Surgical, diagnostic backlog may have peaked in Manitoba, doctors group says

Doctors Manitoba says the pandemic backlog of diagnostic tests and surgeries may have peaked and is starting to very slowly decrease.

The estimated backlog is now 166,903 cases, a decrease of 2,295 from last month's estimate.

This marks the first time since March 2021 that the backlog has decreased, the advocacy organization said in a news release on Tuesday.

It's a stark change from earlier this year, when the backlog increased by 7,748 cases from January to February and by another 6,302 from February to March. The growth then slowed considerably from March to April, when it went up by 1,311.

"It is good news," said Keir Johnson, spokesperson for Doctors Manitoba. "Not wanting to use the flood analogy more than we maybe need to, but we're hoping that this is a sign of a crest passing and that we're going to start seeing this number shrink month after month, and hopefully shrinking at a much faster rate."

That news comes just days after Winnipeg health-care officials announced that wait times at the city's emergency departments and urgent care centres are beginning to improve, and less than two weeks after Chief Provincial Public Health Officer Dr. Brent Roussin said hospital admissions for COVID-19 appear to have peaked.

Johnson said the improvement reflects a return to pre-pandemic staff numbers in many areas. Many people had been shifted to other areas during COVID-related redeployment.

In some areas, capacity above pre-pandemic levels has been added to help clear the backlog, said the release from Doctors Manitoba, which represents more than 3,000 physicians in the province.

The areas that benefited most from additional volume were ultrasounds, mammography and endoscopy.

The backlog breakdown now consists of:

• 55,728 surgeries, a modest increase of 158 over last month's estimate.
• 44,094 diagnostic imaging procedures, down 2,095 cases from last month's estimate.
• 67,081 other diagnostic testing procedures, an improvement of 358 cases. Those include allergy tests, endoscopies, mammograms, sleep disorder studies and lung function tests.

The backlog for lung function tests, however, continues to increase and is a growing concern, the news release said. 

While the improvements are a welcome shift in direction, more needs to be done, Johnson said. That 2,200 decrease in the total backlog from last month is only a 1.3 per cent change.

"At that rate, it would take 72 months or six years to clear the backlog, and we know that's not what patients want, it's not what doctors want and it's not what the government wants," he said.

5 short-term solutions

Halting the growth of the backlog was only Step 1, Johnson said.

"That means, hopefully, the backlog will will stop growing in future months as well, but that doesn't do anything to really clear the backlog. That's where additional capacity will be needed in our hospitals and doctors offices."

Based on feedback from a variety of physician groups, Doctors Manitoba identified five short-term actions it believes can help speed up the backlog clearing in some areas.

Cataract surgeries: There is an estimated backlog of 5,168 cataract surgeries and the majority are done at Winnipeg's Misercordia Health Centre, which has had a cap on the number that can be performed each year — a cap Doctors Manitoba has previously said should be lifted.

"There is no cap on the number of cataract surgeries that can be performed each year at Misericordia Health Centre," a provincial spokesperson said in an emailed statement to CBC later Tuesday, but did not clarify when that cap was lifted.

Allergy testing: Doctors Manitoba estimates there is a backlog of 4,121 allergy tests.

The outpatient clinics restricted the number of in-person visits during pandemic, requiring the rest to be conducted virtually.

"For allergy testing, it's really difficult to do the test virtually. That's something you need to do in person," Johnson said.

At this stage of the pandemic, increasing in-person visits in outpatient clinics is reasonable and necessary, he said.

Mammograms: Doctors Manitoba called for an increase in volume to catch up on the backlog of breast cancer screening and bring wait times back to pre-pandemic levels.

The estimated backlog of mammograms is 34,861, making it difficult to meet recommendations for women between the ages of 50 and 74 to get one every two years.

The province's diagnostic and surgical recovery task force is working with CancerCare Manitoba to plan for an increase in mammograms volumes, the province's spokesperson said.

Complex lung function and respiratory tests: Remove restrictions on testing procedures so they can be offered at more clinics.

There is an estimated backlog of 10,106 of these tests, used to diagnose, treat and monitor acute and chronic lung conditions. They are also used to assess fitness for surgery, including for lung cancer. They could be offered at additional clinics to increase capacity but the province limits them to hospitals and one large clinic.

Nurse/technologist shortages: A targeted human resource strategy is needed to recruit and retain more nurses and technologists, Doctors Manitoba said.

The shortage of skilled staff is the biggest barrier to clearing backlogs, the organization said.

Address high levels of burnout and low morale to retain existing staff, and offer special incentives to those willing to take on more shifts rather than mandating overtime, Doctors Manitoba said.

The suggestions have all been shared with the province and, as additional actions are identified, they will also be shared in the hope the government will adopt them, Doctors Manitoba's release states.

"We haven't had a definitive answer in many of these areas yet, but certainly an openness to receiving them and definitely a signal of wanting to collaborate on any and all options to clear the backlog, so we appreciate that," Johnson said.

Addresing the pandemic backlog is a priority for the provincial government, a spokesperson said in a statement emailed to CBC.

The province's diagnostic and surgical recovery task force is working on initiatives "that will hopefully lead to spending every penny of the $110 million" allocated in the latest provincial budget to address the backlog, with the expectation it will approach the government for more funding.

Surgical procedures across the province are at or above 2019 baselines, the provincial government spokesperson said, and Winnipeg's elective surgery program operated above pre-pandemic levels last week.

"While longer-term planning is important to change the health-care system to better meet diagnostic and surgical needs, these take time to plan and implement," the provincial spokesperson said.

In the meantime, "multiple short-term internal and external opportunities" such as "out-of-province agreements to build interim capacity … [provide] time to respond to and manage the wait lists," the province said.