Ontario needs to find innovative solutions to clear backlog of medical services: experts

An analysis by the Ontario Medical Association (OMA) found a backlog of 15.9 million healthcare services due to the COVID-19 pandemic. Physician leaders suggest healthcare reform is needed to clear the backlog. “We have to look forward. We have to find innovative solutions,” said Dr. Sohal Goyal, an assistant clinic professor at the Department of Family Medicine at McMaster University and a family physician in Mississauga at an OMA press briefing earlier this month. “And we have to make sure that those vulnerable populations aren’t left behind as many of them were left behind during COVID.” Sharing the load across Ontario could help, just like when COVID-19 patients were transferred to ICUs in different regions of Ontario. “It would be a lost opportunity not to build on the experience gained from that—what worked, what didn’t work—and apply it to other conditions where needed,” said Dr. Harindra Wijeysundera, chief of the Schulich Heart Program and head of the division of cardiology at Sunnybrook Health Sciences Centre. Dr. Goyal said some patients are willing to travel outside their local area to get a procedure performed more quickly, but noted not all patients are able to do so. While finding the right solutions will be a challenge, they should follow three principles, Dr. Wijeysundera said. First, it can’t be a sprint, but a marathon. The effort will require the same focus, resources and length of attention that is being given to controlling COVID-19. “What finally emerges from this will likely be a fundamentally different healthcare system." Second, healthcare providers and policy makers need to see the provincial healthcare system as province-wide, with the ability to share capacity among regions. And third, Ontario needs to learn from health equity lessons of the COVID-19 pandemic, he said. To estimate the backlog, the OMA compared billings for six procedures in 2020 with billings during the same period in 2021. The estimate of 15.9 million medical services comes from adding these missing medical services to the existing waitlist for the procedures. The OMA also calculated how long it would take to clear the backlog if physicians were working at 120% of their normal load. “Those estimates would require physicians to work at 120% capacity, which really isn’t feasible,” said Dr. Adam Kassam, the president of the OMA and a physiatrist and clinical associate at Runnymede Healthcare Centre in Toronto. The analysis suggests the backlog is greater in the community settings than in hospitals. Dr. Kassam noted the bulk of managing chronic conditions is done in community settings. The concern is that people who haven't seen their doctors during the pandemic may have developed new symptoms or conditions, he said. “We know that the backlog will continue to grow, and many conditions are going undiagnosed or under diagnosed." When people do visit their physicians these days, they're sicker. “Even though visits have significantly dropped, complexity during visits has increased. In my own practice, I have seen a more than 400% increase in mental health-related visits,” Dr. Goyal said. That complexity is combined with the magnitude of the backlog, Dr. Wijeysundera added. The pandemic has inserted obstacles in each step of the diagnosis and treatment processes, he said. Dr. Wijeysundera said data from CorHealth Ontario looking at coronary valve disease confirm what clinicians suspected. “We know that the patents who got on the wait list are sicker." “The actual wait list is smaller than what we expected when we calculate what the backlog should be." The reason? Patients are missing from wait lists because they are still going through the steps that lead them to surgery, he said. Clearing the backlog doesn’t stop in the operating room, added Dr. Kassam. After diagnosis and intervention, there’s also rehabilitation. Shedding more light on the issue, a new report by Canadian Institute for Health Information illustrates the effect of delays and cancellations during the early days of the COVID-19 pandemic, from April to September 2020. Urgent procedures, like radiation therapy and hip fracture repair, were performed within the recommended time frames. The number of these procedures completed was similar in 2020 as in 2019. Median wait times improved for some cancer surgeries, although the overall number of surgeries decreased by a fifth compared to 2019. Across Canada, cancer surgeries were among the last surgeries to be delayed and the first to restart. There may have been increased capacity for cancer surgeries because of other cancelled or delayed surgeries. The CIHI report found more patients had to wait longer than the recommended time (182 days) for hip and knee replacements in 2020 compared to 2019. In 2020, half of patients waited longer than recommended, in 2019, a third of patients waited longer than recommended. The number of MRI decreased a quarter and the number of CT scans was down by one fifth compared to 2019. The situation has been hard on healthcare staff who have to reassure patients that the waitlist will progress, while watching patients deteriorate, said Dr. Wijeysundera. “There’s a real moral trauma that has come with that,” he said. “The impact on patients has been extremely difficult. The impact on health teams cannot be under-emphasized." Currently, the OMA is developing recommendations on how to address the backlog, but they've got their work cut out for them. A recent report from the province's Financial Accountability Office suggested it will take more than three years and $1.3 billion to clear the backlog of surgeries and diagnostic procedures.

Ontario needs to find innovative solutions to clear backlog of medical services: experts

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