Demand pushes MRI wait up to a year

Posted on February 23, 2009 in Health Debates – Ontario / Health Care – Demand pushes MRI wait up to a year
February 23, 2009.   LISA PRIEST

Waits for MRI scans in Ontario – used to diagnose multiple sclerosis, cancer, and chronic back pain – are startlingly long, with at least one hospital reporting a queue of almost one year.

The province’s targeted waiting time for the lowest priority scan – such as those with chronic back or knee pain – is 28 days. But the waiting time is 100 days, which means 90 per cent of all patients receive their scan within that time period, with the remaining 10 per cent waiting longer.

The range in waits throughout the province is dramatic: At Bluewater Health in Sarnia, Ont., 90 per cent of patients had their scans done within 17 days. At The Ottawa Hospital, which has the longest waiting times, that number is 360.

This is according to data from October to December, 2008, the latest available.

“It’s very distressing to me and a source of many phone calls of complaints from physicians and much personal angst because I don’t think it’s right,” said Mark Schweitzer, chief of diagnostic imaging at The Ottawa Hospital, where there are three MRI machines. “We are very resource starved.”

Though machines at the hospital are operated 22 hours a day, six days a week, some cancer patients are waiting up to a month for an MRI, which is required to determine the stage of their disease, Dr. Schweitzer said.

Patients who gain quick access are those who have lost consciousness or are experiencing an acute neurological problem, such as sudden paralysis. Chronic back and knee-pain sufferers wait the longest for the scans.

Savvy patients can speed things up by getting a referral to a hospital with shorter waits and driving across town: For example, St. Joseph’s Health Centre in Toronto’s west end has a 34-day waiting time, compared with St. Michael’s Hospital in the city’s downtown with 108 days.

Though the lengthy queues at The Ottawa Hospital are largely due to too few scanners, the cause of ballooning waiting times in the rest of the province remains something of a mystery.

“We know that a lot of money has been put in; I believe we are doing twice as many MRI scans as we used to be but the wait times are still there,” said Angie Heydon, chief operating officer of the Ontario Health Quality Council, a government-funded agency that monitors the quality of publicly funded health services. “And the question is why.”

Alan Hudson, head of Ontario’s waiting-time strategy, said that while waits for MRIs have decreased since the province began tackling the problem in 2004, they are not dropping nearly as quickly as waiting times for CT scans, cataract surgery and joint replacement.

“We are worried there are inappropriate scans being done,” said Dr. Hudson. “The demand is going up all the time.”

For that reason, an appropriateness study on MRIs is to be done to help determine whether the scans are being performed on the correct patients.

David Vickar, president of the Canadian Association of Radiologists, said it’s imperative to look at whether MRIs are being used appropriately.

“We know that from previous studies, not from Canada, but from other parts of the world that there are examinations requested by physicians that are not necessarily the most appropriate,” Dr. Vickar said in a telephone interview from Edmonton.

“That is not to blame physicians, it’s a combination of many things.”

Across Canada, the number of MRI machines has increased, with 222 of them operational in 2007, up from 149 in 2003, according to the Canadian Institute for Health Information.

Despite those increases, Canada – with six MRI machines per million people – is below the Organization for Economic Co-operation and Development median of seven machines per million people in 2005.

Lengthy queues in the public system have meant a boon for private MRI operators.

“We have definitely noticed an increase in volume, starting in November,” said Shannon Muldrew, director of client relations for St-Joseph MRI in Gatineau, Que., a short drive from Ottawa.

In the past, most referrals were from specialists; recently she has noticed family doctors making referrals, particularly for musculoskeletal problems, such as chronic knee or back pain, where a basic scan can be purchased for $695.

“When people come through the private system, these people willing to pay really are suffering and do likely have a positive finding on their scan,” said Ms. Muldrew.


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