Primary Care Access:

31% of family physicians are no longer accepting new patients and a further 38% accept new patients with restrictions. Of those who selectively accept new patients, more than one third accept only the family members of existing patients. The number of family physicians accepting new patients has declined from 73% in 1999, and is the lowest level since the survey began.

The average wait time for a routine booking has also increased during each year of the survey. Compared to 1999, fewer family physicians indicated that they deliver babies, working in a continuing care institution or make home visits.

Two new questions were added this year. Physicians were asked if they are actively recruiting physicians to their practices. 43% answered yes. 93% of family physicians indicated that they are "experiencing difficulty in finding specialists who will accept referrals.

Are you accepting new patients?"

(From Family Physicians Survey)

307 out of 640 physicians responded; response rate: 48.0%

69% of doctors indicated that they were accepting new patients, a decrease from 1999 when 73% accepted new patients, and the lowest level since the survey began.

Figure 1: Physicians Accepting New Patients

Yes - 1997: 83%, 1998: 70%, 1999: 73%, 2000: 69%

Figure 2: Physicians Accepting New Patients

"Please provide a brief explanation of restrictions to your practice?"

(from Family Physician Survey)

109 explained the restrictions to their practice out of 115 doctors who indicated restrictions.

Figure 3: Physicians' Restrictions to Practice

By association (50%)
The most common restriction in this category was "family members of existing patients", with 35.8% of physicians with restrictions; "referrals from other physicians" - 9.6%; "friends of patients" - 4.1%.

Restricted to certain types of care (21%)
These physicians only accepted patients for only certain types of care, including: breast problems, Obstetric and Gynecology, Psychiatry, maternity, and HIV patients.

Excluding certain types of care (11%)
These physicians indicated that they had restricted their practice to avoid patients with time-consuming medical conditions including: chronic/severe pain, back pain, fibromyalgia and WCB claims. Physicians also indicated that they do no longer did Obstetrics or Pediatrics.

Type of Patient (7%)
These physicians restricted their practice to certain segments of society including: students, people who live in the area and Francophones. (These included physicians working for student services, etc.)

Other (11%)
Responses included: medical-legal cases only; take on patients only after meeting the patient first; for consultation only; limit new patients to specific time periods.

"How soon can you book patients on a routine basis?"

(from Family Physicians survey)

306 responses out of 604. 50.7% response rate.

Table 1: Family Physicians' Routine Booking

Average of 8.48 days with a median of 2 days. The booking times ranged from immediately to 5 months; with eight outliers removed from the data, the average wait time is 6 days.

Figure 4: Booking Time for Routine Patients

Access to Surgical Services:

There were some improvements over 1999 in total wait time from initial appointment to surgery, notably in Neurosurgery, Urology and Vascular Surgery. Orthopedics improved marginally over 1999, but for non-urgent cases, the wait time was still twice that in 1998. Wait lists for Cardiac Surgery continued to increase.1 Ophthalmology wait times for urgent cases improved slightly; however wait times increased for non-urgent cases. Total wait times increased for general surgery for both urgent and non-urgent patients. Wait times for non-urgent plastic surgery increased dramatically to one year. Otolaryngology continued to have wait times of close to one year for non-urgent procedures.

¹Total wait times for Cardiac Surgery are calculated as time to referral to cardiologist and from cardiologist to surgery.

Wait times for an referral to various subspecialties are recorded for the first time in this year's survey.

Access to Medical Specialists:

In general, wait times for medical specialists and psychiatry increased. Obstetrics and Gynecology showed an improvement and Pediatrics remained fairly constant. Wait times for Cardiology continued to increase. The difficulties referred to by Family Physicians in making referrals to Gastroenterologists and Psychiatrists were reflected in increased wait time.

A number of subspecialties are reported for the first time this year so comparisons are not available.

"How soon can you book patients to be seen by the following specialists?"

(from Family Physicians Survey), and

"How soon can patients be seen in you office for non-urgent/urgent problems?"

(from Medical/Surgical Specialists Surveys)

Non-Urgent Specialist Wait Times (in days)

Urgent Specialist Wait Times (in days)

Access to Psychiatry:

Of 36 psychiatrists who responded, 11 indicated that their practices were temporarily closed to new patients. Two others indicated that their practices were limited to specialized services such as third party assessments. One respondent indicated a 2.5 year wait and temporary closure of the practice; this data was considered an “outlier” and removed from the survey results.

There is a marked difference between the wait times reported by family physicians and those reported by psychiatrists. As specialists were not asked if they were accepting new patients and only three respondents explicitly differentiated between their own patients and new referrals in stating wait times, it is difficult to draw further conclusions from the data. However if non-urgent wait times are calculated by excluding those who indicated they were not accepting new referrals or distinguished between their own patients and new referrals, wait times increase from 73 days to 82 days.

If respondents who stated they are not seeing new patients are excluded, and urgent wait times calculated for those who either indicated a single urgent wait time or specified wait times for new patients, urgent wait times increase to 23 days (based on 23 of 36 respondents).

