Survey critics unwilling to acknowledge wait-time problem in Canada

Printer-friendly version
Appeared in Vancouver Sun, December 16, 2016

Fact—if you leave a medical condition untreated for too long, it can turn into a debilitating chronic condition. For too long, we have failed to address the fundamental causes of wait times for medical treatment in Canada, and they are now our health-care system’s defining characteristic.

In 1993, when governments and policymakers were still questioning whether wait times existed in Canada, the Fraser Institute published the results of the first national estimate of wait times—9.3 weeks between referral from a GP to receipt of medically necessary treatment. This year, the estimated wait was 20 weeks—the longest ever in the history of the survey.

Most provincial governments understand this is a serious issue, and that the Fraser Institute’s survey is the only comprehensive, nationally comparable estimate of wait times that can track changes over two-and-a-half decades. However, there are still those last few defenders of the status quo—unwilling to acknowledge the problem, and choosing to hurl accusations and insults rather than working towards improving measurement and proposing solutions.

For example, a recent article published on the CBC’s website by reporter Kelly Crowe questions the survey’s methodology and author’s motives. Since responding to each criticism in 700 words is difficult, let’s focus on the most egregious.

In general, the article questions whether the results of the survey count since “only around one in five doctors participate” and tacitly casts doubt on the results because physicians have a chance to win $2,000. First, it’s remarkable that anyone would choose to ignore the voices of one-in-five physicians who (on average) say there’s a serious problem with the time it takes for patients to receive treatment. Second, a 20 per cent response rate is well in line with other population-based surveys of medical professionals in Canada. Population-based surveys are different from those based on a “sample” of the population. The latter, for instance, could have a 100 per cent response rate but only question 100 physicians. Instead, the Fraser Institute’s survey is sent out to almost every specialist in Canada (practicing in 12 medical specialties) listed on the Canadian Medical Association’s [CMA] membership rolls– meaning the achievement of a 20 per cent (voluntary) response rate is no mean feat.

For example, the National Physician Survey (NPS)—a collaboration of the CMA, the CFPC, the Royal College, the CIHI and Health Canada—reported a 16 per cent response rate in 2014. However, both surveys (the Fraser Institute’s and the NPS) should be taken seriously because of the large number of responses—2,357 specialists and 10,191 physicians (including family doctors and other specialists) respectively. Similarly, the NPS also offered a $1,000 prize draw for respondents, a standard courtesy for voluntary surveys like ours.

More mudslinging in the article comes from Steven Lewis, a health policy consultant based in Saskatoon, who calls our survey “preposterous” and the methodology an “abomination.” Mr. Lewis rhetorically asks “[w]hy not use a thermometer rather than asking people for their opinion about the weather.” To answer the (admittedly witty) analogy in the same vein—the reason is because, at present, the thermometers available use different temperature scales and only measure certain temperature ranges, and most importantly people are already screaming out about the fact that they’re freezing in the cold!

More directly, government websites measure wait times for different sets of procedures in different ways, and often ignore the wait to see a specialist (usually only measuring the wait from hospital booking to treatment). Importantly, when asked, 2,357 doctors said the average wait time was 20 weeks, and longer than what they consider clinically reasonable. It would be remarkably arrogant to ignore their voices.

Finally, the article ends with Karen Palmer, a health policy analyst and adjunct professor at Simon Fraser University, blaming “miscommunication” in the medical sector for the long waits patients often endure. While it’s certainly possible that marginal improvements can be made by streamlining the triaging process (as Palmer recommends), to suggest that long wait times in Canada are primarily the result of physicians not communicating well with patients (or because “[s]ometimes patients forgot to book appointments”) is blatant oversimplification.

It’s time for everyone to come together on this crucial issue that affects the lives of patients. Instead of simply challenging those who are providing information, try providing new and better measures. Instead of questioning the motives behind such measurement, offer concrete solutions. Importantly, remember that long wait times affect real people—Canadian patients and their families—and to disregard their hardship is heartless.

Subscribe to the Fraser Institute

Get the latest news from the Fraser Institute on the latest research studies, news and events.