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The Waiting Game
Access to Medical Specialists in Canada By Jamie Moore
, a consortium of medical associations, regional health authorities, the four western provincial ministries of health and health research centers.
"There are, no doubt, countless reasons for long waiting lists. One is a shortage of resources, both money and qualified staff, including nurses, family physicians, specialists and technicians," according to a 2002 report by the Commission on the Future of Health Care in Canada.
Sholzberg-Gray blames the shortage on 1980s cutbacks in medical school enrollment. "Another reason is some specialists want to work fewer hours, and there are always specialists retiring," she says.
The group's panel of family physicians and other medical professionals laid out a new set of criteria to more fairly and methodically prioritize patients on waiting lists. It's now up to specialists around the country to implement the system. Now, patients complete a multiple-choice questionnaire about their medical condition. Every response scores a different point value, the sum of which allows doctors to prioritize each patient.
"We haven't solved the problem of waiting lists in Canada, but we've made significant progress," says Dr. Tom Noseworthy, chair of the WCWL steering committee.
The Cardiac Care Network of Ontario is no stranger to progress. Among providers in the field, the network has gained legendary status for its computerized patient registry. Seventeen cardiac centres combine their patient waiting lists on the centralized registry, which keeps track of patients until their procedure. The Cardiac Care Network also uses a patient intake assessment that calculates an urgency rating score and helps prioritize patients. Both systems work together so that, regardless of the procedure needed, the more serious the patient's condition, the sooner he or she receives care.
Newfoundland tracks its cardiac care patients a bit less formally. Each week, the province's cardiac surgeons and cardiologists meet in St. John's to discuss individual patient needs and priority. It's simple. Those worse off get treated first, says Dr. Rogers, who lived and worked as a family doctor in St. John's before moving to British Columbia.
Until these strategies catch on throughout the country, some stopgap solutions are already in place. Increasing enrollment capacities at Canadian medical and nursing schools is one. Relying on U.S. surgeons is another. After reaching a waiting list "crisis" for coronary artery bypass surgery in British Columbia, the Ministry of Health arranged a contract with four Seattle hospitals to provide surgery for up to 200 of the province's cardiac patients per year.
"It's important that patients understand the limitations of the health care system," says Dr. Rogers. "They must be patient and reasonable with their doctors, yet be advocates for themselves and make sure their voice is heard."