Doctors Share Short-Term Prescription to Reduce Pandemic Backlog

Doctors Manitoba released its monthly estimate on the pandemic backlog of diagnostic tests and surgeries, finding the backlog may have peaked and is starting to very slowly decrease. Physicians have also offered suggestions for short-term actions to help speed up clearing the backlog.

​“As a family physician, I care for patients each and every day who are stuck in the backlog and waiting for a diagnostic test or surgery,” said Dr. Candace Bradshaw, Doctors Manitoba’s new President for 2022 – 23. ​“These patients are waiting in pain and at this point there’s not a lot I can tell them to address the uncertainty they face about their wait time.”

The total estimated pandemic backlog is now 166,903 cases, a decrease of 2,295 from last month’s estimate. This is the first time in over a year that the backlog has decreased. This reflects a return in many areas to pre-pandemic volumes which stops the backlog from growing, while in some areas additional capacity above pre-pandemic levels is now starting to clear the backlog.

The updated backlog estimate includes:

• 55,728 surgeries (as of March 2022), a very modest increase of 158 cases over last month’s estimate.
• 44,094 diagnostic imaging procedures (as of March 2022), down 2,095 cases over last month’s estimate.
• 67,081 other diagnostic testing procedures (as of April 2022), including allergy tests, endoscopies, mammograms, sleep disorder studies, and lung function tests, an improvement of 358 cases over last month’s estimate. 

Estimated decreases in the backlog were largely fueled by additional volumes in ultrasound, mammography and endoscopy. Most other areas were basically unchanged from last month, with very modest increases or decreases. The backlog for lung function tests, however, continues to increase and is a growing concern.

The full Surgical and Diagnostic Backlog Dashboard can be accessed at Doc​tors​Man​i​to​ba​.ca/​b​a​cklog.

Doctors Offer Short-Term Actions

Based on feedback from a variety of physician groups, Doctors Manitoba has identified five short-term actions to help to speed up clearing the backlog in some areas:

1. Cataract Surgery: Lift the annual cap on the number of cataract surgeries that can be performed each year at Misericordia Health Centre.
   
2. Allergy Testing: Remove the limit on in-person appointments and return nurses to outpatient clinics so specialists can catch up and keep up on the backlog.
   
3. Mammograms: Increase the volume to catch up on the backlog of breast cancer screening and bring wait times back to pre-pandemic levels.
   
4. Complex Lung Function and Respiratory Tests: Remove the restrictions on these testing procedures so they can be offered at more clinics.
   
5. Nurse/​Technologist Shortages: A targeted human resource strategy is needed to recruit and retain more nurses and technologists, as the shortage of these skilled staff is the biggest barrier to clearing the backlog. Short-and medium-term actions include addressing high levels of burnout and low morale to retain existing staff, offering special incentives to those willing to take on more shifts rather than mandating overtime, maximizing the use of agency staff, and pursuing aggressive out-of-province recruitment.
   

“Doctors Manitoba continues to work with physicians to offer constructive advice to the province on how to tackle this massive backlog,” explained Doctors Manitoba Board Chair and Past-President Dr. Kristjan Thompson. ​“We appreciate the provincial government’s significant financial commitment to address the backlog, and we hope that commitment can help to fund these concrete short-term actions to get patients the care they need.”

See the backgrounder below for further details on each of these short-term actions.

Doctors Manitoba continues to work with physicians to identify other actions to help clear the massive pandemic backlog, and identify other areas wherewait lists have grown during the pandemic. Work also continues on updating the methodology to estimate the backlog, recognizing some of the surgeries and tests missed during the pandemic may no longer be required after over two years of disruptions.

- 30 -

BACKGROUNDER

Doctors Share Short-Term Prescription to Reduce Pandemic Backlog

Doctors Manitoba is continually working with family physicians and specialists to identify opportunities to clear the massive backlog of over 166,000 diagnostic tests and surgeries. These efforts have been grouped into two priorities:

1. Returning to baseline, pre-pandemic volumes: With the Omicron wave of the COVID-19 pandemic, the initial focus has been on returning diagnostic and surgical capacity to pre-pandemic volumes. Once achieved, this will stop the backlog from growing any larger. 
   
