Pandemic has left backlog of almost 16 million medical procedures in Ontario, doctors say

The COVID-19 pandemic has left an estimated backlog of 15.9 million surgeries, diagnostic exams, screenings and other medical procedures that should otherwise have been performed in Ontario, the Ontario Medical Association (OMA) says. 

That averages out to more than one missed medical procedure per Ontario resident, said OMA president Dr. Adam Kassam in an online media briefing on Wednesday.  

"COVID-19 cases in Ontario are finally falling," he said. "But three significant waves of infection have created a lengthy backlog of surgeries, diagnostic exams and other health-care procedures."

In a statement, the OMA estimated that the top six missed or delayed procedures in the province are:

• MRIs (477,301)
• CT scans (269,683)
• Cataract surgeries (90,136)
• Knee replacements (38,263)
• Hip replacements (16,506)
• Coronary bypass surgery (3,163)

These estimates are in addition to the number of people who were already on waiting lists prior to the pandemic, the OMA said. 

The association calculated the numbers by comparing OHIP billings for procedures in 2020 to billings in 2021. That method should give a fairly accurate estimate, Kassam said, because there's no reason that the number of people requiring medical attention for non-COVID medical conditions would have declined year-over-year.  

"Many conditions are going undiagnosed or underdiagnosed," he said. "Many people have not yet seen their doctors during this pandemic and may have conditions we actually don't yet know about."

Cancer screening, bloodwork down

The backlog for screenings and procedures delivered in the community (for example, those handled at family physicians' practices) is higher than the backlog in hospitals, the OMA said.

"We have seen less preventative tests done to screen for illnesses, such as mammograms for breast cancer, tests for colon cancer detection and PAP tests for cervical cancer," said Dr. Sohal Goyal, a family physician and chair of the Mississauga Halton Primary Care Network, who spoke at the OMA briefing. 

"Less cardiac testing has been done to detect heart disease. Less bloodwork for disease detection like high cholesterol." 

That means the kind of early detection that leads to early treatment or prevention of illnesses, such as stroke, isn't happening as much as it should, Goyal said.  

In addition, he said, many patients with chronic conditions such as diabetes aren't being monitored. 

Dr. Sandra Landolt, a dermatologist in Thornhill, Ont., and chair of the OMA's dermatology section, said she's worried there's a "backlog that we don't even know about yet," as patients miss early detection of melanoma and other serious skin cancers. 

Clearing backlog could take months

Delays in detection and treatment have meant that cardiac patients are sicker by the time they see a doctor and are put on a waitlist, said Dr. Harindra Wijeysundera, head of the cardiology division at Sunnybrook Health Sciences Centre.  

The OMA also emphasized that mental health issues have increased during the pandemic and will require ongoing care in the years ahead. 

Clearing the backlog would take between four and 22 months, depending on the procedure, if health-care staff worked at 120 per cent — something that's not sustainable, the OMA said. 

As a result, the association is consulting with its members, other health-care partners (such as nursing associations) and the public to come up with recommendations to more efficiently tackle the backlog, Kassam said.

One of the problems that can be addressed now is the mistaken perception that doctors still aren't available to see patients during the pandemic, said Goyal, the family physician. 

"We are open," he said. "Reach out to your doctor."

"Go for your screening test as the system is opening up. Go for that bloodwork that's been pending. If you're vaccine-hesitant, reach out to us and we can help answer your questions."

Patients anxious as they wait

Both Goyal and Wijeysundera, the cardiologist, said doctors recognize the anxiety many patients are feeling as they continue to endure long waits for procedures or screenings.  

"I acknowledge how hard this is. But I also would encourage all the patients out there who are waiting to not to wait in isolation," Wijeysundera said. "The wait time is not a static thing."

"They're not alone in this, they're not isolated. Engage with us and we'll work through a solution," he said. 

"We understand that you're feeling anxious or helpless," Goyal said. "We will do what it takes to make sure that we go through that backlog and support you.

"We're going to continue to explore more solutions."