Wait times are a perennial flash point for health systems. The recent release of the Fraser Institute’s report on wait times and access to speciality care suggested that wait times for patients to see specialists are higher than ever across the nation. Predictably, this headline produced the usual calls of a “crisis” in our healthcare system, a need for a system overhaul, and cries that it’s time to introduce a two-tier system. However, while this pent-up frustration comes out of the experience of patients, caregivers, and providers knowing first-hand the anxiety or uncontrolled symptoms that remain unaddressed for months by these long wait times, the report relies on questionable methodologies. Large payments to survey participants, statistics based on participant recollection rather than real measurements and suspect self-selection of respondents call into question the validity. And critics in the health policy realm have suggested that this type of report is a thinly veiled way to disseminate criticisms of the public healthcare system in Canada. We shouldn’t base policy-making or system changes on this sort of evidence.
The challenge is that in Ontario, along with wait times for various tests and procedures, long wait times to see a specialist are frustrating for patients and for referring providers because these times are also wholly unknown. In general, there is little published, systematic or up-to-date information on wait times either for specific doctors or at an aggregate level. This leads to uncertainty for the referring provider and anxiety for the patient — should a patient consider travelling an hour away if a rheumatologist there could see him a month sooner? Should a provider consider referring outside her academic institution if a colonoscopy could be done 3 months earlier just down the street?
However, these trade-offs are hard to evaluate due to the lack of information at the point of referral. And this is because Ontario has a major challenge in measuring true waiting times from the time of referral to eventual appointment time with the specialist — as the time of the initial referral cannot be easily traced back solely from billing information. (It is impossible to tell at which appointment, among many, a family doctor initiated a referral, for example). Some studies have ambitiously reached into patient-level data to try to retrospectively match the date a referral was initiated with a subsequent appointment date with the specialist, which can be helpful, but doesn’t provide realtime up-to-date information on actual wait times for specific specialists.
However, this doesn’t mean that wait times can’t be measured. At ConsultLoop, we have been quietly tracking *real* wait times since our launch 5 months ago. Across over 32 specialty types, and across 6 Local Health Integration Networks in and around the Greater Toronto Area, we have been following the elapsed duration from the time of a referral is made by a family doctor to the date of the eventual appointment for the hundreds of specialists who have already received referrals through ConsultLoop.
While our data set is still small, referring providers and clinics love what we give them: regularly updated and instantly available information on wait times on 2000 specialists in the ConsultLoop Directory at their fingertips. Finally, they can see actual wait times, and weigh this against other characteristics of the specialists to choose the best specialist for their patient. This is the future of healthcare data – up-to-date, reflecting real use, and in the hands of the front line clinicians to influence care decisions.
As we grow, we will continue to provide micro-level insights into wait times (such as the wait time for a single specialist) but also hope to collect broader data and higher-level views (such as, which region has the longest wait time for a dermatologist?) to influence broader system planning — but this time, based on real numbers, not retrospective guesses.