   
2. Adding additional capacity, to clear the backlog. After over two years, Manitobans need their health care system to add significant new capacity to catch up and keep up with the need for tests and surgeries. This can include adding more capacity in hospitals, which have traditionally been the home for most testing and surgeries, as well as considering out-of-hospital capacity in doctors’ offices and surgical centres. 

As most parts of the health system return to pre-pandemic volumes, Doctors Manitoba has been focusing on ways to add additional capacity to the health system. An initial list of short-term actions have been identified, through consultation with physicians. These have been shared with the province. As additional actions are identified, they will be shared with the hope the province will adopt them to accelerate clearing the massive backlog of tests and surgeries. 

1. Cataract Surgery

Doctors Manitoba estimates there is a backlog of 5,168 cataract surgeries in Manitoba. Misercordia Health Centre performs the majority of these surgeries in Manitoba, and its operating rooms have faced repeated closures as nurses were deployed to support the pandemic response. However even before the pandemic, there has been an annual cap on the number of cataract surgeries that can be performed at Misericordia. 

Doctors Manitoba recommends removing this annual cap now, which will better position the ophthalmologists and leadership team at Misercordia to ramp up their capacity and perform more cataract surgeries than ever before.

2. Allergy Testing

Doctors Manitoba estimates there is a backlog of 4,121 allergy tests in Manitoba, affecting both children and adults. Many of these tests occur during in-person visits to the hospital, but the outpatient clinics that are home to these visits have restricted the number of in-person visits that can occur during pandemic, requiring the rest to be conducted virtually. Like other parts of the health system, outpatient clinics have also faced staffing shortages as nurses were redeployed to support the pandemic response. 

Doctors Manitoba recommends removing the limit on in-person appointments in outpatient clinics. At this stage of the pandemic, increasing in-person visits in outpatient clinics is reasonable, especially for those appointments that require in-person testing. Further, the health system should ensure outpatient clinics return to pre-pandemic staffing levels, and identify if additional staffing is needed to support physicians in increasing capacity to catch up on the backlog of testing.

3. Mammograms

Doctors Manitoba estimates there is a backlog of 34,861 mammograms in Manitoba. Wait times in some areas, most notably Winnipeg, are longer than before the pandemic, making it difficult to meet recommendations for all women between the ages of 50 and 74 receive a screening mammogram every two years.

With over 34,000 mammograms missed during the pandemic, it’s important to focus on catching up quickly because cancers identified at earlier stages are easier to treat. 

Doctors Manitoba recommends increasing the volume of mammograms performed in Manitoba to catch up, and keep up, with meeting the breast cancer screening needs of women in the province.

4. Complex Lung Function and Respiratory Tests

Doctors Manitoba estimates there is a backlog of 10,106 lung function and other specialized respiratory tests. While other backlogs are starting to peak and even decline, the estimated backlog for lung function tests increased by 7% last month alone. 

Specialized lung function tests are used to diagnose, treat, and monitor acute and chronic lung conditions, such as COPD, asthma and pulmonary fibrosis, as well as shortness of breath after COVID. These tests are also used to assess fitness for surgery, including for lung cancer. These tests could be offered at additional clinics as a way of immediately increasing capacity to address the backlog, however the province currently limits these tests only to hospitals and one large clinic. 

Doctors Manitoba recommends removing the restrictions on lung function testing procedures so they can be offered at more clinics.

5. Nurse/​Technologist Shortages

A targeted human resource strategy is needed to recruit and retain more nurses and technologists, as the shortage of these skilled staff is the biggest barrier to clearing the backlog. While there were shortages before the pandemic in many areas, it appears the situation has deteriorated during the pandemic. This is making it difficult to return to pre-pandemic baseline capacity, let alone increase capacity to clear the backlog. 

This is a complicated issue that will require collaboration with employers, regulators, unions, professional associations and others.

The health human resource strategy could include:

• Short-term actions such as addressing high levels of burnout and low morale to retain existing staff, offering special incentives to those willing to take on more shifts and maximizing the use of agency staff rather than mandating overtime. 
  
• Medium-term actions such as pursuing aggressive out-of-province recruitment for nurses and technologists. This has to be well-coordinated with all the relevant partners, including employers, regulators, immigration, and others.
  
• Long-term actions such as expanding existing training programs and introducing new programs for disciplines that can help, such as OR technologists.