“My knees are really bad. How long am I expected to wait to see the specialist, then wait for surgery? I’ll be unable to walk if it takes much longer!”

By Pat Irwin

Under the terms of the Canada Health Act, all legal residents of Canada are entitled to receive healthcare services without additional payment, if the procedure is defined as medically necessary and is provided either in a hospital or by practitioners such as physicians.

The inconvenient side of our universal healthcare system, however, is the existence of lineups for non-emergency services. Today, despite our best efforts, waiting can mean health-threatening delays in treatments, piecemeal care and anxiety on the part of both patients and families. Some people may not even be able to easily access the healthcare system because they are unable to find a family doctor.

Approximately 70 per cent of Canada’s healthcare expenditures are paid by public sources, with the rest paid privately through private insurance or directly by patients. How do some people ‘jump the queue’? What’s practical, what’s ethical, and what’s legal?

Let’s look at how some real-life people tackled their situations.

Check online for information
When Elspeth learned she needed a hip replacement, she was optimistic at first. She was relatively young and fit, and left her GP’s office with the expectation that arrangements would move quickly. But it took a month to see a specialist, who gave her a surgery date that was three months away.

All provincial governments are monitoring waiting times on a province-to-province basis for the most popular procedures, which are non-emergency surgery and diagnostic imaging. These include tests like MRIs and CAT scans, and surgeries such as hip and knee joint replacements, cataract removal, coronary artery bypass surgery and cancer radiation therapy.  Users choose the procedure and their preferred hospital or doctor, and can then view the wait times for that doctor or hospital. The websites also monitor wait times against provincially set ‘wait time targets’ for major types of surgery. From the site, additional detail can be found such as which hospitals in a specific geographic area do the procedure, the wait times for each, and the provincial average wait time for the procedure. A list of these sites is provided below.

Investigate options
However, even the best wait-list can’t change that a patient may have to wait an average of 205 days for a hip replacement, or even 45 days for fast-growing liver cancer surgery. Do research beforehand so you can ask questions at the appointment with the specialist. Elspeth reports, “I had researched a new, less invasive procedure called hip resurfacing, which is aimed at younger, more active patients. At age 59 I was right on the margin, but my orthopedic surgeon agreed and was able to do it in six weeks.”

Consider the private route
The so-called ‘two-tier system’ has actually existed in Canada for many years, funded by private sources such as private insurance plans, employer-provided health plans and other out-of-pocket payments. For example, while provincial health insurance plans prohibit charging for medically necessary services that are covered by provincial plans, or selling private insurance to cover those services, a physician may practise in privately owned hospitals or clinics.

Ownership is considered a separate issue from sources of payment. Very few physicians work entirely in the private sector; many practise both publicly and privately. Private clinics generally offer procedures that are not covered (or are covered only partially) by public funds, such as cosmetic surgery.If you are considering a private approach, do your homework. Check your health insurance plan (and your spouse’s, if you are covered), and inquire about co-payments. For example, one patient bypassed a nine-month wait to get an MRI within a week, using her employee benefits plan and a co-payment—all perfectly legal.

Try a referral service
Referral agencies have been quick to respond to the desire for faster service. These agencies have relationships with private clinics and hospitals in Quebec or British Columbia that allow private hospitals, and to the United States. Private ‘executive medical’ clinics exist in all major Canadian cities, many of which are branches of private American companies such as The Cleveland Clinic. Membership in these clinics is often a corporate executive benefit.

Many Canadians seek medical assistance by going directly to clinics in the United States, sometimes seeking referrals through their provincial medical plan to subsidize the costs. These are usually for therapies not offered or approved in Canada, or that have unreasonable waiting times because of limited availability of the procedure.

When a family physician ceases practice
Fred and Muriel Davis were taken aback when their long-time doctor announced his retirement, and they asked who would be taking over his practice. His response? “No one. There just aren’t enough doctors going into  family practice.” He told them they had six months to find another doctor, and to check with him before then to get a renewal on their prescriptions.

Royal College of Physicians and Surgeons of Canada, the College of Family Physicians of Canada, and the Canadian Medical Association all have strict guidelines for retiring physicians:
• They are expected to notify only those patients to whom they are actively providing care, and should remind patients where they can go to obtain emergency or urgent care.
• They must make appropriate arrangements for either the retention or transfer of patient medical records, and give patients information on how to access their medical records.
• They should try to ensure that patients requiring ongoing care (in hospital or care facilities, or post-operative follow-up) will continue to receive necessary care.
• They should try to facilitate patient access to any prescription medications required for long-term or chronic conditions by providing patients with prescription renewals or repeats of the required medication.

Fred and Muriel’s doctor acted within the College’s guidelines by providing reasonable notice; attaching a list of local walk-in clinics, emergency departments and the province’s Telephone Health Advisory Service; and meeting with patients regarding medication orders. But was this really enough?

Find doctors who are accepting new patients
The first option is to ask your retiring doctor and the office staff for recommendations and where other patients will be transferring. Also ask friends, colleagues and the local hospital for names—but remember, your search will be confined to those physicians who are accepting new patients.

Check your ministry of health’s website. In Ontario, the Ministry of Health and Long-term Care (health.gov.on.ca) offers Health Care Connect to help you find a doctor or nurse practitioner, so long as you have a valid Ontario health card. Upon registering (either online or by phone), you will complete a health information questionnaire to determine your level of need. This health information and your contact information will be given to a nurse in your community called a Care Connector, who is assigned by the program to help you in your search for a provider accepting new patients in your community. Priority is given to those with the most need.

Consult your provincial College of Physicians and Surgeons. You can search for family doctors in your area who are accepting new patients, or do an advanced search for your specific needs (such as geriatric medicine specialists or doctors attached to specific hospitals).

If you are from a smaller community, a search may not turn up anyone who meets your criteria. The website also warns that the College cannot guarantee that any doctor will be accepting new patients.Try to join a group practice, so you can see any physician in the group without having to wait to see a certain one.

Evaluating your options
Once you have a list of doctors who are accepting new patients, do some research. Call the doctor’s office and ask the office manager:
• How old is the doctor, and how long has he or she been in practice? (Be sure your new doctor will not be retiring soon.)
• What are their after-hours policy and the doctor’s hospital privileges? What laboratory services are available?
• Does the doctor have other patients similar to your situation? (If you are a senior, for example, are seniors welcome in the practice?)
• What are the major services of this family practice? (One senior recently signed on with a new family doctor, only to find the office teeming with flyers promoting Botox injection services!
• Is the office near transit or parking? If appropriate, is it accessible for persons with disabilities?

Once you have developed a short list of three to five names, book an appointment. When you get there, observe the waiting room: how many staff are there; how they treat other patients and other seniors; how many patients are waiting and how long they wait; and the general atmosphere. When you meet with the doctor, explain your mission and gauge whether he or she is listening, and seems interested and motivated to take you as a patient.

Once you are home, review your checklist, listen to your instincts, make your choice and request that your files be transferred. Six months may seem like plenty of time to look, but finding the right fit may take time. Since this will be one of the most important relationships you have in the coming years, invest the time and effort to make the best choice.

Become a wait time advocate The Wait Time Alliance (waittimealliance.ca) suggests Canadians become involved in the issue of wait times:
• Get informed. Know what wait times are in your province.
• Contact your MP and MPP/MLA, and your provincial and regional health authority’s ombudspersons.

Pat Irwin, BA, AICB, CPCA, is President of ElderCareCanada.