Comments from psychiatrists centred on bed shortages, and difficulty in accessing resources for patients who need help with financial, accommodation and other needs.

Emergency Room usage by Family Physicians:

Some Family Physicians responded to the question "how soon can you book patients to be seen by the following specialists" by indicating that urgent patients were sent to Emergency:

Emergency Room Usage

Consultation to routine surgery wait times (in days)
(from Surgical Subspecialists Survey)

Consultation to urgent surgery wait times (in days)
(from Surgical Subspecialists Survey)

Total Wait time Non-urgent for Surgical Procedures (in days)
(from Surgical Subspecialists Survey)

Total Wait time Urgent for Surgical Procedures (in days)
(from Surgical Subspecialists Survey)

"How soon can you book the following?"

(from Family Physicians Survey) and

"Are you experiencing any delay in access to the following services?"

(from Medical/Surgical Specialists Survey)

CAT Scan Waiting Time (in days)

MRI Scan Waiting Time (in days)

EMG Study Waiting Time (in days)

Ultrasound Waiting Time (in days)

"Do you deliver babies?"

(from Family Physicians Survey)

299 out of 312 95.8%

Figure 5: Physicians Delivering Babies

The number of Family Physicians who deliver babies has decreased slightly from 19.7% in 1999.

"Do you work in a continuing care institution?"

(from Family Physicians Survey)

297 out of 312 95.2%

Figure 6: Physicians in continuing care institutions

In 1999, 48% of physicians indicated that they worked in a continuing care institution.

"Do you make home visits?"

(from Family Physicians Survey)

Response: 298 out of 312 95.5%

Figure 7: Physicians who make home visits

In 1999, 74.5% of respondents indicated that they make home visits.

"Are you actively recruiting new physicians to your practice?"

(from Family Physicians Survey)

Response: 189 out of 312 60.6%

Figure 8: Physicians who actively recruit new physicians for their practice

"Are you experiencing difficulties in finding specialists who will accept referrals?"

(from Family Physicians Survey)

Response: 289 out of 312 92.7%

Figure 9: Physicians who are having trouble finding specialist

Other comments from the Family Physician Survey

Family physicians commented that they and their office staff spend a significant amount of time referrals with specialists. They stated that many specialists require a letter before the referral will be accepted, and that they then may have to wait many months before they receive a response. In some cases the referral is then refused after a long wait. For urgent cases many physicians sent their patients to emergency to shorten wait times.

Other comments from the family physicians include:

• "Access to specialists has deteriorated significantly since the Klein health care cuts started in 1993. It is absurd that in a center servicing 1,000,000 people or more that patients have to wait so long to access certain specialists."
• "difficulty finding orthopedic surgeons to accept referral of patients with back problems;
• "most specialists like to see a referral letter first before booking, you do not hear from them until a few months later, by then the patient is either improved or dead"
• "it is frustrating - my staff have to wait a long time on hold on the phone. This ties up a lot of their time. It decreases the efficiency of the office."
• "excessively long waits, hard to find specialists taking new patients, referral letters needed".

Other delays reported by Medical Specialists:

• Angiogram
• Audiology : 6-8 months
• Biophysical profile
• Dialysis
• EEG (6 responses): 2 weeks - 6 months
• Echocardiograms (4 responses): 4-6 months
• Endoscopy (3 responses): 2-3 months
• Modified Barium swallow: 8 weeks
• Nuclear Medicine including Thyroid Scan
• * Sleep studies (2 responses)

Comments from the Medical Specialists Survey:

• "6 months plus for menopause clinic; one to two years for pelvic pain clinic"
• "3 months for a CAT scan is absolutely appalling"
• "beds - very difficult to provide for the children of Northern Alberta; delayed admission to PICU and cancelled surgeries are frequent"; delay for echocardiograms. "in addition to above time problems, considerable time is required on the phone"
• "It is possible to get these tests fairly quickly by direct contact with Radiologist!!!"
• "It's the poor patients who need patience!"
• "Severe lengthy waiting lists of months for mental health services for children and adolescents"; also delays for developmental issues and pediatric ophthalmology;
• Several comments about long waits for Otolaryngology.
• "MRI is increasingly important for neurological diagnosis - not only is there a waiting period, but we are not yet up to date on method and reading of brain imaging of very young children"
• "The major delay is still finding beds, not due to lack of beds but lack of staffing"
• "Ultrasound is usually avoided because wait too long"
• "Urgent patients can be seen quickly but only at the expense of overwork and long days"
• "Very difficult to get obstetrical and pelvic ultrasound"
• "We have had to transfer babies out of region & out of province more frequently since May"

Other delays reported by Surgical Specialists:

• Audiology
• Bone scans: 1-2 weeks
• EEG (2 responses: 8 weeks
• Urodynamics: 2-3 months
• Vascular lab: 2-3 months

Other comments from the Surgical Specialists Survey