If you badly break a bone, Toronto is a good place to do it. We have fantastic orthopedic surgeons here. One of them is Dr. Clavicle (not his real name, in case you were wondering). I met him after I fell off a horse last May. (It was not the horse’s fault.)
To see Dr. Clavicle, you show up at an early-morning cattle call in the fracture clinic of a teeming downtown hospital. Every chair is occupied. A sign at the reception desk warns that, because of the unusually high volume of patients, you could wait an hour and a half. First, you get your X-ray. Then you are summoned to a little cubicle to wait some more. Once the doctor arrives, he is friendly but efficient. You have maybe a minute and a half. He has a hundred other patients to see.
Dr. Clavicle fixes collarbones and shoulders. His patients come in relentless, never-ending waves. The message on his office answering machine politely informs you that nobody will call you back. My collarbone hasn’t healed, it turns out, and I need surgery to bolt it back together. Operating room time is severely limited, so the wait is six or seven months. The hospital gets a lump sum from the province every year that has to pay for everything. It cannot afford to pay for all the surgery that people want and need.
This is how we ration health care. Canada ranks 11th out of 11 countries in wait times to see a specialist, according to a survey in an OECD report – and things are likely to get worse before they get better. Forget all the happy talk from people who tell you otherwise.
Across town is another specialist named Dr. Wrist. I know him, too. He patched me up last winter after I tripped and fell on the sidewalk. (It’s been that kind of year.) Luckily, my case was “acute,” which meant I got surgery right away. People whose wrist problems are “non-acute” have to wait a year and a half just for a consultation. And God help you if your problem is in your feet or ankles. The wait time to see Dr. Foot is two to four years. “I have a box of Kleenex that I walk around with,” he told Globe and Mail reporter Lisa Priest. “The No. 1 complaint from patients is: ‘Why are there so few of you?’ ”
The answer is that hospitals can’t afford to have more of them. Budgets have been flat-lined by provincial bureaucrats who are desperate to rein in costs. Relatively rich wage settlements for unionized workers are driving up costs. And so, despite the growing demand from the public, hospitals have no money for more orthopedic surgeons, cardiac surgeons, neurosurgeons and radiation oncologists. Many new graduates in these fields are struggling to find jobs.
Dr. Clavicle has a sister who’s a horse vet. They often discuss the irony that if you are a horse, and not a person, the doctor can see you right away. “The veterinary industry looks for business and caters to a market that wants to be looked after,” he told Maclean’s magazine a while back. “Me? I spend most of my time actively deflecting as much as I can.”
This story has a happy ending – for me, at least. I asked to be put on standby in case a last-minute vacancy came up. Thankfully, one did. Dr. Clavicle’s overworked assistant called me up one day and gave me 30 seconds to decide if I wanted to drop everything and take it. I did. Now my collarbone is bolted back together and I am happy as a clam. After all, I got surgery almost as fast as a horse.