Across Canada, patient experiences with surgical delays and long wait lists sound exhaustingly similar, particularly for non–life-threatening procedures such as hip and knee replacements. Patients may wait for months — or even a year or more — for a surgical consultation. After that, they may have to wait for another year for their procedure.
In the meantime, patients often experience increasing pain, reduced quality of life, and negative effects on their personal and professional lives. Faced with an unbearable wait, some patients opt to leave the public healthcare system for private surgical centers. With this approach, patients eventually get the care they need but spend their savings on expensive procedures, travel, and missed work time.
Provincial healthcare systems are seeking solutions, including public and private options, to address the backlogs that have persisted since before the COVID-19 pandemic. Population growth, the rising demands of an aging population, and declining supply among a depleted workforce contribute to a conundrum that has persisted for more than a decade.
“In Canada, as in many countries, there are exponentially escalating demands on the healthcare system, where [satisfying] the needs of a growing and aging population will always be a challenge,” Sean Cleary, MD, chair of general surgery at the University of Toronto, Toronto, Ontario, Canada, and past president of the Canadian Association of General Surgeons, told Medscape Medical News.
“We’ve been talking about wait times and capacity for a long time, and we continue to look at ways to make the process better,” he said. “How do we deliver care in an efficient, appropriate, and effective way? There’s no magic solution, so we have to continue to pick away at it.”
Recent Surgical Backlogs
To measure progress toward shorter wait times, the Canadian Institute for Health Information (CIHI) looks at annual changes in surgical volumes, hip fracture surgeries within 48 hours, and joint replacement wait times.
Surgical volumes returned to prepandemic levels in 2022-2023, when 2.22 million procedures were performed. Volumes increased further to 2.33 million in 2023-2024, marking a 5% uptick from 2019-2020, according to a CIHI report released in late October.
Although more surgeries are being performed, wait times remain longer than considered acceptable, particularly for hip and knee replacements, which are among the top three most common inpatient surgeries in Canada. In 2023, about 62% of these surgeries fell within the benchmark wait of 26 weeks. The proportion ranged broadly from 28% in Prince Edward Island and 36% in Saskatchewan to 60% in British Columbia and 77% in Ontario.
“At a national level, wait times for most reported procedures remain longer than the prepandemic levels, although the volume of procedures has returned to prepandemic levels,” said Cheryl Chui, director of health systems analytics at CIHI.
“Surgical delays can lead to negative health outcomes, including worsening medical conditions, increased pain, and even death,” she said. “Addressing these delays is essential to improve patient outcomes.”
The private cost of these public queues for medically necessary care can add up, according to a recent report from Fraser Institute, Vancouver, British Columbia, Canada. For instance, in 2023, the estimated cost of waiting for care in Canada equaled nearly $3.5 billion, or about $2871 for each of the 1.2 million Canadians waiting for treatment last year.
Fraser Institute researchers found that national median wait times from a general practitioner referral to treatment were nearly 28 weeks in 2023, up from 9 weeks in 1993. In addition, wait times from specialist appointment to treatment was 13 weeks, which is about a month longer than what physicians considered to be clinically reasonable, at about 8 weeks.
“That being said, context is important. Even in 2019, patients in Canada were waiting 19.8 weeks between referral and treatment. In other words, wait times are a structural issue that have been exacerbated by the pandemic,” said Bacchus Barua, the study coauthor and director of health policy studies at the Fraser Institute.
However, “long wait times for care are not a necessary price that needs to be paid to maintain a universally accessible healthcare system. There are at least 30 other high-income countries that share the goal of universal healthcare,” he said. “Unfortunately, the current approach in Canada is focused on the preservation of the [current] system, with the patient left to bear the consequences.”
Testing Solutions
The COVID-19 pandemic reduced patient access and increased healthcare worker burnout. Provinces have tested various solutions to boost procedure volumes, reduce wait times, and rebuild the healthcare workforce — with varying degrees of success.
In Alberta, Canada, for instance, the Alberta Surgical Initiative was formed to address surgical backlogs and reduce wait times for non–life-threatening procedures. During that time, many healthcare providers migrated from public systems to private surgical centers, which has exacerbated problems with access. New public-private partnerships are expanding the use of surgical centers to provide publicly funded procedures, and a centralized intake program is helping to increase access to surgeons with shorter wait times. Yet, wait lists remain long as high demand persists.
In Ontario, nonurgent surgical wait times for the same procedures vary broadly between hospitals — by a factor of as much as 15 in some areas — according to a study published in PLOS ONE in August. The authors recommended adopting a centralized referral system, which could reduce the first part of the wait list, as well as teams of surgeons for common procedures, which could pool availability and reduce the second part of the wait list.
“Most provinces are taking some common actions to address longer wait times,” Chui said. “The most important strategy is central intake, where all patients are queued on one list and have the choice to wait for a specific doctor or take the first available surgeon.”
Provinces are also managing operating room times to increase capacity, monitoring wait lists to ensure appropriate patients are on their lists, and using central case managers to arrange surgeries, she said. Communication with patients and relevant stakeholders is also key.
“Importantly, patients will always be waiting for nonurgent surgery, and this time is stressful for patients. Reframing the wait times as an opportunity to prepare for surgery (prehabilitation) can improve patient clinical outcomes (mental and physical health) and the patient experience, which can reduce the burden on healthcare systems,” said Khara Sauro, PhD, professor of head and neck health services research at the University of Calgary, Calgary, Alberta.
Sauro and colleagues have researched surgical delays before and during the pandemic across several Canadian provinces. Although some backlogs are being cleared now, she noted, surgical wait times were an issue before the pandemic and remain a persistent issue today.
“We can’t fix what we can’t measure, so it is important to continue to monitor and understand surgical wait times so we can adapt to the needs of the population,” Sauro said. “However, we need to move beyond measurement and use evidence to inform change. Times of challenge breed innovation — this is a great opportunity for policymakers, healthcare providers, and researchers to work together to find innovative solutions to the challenge of long surgical wait times.”
