How to reduce Canadians’ painfully long waits to see a specialist

Just figuring out who’s available at any given time is a guessing game that can swallow up weeks of time, adding to the many months it takes to get seen after the referral has been accepted. Referrals are mostly an opaque process involving family doctors’ best guesses at which specialist can see their patients the soonest.

These days, referrals are increasingly rejected, either because the specialist no longer has appointments to offer or because the patient doesn’t live in the catchment area (even if they work there). Either way, the ball gets passed back to the family doctor in what amounts to a triple-whammy:

• Patients suffer more as wait times lengthen

• Emergency rooms are more likely to become an option

• Family doctors are tasked again with finding an available specialist.

But Canadians are a patient bunch, having long endured some of the lengthiest waits to access specialty care among OECD countries for years. It’s a dubious distinction that doesn’t even factor in the time family doctors need to figure out who’s actually available.

Canadian surgeons reported in 2023 that the median time it took to assess a patient and start their treatment had been 30 weeks in 2021, over 4 times the wait in 1993. Ontarians fared the best—waiting a mere 22 weeks—while Nova Scotians faced a whopping 57-week wait.

Lowering harmful wait times means rethinking old ways of doing things. Most family doctors (including me) are stuck in the rut of guessing who’s available and submitting that referral to that one specialist, fingers crossed. Switching to a centralized intake of referrals would take the guesswork out of the situation. Rather than referrals being sent to a single specialist, patients would be triaged to see the first available one. It’s a model that retail chains like Walmart have long employed because making the most out of limited resources—be they cashiers or specialists—is what moves the line the fastest.

Chronic conditions would ideally be referred to a team rather than a lone specialist. Someone with diabetes would have access to a dietician, exercise classes, an optometrist and a clinician. A patient in need of a knee replacement would first be triaged and referred to an occupational therapist, a physiotherapist and if necessary, an orthopedic surgeon. This would ensure that patients are referred appropriately and free up much-needed appointment slots.

Sound too good to be true? Back in 2017, Toronto’s Rapid Access Clinic for hip and knee arthritis and low back pain applied this model of care, but it languished. That’s because family physicians were too used to referring to individual orthopedic surgeons, even though patients fare better with a team approach.

Asking family doctors to switch to centralized intake is a big ask. It’s not the entire solution to reducing Canada’s long waits, but it’s an absolutely critical first step to reduce the very real suffering of patients, loved ones and family members that comes with potentially deadly wait times, and to improve the efficiency of our system.

Iris Gorfinkel is a family physician, clinical researcher and a medical contributor for CBC in Toronto.