Has Canada’s Wait List Strategy Made Pathologists the “Cinderella” of Oncologists?
Terence Colgan, MD, FRCPC, FCAP, MIAC
Terence Colgan, MD, FRCPC, FCAP, MIAC, is the head of Gynaecological Pathology, Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario. E-mail: tcolgan@mtsinai.on.ca.
More than 5 years ago, Jean Chretien announced a historic agreement establishing a health council to oversee the quality of health care in Canada.1 At last, pathologists saw an opportunity for placing pathology issues on the table. In 2009, it’s reasonable to ask, “Was this initial enthusiasm misplaced?”
Each province and territory has agreed to report on a number of common indicators. These performance reports are used “to support the development and implementation of health system policy.”2 The key health service indicator for pathologists is the cancer care wait list since cancer diagnosis is such a major part of pathology practice.
Does the current wait list for cancer care reflect the contribution of pathologists? Although some measures of cancer wait times have included the time taken from the first diagnostic procedure to initial treatment, inclusive of pathology diagnosis and subsequent referral,3 Canada’s cancer wait is defined as the time from decision to treat to the administration of surgery, radiotherapy, or chemotherapy.4,5 So, although access to surgical, medical, and radiation oncology is measured in current wait list measurements, the specific contribution of pathologists is not.
The validity of the chosen wait times strategy and measures has been challenged, but an independent review of Ontario’s Wait Times Strategy by Senator Kirby in 2007 validated its integrity.6 The measures have become part of a systemic process and key drivers of provincial and federal resource allocations. Indeed, the provinces and territories have agreed to guarantees for timely access to health care by 2010. In 2007, Ottawa budgeted over half a billion dollars for patient wait times guarantee and pilot projects.7
Five years on, how has this unfolding story affected pathologists? Provincial and federal resources move to fulfill promises of cancer wait times guarantees. Oncologists are recruited. Operating room time is expanded. But pathologists can only watch as resources are diverted to oncologists and clinics to shrink wait lists.8 Without measurement, pathology becomes the Cinderella of cancer specialties, subject to neglect. But have wait lists led to more than just neglect? There is a suggestion that the wait list strategy is having two other detrimental effects on pathology.
Firstly, there is anecdotal evidence that the biopsies, the resection specimens, and the molecular tests from newly appointed oncologists pour into Canadian pathology laboratories that have received no, or minimal, incremental resources. Hospitals or regional systems may have received incremental funding to address deficiencies in cancer wait lists, but these resources often do not reach the pathology laboratories since they remain outside “the box.”
Secondly, implementation of a comprehensive wait list strategy requires real-time, high-quality electronic records and information systems. Resources for the development of these necessary electronic health records flow into clinical settings, but, once again anecdotally, laboratories tap their own capital budgets to fulfill unfunded demands for systemic compatibility. With capital funds inadequate to build modern pathology practice, Canadians are denied access to technological advances.9
Diverted resources, increasing volumes, and shrunken capital budgets – are these the dynamics of Canada’s wait list strategy on pathology? We don’t have data. We need the data. It’s a challenge for the CAP Executive to take up: to collect data, come to conclusions, and then, if necessary, challenge Ottawa and its wait list policy. This is really our only choice. We can’t expect Prince Charming to come along with the crystal slipper and take pathologists to the ball. The ball started 5 years ago … and is well under way.
References
- Health Canada. Health care renewal. Ottawa (ON): Health Canada, 2003; http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/ftcollab/2003accord/nr-cp-eng.php. Accessed December 10, 2008.
- Health Canada. Health care system – performance reporting. Ottawa (ON): Health Canada, 2004; http://www.hc-sc.gc.ca/hcs-sss/delivery-prestation/ftcollab/2004-fmm-rpm/fs-if_12-eng.php. Accessed December 10, 2008.
- Mayo N, Scott S, Shen N, et al. Waiting time for breast cancer surgery in Quebec. CMAJ 2001;164:1133–8.
- Ontario Ministry of Health and Long-Term Care. Definition of cancer surgery wait times. Toronto (ON): The Ministry, 2002; http://www.health.gov.on.ca/transformation/wait_times/providers/wt_data.html#1. Accessed December 10, 2008.
- Simunovic M, Thériault ME, Paszat L, et al. Using administrative databases to measure waiting times for patients undergoing major cancer surgery in Ontario, 1993–2000. Can J Surg 2005;48:137–42.
- Ontario Ministry of Health and Long-Term Care. Kirby validates integrity of wait times strategy [news release]. Toronto (ON): The Ministry, 2007; http://www.health.gov.on.ca/english/media/news_releases/archives/nr_07/feb/nr_020107. Accessed December 10, 2008.
- Office of the Prime Minister. Canada’s new government announces patient wait times guarantees by 2010 [news release]. Ottawa (ON): The Office, 2007; http://pm.gc.ca/eng/media.asp?id=1611. Accessed December 10, 2008.
- Kondro W. Systemic changes needed to resolve queues. CMAJ 2006;175:343.
- Esmail N, Walker M. How good is Canadian health care? 2008 report. Fraser Institute, 2008; http://www.fraserinstitute.org/commerce.web/product_files/HowGoodisCanadianHealthCare2008.pdf.
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