Surgeons Warn of Risks from Delays in Women’s Gynecological Care

Long wait times for gynecological surgeries are jeopardizing the health and lives of women across Canada, according to several medical professionals. Dr. Nili Kaplan-Myrth, an Ottawa family physician, has experienced these delays firsthand after facing a long wait for surgery following post-menopausal bleeding. She, along with Dr. Nick Leyland, president-elect of the Society of Obstetricians and Gynecologists of Canada, highlights systemic issues contributing to the problem, including limited operating room access and a perceived hierarchy in surgical importance that undervalues women’s health.

Kaplan-Myrth, who had been postmenopausal for eight years, began experiencing abnormal bleeding in May. “In medical school, we learned that postmenopausal bleeding is endometrial cancer or uterine cancer until proven otherwise,” she stated during a recent interview with CBC Radio’s White Coat, Black Art. Yet, she knows that securing an appointment with a gynecologist who performs surgeries can take anywhere from six months to over a year in Ontario.

According to Ontario Health, average wait times for gynecological surgeries can reach up to four months. This marks a significant increase from a decade ago, when patients waited approximately six weeks for surgery, as reported by the Fraser Institute. A study from the National Library of Medicine in 2020 found that merely consulting a gynecologist could take up to four and a half months.

Delays in treatment often leave women suffering unnecessarily, as Kaplan-Myrth notes that many surgeries are categorized as elective despite their urgency.

Systemic Issues and Patient Impact

The challenges in accessing timely gynecological care stem from long-standing systemic underinvestment and competition for surgical resources. Leyland emphasizes that the lack of comprehensive data on patients waiting for surgery exacerbates the issue. “If you’re not counted, you don’t count,” he remarked, highlighting the need for better tracking of wait times and surgical demands.

Michelle Ganam, a 40-year-old resident of Smiths Falls, Ontario, has been living with the debilitating effects of endometriosis and adenomyosis for 16 years. She describes her daily pain level as a five, escalating to an eleven during menstruation. Recently, she was approved for a hysterectomy but has been informed that it could take an additional 18 months to book. “My fear is that they’re finally going to get in there and then something horrible is actually going to be wrong,” Ganam expressed.

Kaplan-Myrth, who was able to expedite her own surgery due to her medical background, understands how fortunate she is. After navigating the healthcare system effectively, she underwent necessary tests and had her hysterectomy scheduled within five months. This contrasts sharply with the typical 18-month wait faced by many patients, a situation that can lead to dire consequences.

“Many patients diagnosed with what would have been very early pre-cancer end up requiring chemotherapy and radiation simply because they had to wait too long for surgery,” Kaplan-Myrth added.

Gender Disparities in Surgical Care

Leyland points out that a significant pay disparity in surgical procedures exacerbates the issue. Men’s surgical procedures are often reimbursed at higher rates than those for women, even when the surgeries for women are more complex. For instance, in Saskatchewan, a surgeon receives about 50 percent less for treating an ovarian torsion than for a testicular torsion, despite the former being more challenging.

This discrepancy extends to how operating room time is allocated, with gynecologists frequently receiving less time than their orthopedic counterparts. Leyland explained that operating rooms often prioritize hip and knee surgeries, leaving gynecologists with limited access. “Ontario’s priority is hips and knees, and so orthopedic surgeons, who have a much higher volume, get the operating room time,” he said.

In response to these challenges, the Ontario government recently announced a CAD 125 million expansion to reduce surgical wait times for orthopedic patients, which could also indirectly benefit gynecological surgeries. However, when questioned, government officials did not address current wait times for gynecological procedures or whether these surgeries are being prioritized.

Efforts to streamline gynecological care are underway, as demonstrated by a program at Women’s College Hospital in Toronto, where surgeons from several hospitals are using after-hours operating room time for gynecological procedures. Dr. Jonathan Solnik, the clinician lead of the program, explained that this initiative aims to connect patients with the surgeon who has the shortest waitlist, thereby improving access.

As the healthcare system evolves, Kaplan-Myrth advocates for a significant reassessment of how women’s health is prioritized. “It can be life and death,” she emphasized. “Longer wait times mean increased risk of complications, lost work hours, and many women are aware they should take control of their health but find themselves failed by the system.”

The urgency of these issues calls for immediate attention and action to ensure equitable access to necessary gynecological care for women across Canada.