i finally persuaded a radiologist i got to know during my years as a national post health reporter to wrangle zena a somewhat expedited mri slot at his toronto-area hospital — only for her problem to be misdiagnosed there.
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a decade ago i wrote about the surgeon , a transplanted native of london, ont., and how he helped a constant flood of canadian patients fed up with waiting here. now my own spouse had become one of stoffman’s spine-surgery refugees. he finished the appointment by grabbing my phone and urging our family doctor’s office to urgently find zena help in toronto.
that was sept. 9. the mri appointment our family doctor had arranged through regular channels was still three weeks away. three weeks in which the expanding tumour could well have wreaked even more havoc. untreated, such growths impinging on the spinal cord can lead to permanent paralysis or death, says the mayo clinic .
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wait times for mris, ct scans and other medical imaging, always bad, are becoming a “crisis,” say radiologists. the shortage of spinal surgeons and the hospital infrastructure they need to operate has led to waits for elective procedures of up to two years, even as some surgeons, remarkably, go unemployed. from his perch across the border, stoffman said the situation in canada seems to be growing ever more dire.
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and, of course, that longstanding dysfunction has only been exacerbated by the massive backlogs left behind by repeated hospital lockdowns during the pandemic.
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meanwhile, as we searched for alternatives, i was taken aback to discover a weird twist of the system in ontario. patients dealing with third-party payors — workers compensation, insurance companies, employers, nhl teams and the like — can access private imaging clinics that work surprisingly fast. most claim to offer a scan within a couple of business days — yes, days, not months. but they were out of bounds for us: it’s against the law for the clinics to serve patients suffering a condition that’s covered by medicare.
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bizarrely, much of the medical system still relies on facsimile transmissions , and it took another week — until aug. 10 — for the hospital to find one of the requisitions our family medicine office says it had repeatedly faxed. zena was given a slot on aug. 19, lightning-fast for an “elective” mri.
delays in getting scans have grown worse in recent years, shooting past the average wait nationwide of 89 days for an mri before the pandemic, car said in october.
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canada ranks 12th among 16 higher-income countries in the number of mri machines per capita, the commonwealth fund reported in 2020. the united states had almost four times as many mri systems for each million citizens as canada; japan five times more.
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there are, though, other ways to harness private enterprise. what snyman accessed was privately paid medical imaging. ontario’s conservative government plans to expand the use of privately delivered imaging — for-profit clinics that provide scans funded by medicare — insisting they will reduce public-system wait times.
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meanwhile, statistics from the canadian institute for health information suggest wait times in the public system are generally not shorter in provinces that allow privately paid imaging.
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at the same time, many orthopedic surgeons finish their training and simply can’t find full-time positions , which require a hospital or health authority to provide all the funding needed to accommodate their work. between 2015 and 2020, 123 of the 430 graduating orthopods, as they’re colloquially known, were still seeking full-time jobs, while another 72 had decamped to another country, usually the u.s., according to the canadian orthopedic association .
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to get those people at least assessed sooner, rampersaud devised innovative “rapid access clinics,” where physiotherapists and chiropractors quickly evaluate lower-back-pain patients, sending those who would benefit from an operation to a surgeon.
in zena’s case, it was that trip to niagara falls that saved the day, though stoffman sensibly suggested that the major surgery she needed would best be carried out close to home. he said he sees at least a half-dozen patients from canada every month, often forced to give up work as they wait for an operation here, or unable to get any help at all because they’re among the 6.5 million canadians who lack a family doctor. a framed copy of my 2013 story on the unique cross-border aspect of his practice still hangs in his office today.
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americans generally need good health insurance or deep pockets to access the kind of speedy treatment stoffman and colleagues offer. even with obamacare, 22 million u.s. residents remained completely uninsured last year. not only does the u.s. perennially rank last in the commonwealth fund’s international health-care rankings — right behind canada — american life expectancy is five years less than ours.
and while canadian hospitals must limit procedures to control costs, those south of the border often face an opposite pressure, earning more revenue with each additional procedure they provide. a fascinating 2019 study co-authored by rampersaud found that new york state performed three times as many elective spine operations per capita as ontario. the paper suggests the american system does too many surgeries — risking either no benefit or actual harm for some patients — and canada too few.
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