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Clearing millions of backlogged medical procedures a marathon, not a sprint, doctors say

Physicians say it will take time to catch up, but they urge patients not to ignore medical concerns
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Ontario's medical doctors are urging their patients to step forward and speak up about their ailments and health needs now before things get worse, as has happened for too many patients during the COVID-19 pandemic.

That was part of the message that came out of an online forum with the Ontario Medical Association (OMA) Wednesday where several physicians discussed how the pandemic left too many patients unable, or afraid, to visit their doctors with the result that in many cases people got sicker.

Dr. Adam Kassam, the newly installed president of the OMA was the moderator of the event. 

He noted that as COVID-19 cases are dropping off in most of Ontario, there is still a serious backlog of medical procedures that need to be addressed. Kassam said the information was based on data collected by the OMA in 2020 and 2021. 

"Over that period of time we found an estimated backlog of 15.9 million health care services that were delayed," said Kassam. 

He said it was close to one procedure per person for the population of Ontario (14.7 million in 2020).

More specifically, Kassam said the data showed the most common delayed medical procedures are MRIs, CT scans, cataract surgeries, knee and hip replacements and coronary artery bypass grafts.

"The backlog really is considerably higher in community settings than it is in hospitals," said Kassam. 

He said patients have put off visiting the doctor for common medical procedures such as mammograms, pap tests and colon cancer screenings which is part of the usual approach to preventive medicine.

Kassam said the doctor's office is also where chronic conditions such as high blood pressure and diabetes are identified and managed.

He said it is important to note that the pandemic backlog is in addition to the waitlist for medical procedures that existed before the pandemic occurred.

Kassam also reviewed the number of months that it takes to get common procedures looked after. He suggested that even with hospitals and medical staff working at 120 per cent of capacity, clearing the backlog would require:

  • 22 months for knee replacements;
  • 21 months for cataract surgeries;
  • 14 months for hip replacements;
  • 10 months for cardiac surgery;
  • 10 months for MRIs;
  • 4 months for CT scans.

Regardless, Kassam said the backlog has to be addressed now. He said it is one of the reasons why the OMA has launched a survey of Ontario residents to find out what everyday people think should be some of the immediate priorities, such as improving long-term care and dealing with the pandemic backlog.   

 "So I encourage everyone to speak up. Have your say. Help us shape the future of healthcare," said Kassam

Dr. Sohal Goyal, a family physician who took part in the teleconference, confirmed the OMA data showing a big drop in patient visits. But he added that another unexpected factor has come forward.

"Even though visits have significantly dropped, the complexity of illness during visits has increased. In my own practice I have seen an over 400-per-cent increase in mental health-related visits," said Goyal. "The stress caused by the pandemic increased depression and anxiety affecting relationships and increased burnout." 

Goyal predicted the pandemic will produce long-term mental health effects. He said patients have to be aware that doctors are waiting for them to come back to clinics and doctor's offices.

"I want to stress to patients that your Ontario doctors are open. We're ready to talk to you, to see you and help you through the crisis."

Also taking part in the event was dermatologist Dr. Sandra Landolt, who said she, too, saw many patients, most with skin cancers, leading up to the pandemic. But with the pandemic restrictions, fewer people travelled, fewer people had any outside contact with others and less screening tests were done with the result being a marked increase in worsening skin cancers. 

Comments also came from cardiologist Dr. Harinda Wijeysundera who said one of the issues is not merely the "enormity" of the backlog, but also the "complexity"

"It is not simply a larger number of patients on a wait list that need care, but rather it is a care deficit," said Wijeysundera. 

He said each of the many steps along the way to being diagnosed, to seeking treatment, to making appointments to getting tested or screened requires overcoming numerous obstacles, all of which were made more difficult because of the pandemic.

He added that in many cases with cardiac patients now on wait lists, the patients are sicker, which is to be expected. Wijeysundera added that the wait list is less than what was expected, but there is a feeling that doctors are just seeing the tip of the iceberg with the sicker patients. He said there are many patients who need care, but are not so sick that they have come forward seeking treatment.

He added that overcoming the backlog is not going to be a sprint event, where the medical community treats the problem and returns to the status quo. Wijeysundera said overcoming the backlog will be a marathon effort that will take many months. 

Wijeysundera also remarked that one of the "themes" of the pandemic has been inequity in that people who are marginalized and racialized are the ones who were most poorly serviced in terms of health care. He said that would need to be addressed in the work to get through the backlog.

Wijeysundera also addressed a question of calculating wait times between diagnosis and actual treatment. He said one of the things he expects to see is that treatments will likely be more advanced. 

This means a patient will be given later stages of treatments because in many cases, their condition will have advanced to the point where patients are more sick, and thereby requiring more advanced treatment. He said just because there was a pandemic, there is no reason to believe that other diseases would stop progressing as they always have.

In terms of tangible solutions, it was suggested the medical community might adopt one of the pandemic procedures of moving patients to areas where they can get immediate care. This has been done with COVID-19 patients in intensive care units (ICU) in one city being transferred to an ICU in another city.

Wijeysundera commented that "we need to be open to that possibility," to make full use of the capacity of Ontario's health care system.

He said the ability to shuffle patients around the province was significant in helping to reduce the impact of the pandemic in many hot spot areas in Ontario.

As the forum wrapped up, Goyal repeated his suggestion that any patients feeling hesitant or worried about visiting their doctors should reach out immediately to get a check up and to spend some time with their primary health care provider. 

Len Gillis is a Local Journalism Initiative reporter at He covers health care in Northern Ontario.


Len Gillis, local journalism initiative reporter

About the Author: Len Gillis, local journalism initiative reporter

Len Gillis is a Local Journalism Initiative reporter at covering health care in northeastern Ontario and the COVID-19 pandemic.
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