Thousands of Canadians are on doctor wait-lists. Are they effective?

In Ontario, the average wait time for the thou‐ sands of prospective pa‐ tients on the province's list looking to be connected to a family doctor is, ac‐ cording to the government, around 90 days.

But that, of course, is the average. And depending where one may reside in the province, the wait time can be significantly longer.

"In some places, we have patients who've been on the list for years," says Dr. Mike

Green, president of the Col‐ lege of Family Physicians of Canada and a Kingston, Ont.based doctor.

According to a recent survey, around six million Canadians are without a family doctor. But some provinces, to help facilitate a match, have created central‐ ized waiting lists where peo‐ ple can register and eventual‐ ly be matched with physi‐ cians who are taking new pa‐ tients.

In April, for example, the B.C government announced it was launching a new online system where people looking for doctors could register. (Last year, the province said there were 895,000 people in B.C. without a family doctor.)

Yet while some healthcare observers and experts believe the idea of such lists is a good one, in some provinces, challenges remain. 15,000 on list for 3 years In March, Nova Scotia Health reported more than 150,000 people were still waiting on its list as of Feb. 1 to be matched with a doctor, and that 10 per cent, or about 15,000 people, had been on the list for more than three years.

In Ontario in 2022, ac‐ cording to the government, over 44,000 people were con‐ nected to a primary care provider through its system, Health Care Connect (HCC). However, there are currently nearly 200,000 patients regis‐ tered with HCC across the province, according to Ontar‐ io's Ministry of Health.

Green, who is part of a study looking into the effi‐ ciency of these waiting lists, says wait times have in‐ creased along with the num‐ ber of people on the list. How long that wait time can last often depends on where one lives and the health-care re‐ sources available.

He said one issue with Ontario's wait-list is that if someone were to move from one place to another within the province, they wouldn't be allowed to sign up for HCC to find a new doctor unless they quit their doctor's prac‐ tice from their prior resi‐ dence.

"And with the difficulty people have been having to find any family doctors, everybody's afraid to quit their family doctor to get on the list," he said.

That means that person is clogging up an opening for someone else.

Yet despite some issues, Green said he still thinks the best way for those looking for a doctor is to get on the list. He said many health-care officials, particularly those opening up new practices, will pull patients from those lists.

Small fraction use lists However, despite the ben‐ efits for patients, he said, at least in Ontario, only a rela‐ tively small number of the unattached patients in On‐ tario use them. About 200,000 are registered on HCC. But more than two mil‐ lion Ontarians are without a doctor, according to the On‐ tario Community Health Pro‐ files Partnership, a website that publishes data on health-related services to meet community needs.

"So one of my questions would be, is this because people feel that they're wait‐ ing on them too long, so it's not worth it? Or is it they're ... really not feeling like that's an effective way of connect‐ ing them?" Green said.

"I think that's the biggest frustration for the public, is feeling that they go on the list, they don't know how long they're going to wait."

Dr. David Barber, chair of the section on general and family practice at the Ontario Medical Association, said he believes Ontario's wait-list may just be too bureaucratic, with patients, HCC staff and doctors having to repeatedly going back in forth with each other, trying to make a con‐ nection.

"It's a huge process," he said.

However, Barber acknowl‐ edged that the main problem is doctor shortage.

"You can have the best waiting list in the world, but if you don't have anywhere for those people to go, it's irrele‐ vant."

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Mylaine Breton, a profes‐ sor at the University of Sher‐ brooke's medicine and health sciences faculty who re‐ searches doctor wait-lists, said she believes such lists are effective, and do help fa‐ cilitate a connection between a prospective patient and doctor, "at some point."

"In Quebec, the main en‐ try point [to be] attached to a family physician is through the centralized waiting list," she said. "You will be at‐ tached [to a doctor], but you can wait four or five years," she said. "It's not efficient. But at some point, it's work‐ ing."

Prioritization needed

Breton believes there should be a prioritization process on such lists for pa‐ tients who are in greater need of a physician. Some of her research into these lists found that when the central‐ ized wait-lists were coupled process with financial incentives in Quebec for doctors, it in‐ creased enrolment of new patients.

However, most of the in‐ creases in enrolment were patients not classified as vul‐ nerable, meaning those most vulnerable weren't being giv‐ en precedence to the degree that policymakers had hoped, her research shows.

Dr. Tara Kiran, a family physician at St. Michael's Hospital, and the Fidani chair in improvement and innova‐ tion at the University of Toronto, said these lists need to be accessible to the vul‐ nerable, along with those new to Canada who may not speak the language.

"Is [the wait-list] some‐ thing that they even feel comfortable and safe using? Or is it accessible to them from a language perspec‐ tive?" she said.

Those who are more edu‐ cated and wealthier are more likely to be able to find out about and attach themselves to such a list, Kiran said.

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Kiran said she believes a centralized wait-list is a good idea, as there needs to be an organized way for people to access care.

However, she said how well the actual concept works will certainly depend on im‐ plementation.

"Who are you drawing from? How do we make sure that the most vulnerable side are actually getting on those lists, and then being priori‐ tized?"

Kiran said she had a pa‐ tient with Type 1 diabetes and other chronic medical conditions who had moved to Sault Ste. Marie, Ont., and was told they would have to wait 10 years on HCC for a family doctor.

"That's, clearly, a system that is not working."

At one point in time, there were actually financial incen‐ tives for doctors to take on particularly vulnerable pa‐ tients from HCC, she said.

"And those incentives had not been in place for several years now. So financial incen‐ tives is one way to motivate doctors.

"You can say you can blame the supply, there's not enough doctors. But it also relates to, are we motivating and incentivizing people to be part of this? Are we set‐ ting up structures in a way that also supports people to take it on? Are we making that process smoother?"