Wednesday, December 01, 2010

Ontario's bariatric surgical wait times set to skyrocket.

One of the things that is quite true about Ontario's efforts in increasing in-province access to bariatric surgery is that Ontario is light years ahead of virtually all of Canada's other provinces.

That said, the likelihood Ontario will ever be able to meet bariatric surgical demand is virtually nil.

Why do I say that?

Well in his lecture this past Saturday, Dr. Mehran Anvari, project lead of Ontario's bariatric registry, talked about numbers. And the numbers just don't add up.

Currently he reports that this year Ontario will perform 1,700 surgeries. Next year 2,200, and the year after that 2,800. He also reports,

"Our goal is eventually to reach close to three and a half thousand to four thousand which we believe is what is necessary in Ontario"
In terms of demand, we know that between 2006 and 2009 demand for out-of-country bariatric surgery for Ontarians tripled to near 1,600.

That sure sounds like a rapid rise in demand, and perhaps if demand were to triple again by 2012 and if somehow Ontario was on track to do even 5,000 bariatric surgeries a year that'd be enough to keep up. Assuming of course demand didn't continue to rise.

But here's the rub.

Dr. Anvari reports that Ontario's current monthly average of referrals through the bariatric registry is 800-900/month. That means that even without an increase in demand (a strange assumption given the apparently exponential rise in same), 2011 alone will see roughly 10,000 referrals. And yet Dr. Anvari is talking about a 2011 goal of performing 2,200 surgeries, a 2012 goal of 2800 surgeries and an "eventual" goal of 4,000 surgeries. That means that by the end of 2011, even if only 70% of those referred were appropriate and actually went on to seek surgery, there'll be a 3.1 year wait list for surgery (not even counting those already waiting). By the end of 2012, it'll be 4.2 years. And even if we even somehow manage to reach what Dr. Anvari called an "eventual" goal of 4,000 surgeries a year, and still assuming no increase in demand and only 70% of folks referred going on to have surgery, we'd see the wait list grow by another 8 months each and every year.

Now while I'm scared to tempt Dan Gardner's scorn, I'd guess that given the meteoric rise Ontario has experienced in bariatric surgical demand, combined with the ongoing rise in obesity rates, increasing public and physician understanding of bariatric surgery, and more and more success stories to spread the word themselves, demand will continue to rise and there's a great deal of room for movement. Remember, in terms of eligibility, there are likely on the order of 360,000 Ontarians that would meet bariatric surgical criteria and that's a number that to some extent is self-replenishing. That means the 10,000 projected referrals for this year represents less than 3% of eligible patients.

Remember too, these aren't benign waitlists. Unlike wait times for things like joint replacements, suffering will increase and some people will likely die as a consequence of not having access to this procedure sooner.

Ultimately our system is broken. The sooner the public and politicians understand that, the sooner we're likely to see innovation.