical conditions. Also, long wait times can have financial consequences when medical conditions impact the individual's ability to go to work (3). People may be forced to take time off of work while awaiting treatment (3). Again, financial problems can be a major stressor, which can worsen mental health states.

Research indicates that there is no single cause of this problem but rather a combination of factors contributing to this disparity. So far, the leading causal factor seems to be a lack of specialists and technology (1). Understandably, lower resources mean that people will have to wait their turn. However, wouldn’t the obvious solution be to simply increase resources to fill in this gap? The answer is it is not that simple. Even if more specialists were trained, there are still not enough resources in hospitals or clinics for testing. In other words, if we increase the number of specialists in Canada, we would also have to increase the number of hospitals, diagnostic screening and imaging technology, testing laboratories, and more. It is a costly process that is not even guaranteed to work in rural areas in Canada. Rural areas already have a very low physician-to-doctor ratio compared to urban regions (5). It is reflective of the small populations that live in vast areas across Canada. Many Canadians living in rural areas do not even have access to primary health care such as a family doctor (5). With few family doctors, Canadians cannot even get referred to specialists for many of their medical conditions.

COVID-19 has exacerbated the issue by pushing back many specialist appointments and surgeries, leaving many doctors and specialists to believe that they will never catch up (7). In fact, wait times have reached an all-time high at an average waiting period of 22.6 weeks for a specialist in 2020 (7). In other words, the pandemic pushed us in the opposite direction when it comes to rectifying this issue. This is not to excuse long wait times to cancellations from the pandemic because this has been a profound issue long before. In 2019, wait times were an average of 20.9 weeks for medically urgent care (7). Thus, while the pandemic did worsen the issue, as expected, it is certainly not the cause.

A benefit of COVID was the popularization of virtual health care. Virtual health care has been proposed various times as a potential solution to the increasing demand for specialists. With online appointments, specialists can see many more patients and determine urgency from there. Furthermore, a virtual solution to long wait times was proposed by two doctors in Ottawa (8). They presented a new virtual program known as eConsult where all the patient’s information, diagnostic imaging, and even photos of their medical condition can be posted and viewed by the specialist (8). Specialists would then set up virtual appointments with their patients to discuss the next steps and to answer any questions or concerns the patient may have (8). What is disappointing is that this solution was proposed and implemented 10 years ago but is not gaining much popularity (8). While it is used greatly in some areas or by some clinics, it is not a renowned solution. By pushing virtual programs like this into the spotlight, wait times can potentially be reduced significantly. It is not out of the question that people may be hesitant or do not have much expertise when it comes to technology, however, these issues can be overcome with the right efforts being placed on encouraging such progression of virtual health care.

References:

(1) Liddy, C., Moroz, I., Affleck, E., Boulay, E., Cook, S., Crowe, L., Drimer, N., Ireland, L., Jarrett, P., MacDonald, S., McLellan, D., Mihan, A., Miraftab, N., Nabelsi, V., Russell, C., Singer, A., & Keely, E. (2020). How long are Canadians waiting to access specialty care? Retrospective study from a primary care perspective. Canadian family physician Médecin de famille canadien, 66(6), 434–444.

(2) World Population Review (2021). Health Care Wait Times By Country 2021. https://worldpopulationreview.com/country-rankings/health-care-wait-times-by-country

(3) Benefits By Design (2020). How Long Is Too Long? Canadian Healthcare Wait Times. BBD. https://www.bbd.ca/blog/healthcare-wait-times-canada/

(4) CMHA (2008). The Relationship between Mental Health, Mental Illness and Chronic Physical Conditions. https://ontario.cmha.ca/documents/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions/

(5) Malko, A. V., & Huckfeldt, V. (2017). Physician Shortage in Canada: A Review of Contributing Factors. Canadian Center of Science and Education, 9(9), 68-80. https://doi.org/10.5539/gjhs.v9n9p68

(6) Jaakkimainen, L., Glazier, R., Barnsley, J., Salkeld, E., Lu, H., & Tu, K. (2014). Waiting to see the specialist: patient and provider characteristics of wait times from primary to specialty care. BMC Family Practice, 15(16), 1-13. https://doi.org/10.1186/1471-2296-15-16

(7) Fraser Institute (2021, May 5). Wait times—the other health-care crisis. https://www.fraserinstitute.org/blogs/wait-times-the-other-health-care-crisis

(8) Laucius, J. (2018, July 31). A made-in-Ottawa solution to get around long wait times to see medical specialists. Ottawa Citizens. https://ottawacitizen.com/news/local-news/a-made-in-ottawa-solution-to-get-around-long-wait-times-to-see-medical-specialists