Solving Wait Times: Architecture vs. Volume

We have spent decades trying to solve surgical wait times by throwing more surgeons and more OR hours at the problem. It hasn't worked. In Ontario’s musculoskeletal system, the bottleneck isn’t usually the operating room itself; it’s the chaotic, fragmented path a patient takes before they even see a specialist.

When I look at our current state, I don't see a lack of resources. I see systemic friction.

The Hidden Cracks in the Pathway

The traditional referral model is a relic. A primary care physician faxes a referral to a specific surgeon they know. That surgeon’s office is a black box. If that surgeon has a two-year waitlist while the colleague in the next building has a two-month waitlist, the patient—and the system—has no way of knowing.

This creates "hidden cracks" where patients languish in the wrong queues. We see it every day:

• Patients waiting months for a surgical consultation only to find out they aren't surgical candidates.
• Incomplete imaging or missing conservative management (like physiotherapy) that requires the patient to "start over" after their first specialist appointment.
• Redundant administrative touches that add days or weeks of delay without adding a single bit of clinical value.

The Logic of Central Intake

The solution isn’t just "hiring more people." It’s about changing the architecture of access. This is where models like the Rapid Access Clinics for Low Back Pain (RAC-LBP) and the Ontario Workers Network (OWN) come in.

Instead of a fragmented web of individual faxes, we move toward a Central Intake and Triage logic. This shifts the focus from a "person-dependent" system to a "process-dependent" system. When a referral enters a centralized hub, we can apply clinical logic immediately:

1. Risk Stratification: Is this urgent? Is it routine?
2. Completeness Check: Does this patient have the necessary imaging and history to make a decision today?
3. Right Provider, First Time: Many MSK patients don't need a surgeon; they need an Advanced Practice Provider (APP) who can manage their conservative care. By triaging these patients to APPs, we clear the surgeon’s deck for the patients who actually need the OR.

Architecture Over Volume

By treating wait times as a design flaw, we realize that "volume" is a blunt instrument. If you increase the number of surgeons without fixing the intake architecture, you just create a larger, more expensive version of a broken system.

When we designed the digital frameworks for these pathways, our goal was to remove the manual "hunting and gathering" of data. We wanted to ensure that by the time a patient sits across from me in the clinic, the "friction" of the system has already been stripped away. They are the right patient, at the right time, with the right data.

We don't need more "heroics" from individual surgeons working longer hours. We need a system architecture that makes it impossible for a patient to fall through a crack. That is how we actually reduce wait times—by making the path to care the shortest distance between two points, not a maze.

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