Thank you for allowing me to respond to Dr. Johnston. I agree with his observations about the wait-list as encountered now in Alberta. The essential question is, “was it always so?” Based on my own observations, I suspect that there is always variation in a wait-list, which can be managed by the individual surgeon. The longer the wait-list, the more unstable it becomes, and the more likely that patients will look elsewhere, surgeons will book patients expectantly and referring doctors will send patients sooner to get a spot on a long wait-list. Hence the need to get better data when deciding how to deal with a large and unreliable wait-list. The 1 constant in all of this is that orthopedic surgeons will continue to treat their patients according to a professional standard that puts need ahead of all other considerations. My worry is that devolving the responsibility of wait-list management to administrative algorithms driven by simple theories, such as the “queuing theory,” interferes with that which is most important to the surgeon — the relationship with the patient.
Wait-lists increased as a result of a reduction in resources for elective surgical procedures, not because of an inherent problem with wait-lists as run by orthopedic surgeons. The most recent experience in British Columbia would suggest that restoring access to operating rooms dramatically reduces the wait-list. That is where I would prefer to see most of the resources directed in dealing with this problem.
Footnotes
Competing interests: None declared.