Centralized surgery queues cut patient wait times but surgeons slow to get on board, doctors say

Centralized lists that match waiting patients with the next available surgeon are showing promise at reducing wait times, but doctors say there are still some hurdles to overcome before they become commonplace.

Though patients waiting months for surgery might assume they’ve been placed in a central queue that will give them access to the next available spot, that’s usually not the case.

“What we really have is hundreds or thousands of surgeons operating their own private businesses, managing their own wait list of patients,” Dr. David Urbach, head of surgery at Women’s College Hospital in Toronto, told CBC.

“Patients don’t know who has the shortest wait list. Referring doctors don’t know who has the shortest wait list.”

According to the Ontario Medical Association, a physician advocacy group, centralized referrals can reduce wait times by 20 to 30 per cent. 

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In B.C., a program that pools referrals and wait lists for knee and hip replacements saw an 11-per-cent drop in the number of patients waiting more than six months for surgery.

Saskatchewan’s health ministry reported that a four-year program including a central referral registry for all surgical specialities resulted in an 89-per-cent reduction in the number of patients waiting more than three months to go under the knife. However, that program has since ended.

There are similar systems in place, mostly focused on orthopedic and cataract surgeries, in Ontario, Manitoba and Nova Scotia. 

But Urbach says there are obstacles to wider adoption.

“It hasn’t gained a lot of traction among surgeons, and I think that’s one of the barriers,” he said.

‘Typically, it’s about who you know’

Dr. Mohamed Alarakhia, a family doctor in Ontario’s Waterloo-Wellington region, began working on a centralized e-referral program in 2016. He’d become frustrated with a process that saw him referring patients to a limited list of familiar surgeons, without knowing the length of their wait lists.

“Typically, it’s about who you know as a clinician,” Alarakhia said. “If there’s a person down the street that you don’t know that has a shorter wait time, you may not refer the patient there.”

Alarakhia is now the managing director of the non-profit eHealth Centre for Excellence in Kitchener, Ont., which receives referrals from about 7,500 doctors. Patients can use a standard form to indicate whether they want to see a preferred doctor, stay in a certain region or just go with the shortest wait time for care.

“Patients are able to see transparently where they’ve been referred, when they’ve been triaged. They get their appointment online and they can confirm their appointment,” he said.

Alarakhia said patients referred through his system see wait times drop, on average, by more than 50 days for cataract and orthopedic surgery referrals, and by about a month for MRIs.

For patients like Ian Whitehead, who recently spoke to CBC before and after cataract surgery in Kitchener, the reduced wait time is greatly appreciated. His surgeon, Dr. Toby Chan, is one of 16 ophthalmologists who’ve signed up for e-referrals.

“I’m really happy to be where I am today — and I’m getting it done so quick,” Whitehead said.

Surgeons say they need support to switch

But Alarakhia acknowledged that a major shift in procedure like adopting centralized wait lists is going to take time to adopt more widely.

“Clinicians are used to operating independently, not necessarily as groups,” Alarakhia said.

Dr. Sean Cleary, president of the Canadian Association of General Surgeons, said most surgeons are willing to get on board with centralized wait lists, but they need help making the switch.

“The hospitals and the government need to be part of this solution because these centralized programs require infrastructure and they require support and they require a basis of understanding,” he said.

WATCH | The National reports on centralized wait lists:

Single-line or centralized patient wait-lists have been shown to speed up surgery referrals, but Canada isn’t using them across the country. Surgeons say government support and investment could improve health-care systems.

Cleary dismissed the suggestion that some surgeons want to protect their wait lists as sources of income or prestige.

“The opinion that a wait list was somehow a point of pride for a surgeon is really a bit of an antiquated notion,” he said.

“The reality is that every surgeon in Ontario, every surgeon in Canada, is extremely busy. Their ability to provide the care to their patients is not limited by the presence or absence of a wait list.”