Doctors warn that delaying gynecological surgeries puts women’s health and lives at risk

At age 51, Dr. Nili Kaplan-Marth had been postmenopausal for eight years. So when she started bleeding again in May, the Ottawa family doctor knew something wasn’t right.

“In medical school we were taught that bleeding after menopause is endometrial cancer or uterine cancer until proven otherwise,” Kaplan-Myrth told CBC Radio. white coat, black art,

But Kaplan-Myrth knew from her patients’ experiences that it could take six months to a year or more to see a gynecologist in Ontario — especially one who performs surgery. Meanwhile, Ontario Health, Reports average gynecological surgery wait time of up to four monthsTen years ago this wait used to be about one and a half months, According to a study by the Fraser Institute,

Surgical wait times vary across the country, but A 2020 study from the National Library of Medicine It was found that gynecologist consultation alone could take up to four and a half months on average.

Kaplan-Myrth says longer wait times for gynecological surgery are putting many Canadian women at risk.

“These are women who have been suffering for a long time, waiting for a surgery that is supposed to be elective.”

Long delays in gynecological care are caused by systemic underinvestment, competition for surgical resources and challenges unique to gynecology, says Dr. Nick Leyland, professor of obstetrics and gynecology at McMaster University and president-elect of the Society of Obstetricians and Gynecologists of Canada (SOGC).

Leyland says the problem is compounded by a lack of reproducible data on how many patients are waiting for surgery across Canada, what types of surgeries are involved and where delays are occurring.

“If you don’t count, you don’t count.”

living with daily pain

It’s a problem Michelle Ganem knows well. Sixteen years ago, Ganam was diagnosed with endometriosis and adenomyosis, two gynecological conditions that cause pelvic pain and extremely heavy menstruation.

“I’m at pain level five every day and pain level 11 during my period,” Ganam said.

Now 40, the Smiths Falls, Ontario, resident says she was finally cleared for a hysterectomy.

However, before that, she will have to undergo an ultrasound in February “to assess how much damage the endometriosis and adenomyosis have caused.”

Ganam says she was told it could take another 18 months to book a hysterectomy.

“My fear is that they’ll eventually get there and then something really terrible is going to go wrong.”

Kaplan-Myrth says she knows she’s luckier than most of her patients. As a physician, she knows how to navigate the system. She contacted her gynecologist, who performed a rapid biopsy and pelvic ultrasound within a few days. Tests revealed atypical hyperplasia, a precancerous condition.

Within three months, Kaplan-Myrth says she saw a surgeon who scheduled a hysterectomy for October. The entire process took five months – which is much less than the usual 18-month wait prescribed by the gynecologist. But Kaplan-Myrth says she’s well aware that most patients don’t get that kind of access.

“I’ve had this happen to me … where a patient found out that she may have had pre-cancer or early cancer very early, so she had to go through chemotherapy and radiation, because ultimately, by the time she had her hysterectomy, she had aggressive endometrial cancer,” she said.

According to the Canadian Cancer Society, an estimated 8,600 Canadian women will be diagnosed with uterine (endometrial) cancer in 2025, and about 1,700 will die from it. Kaplan-Myrth says it is one of the few cancers whose mortality rate continues to rise, even though the disease is curable if detected early.

Doctors had to pay less for women’s surgeries

Leyland says the huge pay gap is delaying access to timely surgery.

In particular, they noted, procedures involving men are often reimbursed at a higher rate than comparable – or even more complex – procedures for women. For example, he says, in Saskatchewan, a surgeon is paid 50 percent less Despite ovarian surgery being more complex, treating ovarian torsion is easier than treating testicular torsion. Leyland says fees vary by province Most surgical procedures performed on women pay at least 30 percent less than those performed on men.,

“The issues women grapple with are not considered as important as other specialties and patients,” Leyland said. “I don’t believe that, even though I’m a man. I think both issues are important, but we need to be able to address these issues in terms of fairness and how people are compensated.”

Limited access to operating room

Leyland says these disparities also extend to the way operating-room time is allocated to surgeons across Canada.

Due to chronic funding shortages in hospitals, many operating rooms operate only from 8:00 am to 3:30 pm, with later hours reserved for emergencies. In such a tight window, Kaplan-Myrath says general surgeons typically get more operation time than gynecologists.

“Ontario’s priority is hips and knees,” she said. “And so orthopedic surgeons who have a lot of volume are getting operating room time and gynecologists have been told, ‘We’ll make time for you here and there, wherever possible.'”

An additional consequence of this, according to Leyland, is that gynecologists in training “don’t get a lot of time to operate,” he said. “So over time they lose confidence in their ability to perform these surgeries.”

Last week, the Ontario government announced a $125 million expansion to reduce surgical wait times for orthopedic patientsMinistry spokesperson Emma Popovic told CBC the expansion “will also open up operating times for other specialties such as gynecological cancer surgery, where approximately 80% of patients are currently seen within the target waiting time,”

When asked, the ministry did not directly discuss the current wait times for gynecological surgeries in the province or whether other surgical procedures are being prioritized over gynecological care.

Hospitals partner to address surgical backlog

Dr. Jonathan Solnick says surgeons at five Toronto-area hospitals are already taking advantage of the after-hours operating hours at Women’s College, an ambulatory hospital, to perform gynecological procedures faster.

Solnik, the program’s lead physician at the Women’s College, says the initiative, which is funded by the province, matches patients with surgeons with the shortest wait lists.

“Think of it like a bicycle wheel or the spoke-and-hub concept,” Solnik said. “Instead of all the referrals coming to me where it obviously overloads my system and then people wait a long time to see me, they are distributed across a group of qualified comparable specialists so that no one office is overwhelmed.”

Solnik says the goal is a centralized booking system but it will require a lot of administrative support and funding to get it off the ground.

Kaplan-Marth argues that broader changes are needed in how Canada’s health care system views women’s health.

“This could be life and death,” she said. “Having women wait longer for surgery means there are more complications, lost work hours and there are a lot of female patients who are either perimenopausal or post-menopausal and they know they should take control of their health but then we fail them.”