Wait times in healthcare often linked to diagnostic testing—adding more doctors and nurses alone won’t fix that bottleneck

Stories appear in the media daily describing the horrors Canadians are experiencing trying to access timely and quality healthcare. It is tempting to assume the media is being histrionic, that representatives of healthcare professions, such as myself, are over-stating their case.

I can assure you – the crisis is real. And it may be worse than most people think.

It is equally tempting to think of our failing healthcare system in the same way we think of supply chain issues, inflation and the challenges being faced in the service industry – as remnants of the effects of the pandemic that will get better on their own with time.

Unfortunately, our health system breakdown is not only the result of the pandemic. COVID-19 was simply the straw that broke the camel’s back.

Healthcare in Canada is on the verge of collapse because of decades of willful ignorance and inaction by healthcare decision-makers at all levels of government, and throughout the country. Not only was it all predictable -- it was predicted.

Health policy researchers, healthcare professionals, think tanks and others have been sounding the alarm for years. One of the very first meetings I went to when I started my career in 1998 was about the challenges facing healthcare and what needed to be done to avert catastrophe. Even then, it was not a new conversation.

So, if our current crisis isn’t the result of the pandemic, what exactly is the problem?

Governments have too often ignored the fact that healthcare is people. That is, without healthcare workers, we have nothing but empty healthcare facilities. While this might seem obvious, governments routinely ignore the people who actually deliver healthcare.

Announcements made touting large investments in new hospitals, machines and other infrastructure are often devoid of any mention of the people required to transform these investments into actual increases in healthcare delivery capacity.

When governments do bother to include the people who deliver healthcare in their proposed solutions, they are almost exclusively physicians and nurses. Of course, we need more nurses and doctors. Having more of them, however, will not result in meaningful improvements to our system until the number of other healthcare professionals is also addressed.

Our health system delivery is complex and includes a wide range of health workers.

For example, wait times in hospital emergency rooms are often used as a metric for the health of our healthcare system but the bottleneck is not only doctor and nurse care. If you add more doctors and nurses, patients might be triaged more quickly (an important metric), but then they will likely wait just as long -- merely at another stage in the process.

In the vast majority of cases, emergency room physicians need diagnostic tests to determine what is going on with a patient. And these tests are done by medical radiation technologists (MRTs) who conduct X-rays, CT scans and MRIs. Ultrasounds are done by sonographers. Bloodwork and other tests are done by medical laboratory technologists and medical laboratory assistants. Diagnostic testing is also central to the healthcare Canadians get in other settings.

Effective healthcare requires teamwork. Any effort to get us out of the mess we are in will need to reflect this fact and address the staffing needs of many healthcare professions.

And this situation is everywhere, not only in diagnostics. Many of the MRTs in our association work as radiation therapists, treating patients with cancer. The shortages in their ranks over the past months have led to reductions in cancer care services for patients.

The list of what I call ‘invisible healthcare workers’ is long.

We have a shortage of them too – and those who are working are experiencing an unprecedented level of burnout, job dissatisfaction and leaving for early retirement.

We are at a crossroads: governments can continue to do what they have long been doing -- they can even do it harder and spend more money. But as the saying goes, the definition of insanity is doing the same thing over and over again and expecting different results.

Our healthcare system is on life support. Coming off of life support only happens for one of two reasons: either the patient is showing signs of improvement or it is determined that there is no hope of recovery.

Right now, the patient is our healthcare system. Its fate will be determined by the willingness of those who have the capacity to implement change -- and to include all healthcare professionals in their strategies.

Irving Gold is the Chief Executive Officer of the Canadian Association of Medical Radiation Technologists.