A woman waits for knee replacement surgery, the joint pain limiting her mobility, her quality of life diminishing with each month of waiting. She was told the wait would be months; it has become a year. An elderly man waits for cataract surgery, his vision declining, his independence shrinking, the driving he relied on no longer safe. A cancer patient waits for surgery that was supposed to be urgent, the wait time for "urgent" cases somehow still measured in weeks. A surgeon reviews her wait list, hundreds of patients needing operations she cannot provide fast enough, the operating room time insufficient for the demand. A hospital increases surgical capacity temporarily, clearing the backlog, only to see it rebuild within months. A patient pays for surgery in another country, the private option available to those with resources while others wait. Surgical wait lists, the queues of patients awaiting operations, have become defining feature of Canadian healthcare. How these waits are managed, reduced, or accepted shapes patient outcomes and healthcare perception.
The Case for Wait Time Reduction
Advocates argue that surgical wait times must be reduced. From this view, waiting is harmful and unacceptable.
Waiting causes harm. Pain, disability, and anxiety accumulate during waits. Some conditions worsen while waiting. Wait time is not neutral - it has health consequences.
Waits affect outcomes. For some surgeries, longer waits produce worse results. Cancer surgery outcomes may depend on timeliness. Wait times can affect surgical success.
Public expectations are legitimate. Canadians expect timely access to care. Waits that extend for months or years erode trust in the healthcare system. Meeting reasonable expectations matters.
From this perspective, surgical wait time reduction requires: increased operating room capacity; more surgical staff; better scheduling efficiency; and commitment to meeting wait time benchmarks.
The Case for Appropriate Prioritization
Others argue that not all surgical waits are equal. From this view, prioritization and efficiency matter alongside capacity.
Urgency varies. Life-threatening conditions should be treated before elective ones. Appropriate prioritization ensures most urgent cases are done first. Some waiting for less urgent surgery is acceptable.
Not all surgery is necessary. Some operations have marginal benefit. Reducing unnecessary surgery would shorten waits for appropriate surgery. Appropriateness criteria should be applied.
Resources have limits. Eliminating all waits would require resources that might be better used elsewhere. Some waiting may be acceptable trade-off for other healthcare priorities.
From this perspective, surgical waits should be prioritized appropriately with efficiency improvements and appropriate utilization review.
The Benchmark Approach
Wait time benchmarks set targets for maximum acceptable waits.
From one view, benchmarks should be met consistently. Setting targets and then missing them repeatedly is meaningless. Resources should be allocated to meet benchmarks.
From another view, benchmarks may be arbitrary. Clinical variation means not all patients with the same diagnosis need the same urgency. Flexible prioritization may serve better than rigid targets.
How benchmarks are used shapes wait time management.
The Capacity Challenge
Surgical capacity determines how many operations can be done.
From one perspective, more capacity is needed. More operating rooms, extended hours, and more surgical teams would increase throughput. Investment in capacity is investment in access.
From another perspective, capacity must be staffed. Operating rooms without anesthetists, nurses, and surgeons to run them are not capacity. Workforce is the constraint, not facilities.
How capacity is expanded shapes surgical throughput.
The Private Option
Private surgical options exist in various forms.
From one view, private surgery creates two-tier access. Those with money skip the line while others wait. Private options undermine the public system. Access should not depend on ability to pay.
From another view, private options relieve pressure on the public system. Patients who pay privately free public capacity for others. Private surgery can complement public system.
How private surgery is regulated shapes equity.
The Backlog Reality
Pandemic created massive surgical backlogs.
From one perspective, backlog clearance requires extraordinary measures. Temporary capacity expansion, extended hours, and focused effort are needed. Backlogs must be addressed.
From another perspective, backlogs reveal underlying capacity problems. Addressing current backlogs without fixing underlying issues will just recreate them. Sustainable solutions are needed.
How backlogs are addressed shapes recovery.
The Canadian Context
Canadian surgical wait times have been persistent problem. Provincial wait time strategies have had mixed success. Benchmarks exist for common procedures but are often not met. Pandemic greatly increased surgical backlogs. Recovery efforts are ongoing but waits remain long. Private surgical options vary by province. Out-of-country surgery occurs but is not covered. Wait time reporting has improved. Surgical capacity has increased in some areas. The problem is recognized but solutions are difficult and expensive.
From one perspective, Canada must significantly increase surgical capacity to reduce waits.
From another perspective, prioritization and efficiency should accompany capacity expansion.
How Canada addresses surgical waits shapes access to needed operations.
The Question
If waiting causes harm, if waits affect outcomes, if expectations are legitimate, if resources have limits - how should we manage surgical waits? When someone waits a year for surgery that was quoted at months, what promise was broken? When urgency systems work but "urgent" still means weeks, is that acceptable? When private options exist for those who can pay, what equity exists? When backlogs are cleared only to rebuild, what permanent solution is needed? When we compare our wait times to other countries, where do we stand? When we set benchmarks we cannot meet, what are benchmarks for? And when someone needs surgery, how long should they have to wait?