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How a centralized wait list can help clear Ontario’s surgical backlog without outsourcing surgeries to private, for-profit clinics

Ford’s solution to the growing surgical backlog of 206,000 patients is not wise, nor is it a solution. Doug Ford is pushing to permanently outsource 50% of Ontario’s surgical and diagnostic services to private clinics. Why is this a poor idea? Privatization involves the use of privately owned, for-profit clinics where patients pay out of pocket for care. Not only will patients pay more: we all will. Dr. Bob Bell, former CEO of the University Health Network, recently noted that Ontario is paying up to 30 percent more in a for-profit facility than would be paid in a hospital, just to encourage more surgeons to practice privately. It’s doubtful Ford is going to foot that bill himself. Utilizing a for-profit system can and will detriment our universal healthcare system beyond repair. A resilient, properly funded healthcare system is the only way to address the needs of our population.


What is happening in Ontario

The surgical backlog in Ontario is the result of chronic healthcare underfunding. In fact, in 2020 Ontario received the lowest public hospital funding per capita compared to any other province in Canada. As a result, staffing shortages and closed operating rooms are at an all-time high. Hospitals simply cannot afford to pay staff needed to keep ORs open. If Ontario was properly funded, there would be enough surgeons, nurses and ORs to perform surgeries around the clock and on evenings and weekends. Many hospitals offer 24hr MRIs, so why not introduce the same model for surgeries?

Patients are waiting years to be seen by surgeons for things like knee and hip replacements, shoulder operations and cataract removals. With Ford pushing for these procedures to be done in private clinics with surgeons and nurses working in their own practices, even more people will be forced to wait. If Ford put his efforts towards adequately funding hospitals so that they could efficiently care for patients, this wouldn’t be happening.


The idea of a centralized waitlist

Currently, doctors refer their patients to surgeons they are familiar with. However, there are hundreds more doctors available who could perform these surgeries. A centralized waitlist matches triaged patients (from highest priority to lowest) to the next available surgeon. This centralized waitlist would replace waitlists for individual surgeons, which can be years long, and would make better use of specialists. A local doctor has been working on a solution to the backlog problem.


Waterloo-Wellington physician Dr. Mohamed Alarakhia, director of the non-profit group eHealth Centre for Excellence, has been working on an e-referral system since 2016 in which patients can choose to be placed on a centralized waitlist. They can see when they’ve been triaged, who they’ve been referred to, and when they receive an appointment. Patients can choose a specific surgeon and abide by that surgeon’s wait time, or alternatively choose to be assigned to a surgeon with a shorter wait time. Dr. Alarakhia said that patients referred using his e-referral system for orthopedic and cataract surgeries are typically seen more than 50 days sooner, and about a month sooner for MRIs. This allows patients more control over their own health, and eliminates the frustration of unnecessarily long wait times.


Next steps

One of the barriers to implementing such a system is that everyone involved has to be in agreement. Patients need to be willing to be treated by a surgeon their family doctor may not know, and surgeons need to agree to treat these patients. Perhaps the biggest barrier: the government has to put Ontarians first and recognize that privatization is not the solution to our surgical backlog problem. What we need is a properly funded public health system. That is the only way we can create a strong, resilient healthcare system in Ontario.



Written by Chelsea Miller, BScN, RN

October 17, 2023

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