Delays in gynecological surgeries putting women’s health — and lives — at risk, doctors warn

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

“In medical school we were taught postmenopausal bleeding is endometrial cancer or uterine cancer until proven otherwise,” Kaplan-Myrth told CBC Radio’s White Coat, Black Art.

But Kaplan-Myrth knew from her own patients’ experiences that getting in to see a gynecologist — especially one who performs surgery — can take six months to a year or more in Ontario. Ontario Health, meanwhile, reports average gynecological surgical wait times of up to four months. Ten years ago, that wait used to be about a month and a half, according to a Fraser Institute study. 

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

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

“These are women who are suffering over long periods of time, waiting for a surgery that is considered elective.”

Long delays in gynecologic care stem from 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 Gynaecologists of Canada (SOGC).

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

“If you’re not counted, you don’t count.”

Living with daily pain

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

“I live daily at a pain level five and during menstruation, at a pain level 11,” said Ganam.

Now at 40, the Smiths Falls, Ont., resident says she was finally approved for a hysterectomy.

Before that, however, she must undergo an ultrasound in February to “assess how much damage the endometriosis and adenomyosis has caused.” 

Ganam says she was informed the hysterectomy could take another 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.”

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 fast-tracked a biopsy and pelvic ultrasound within days. The 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 — far shorter than the typical 18-month wait her gynecologist described. But Kaplan-Myrth says she’s acutely aware that most patients don’t get that kind of access.

“I have had…where a patient diagnosed with what would have been very early pre-cancer or early cancer, ended up having to go through chemotherapy and radiation, because ultimately, by the time they finally had their hysterectomy, they had invasive 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. It is one of the few cancers with a death rate that has been steadily rising, even though the disease is highly curable when detected early, Kaplan-Myrth notes.

Doctors paid less for surgeries on women 

Leyland says a considerable pay gap is exacerbating delays in access to timely surgery. 

In particular, he notes, procedures involving men are often reimbursed at higher rates than comparable — or even more complex — procedures for women. For example, he says, in Saskatchewan, a surgeon is paid about 50 per cent less to treat an ovarian torsion than a testicular torsion, despite the ovarian surgery being more complex. While fees vary across provinces, Leyland says most surgical procedures performed on women pay at least 30 per cent less than those performed on men.

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

Limited operating room access

Those inequities, Leyland says, even extend to how operating-room time is allocated to surgeons across Canada. 

With hospitals chronically underfunded, many operating rooms run only from 8:00 a.m. to 3:30 p.m., with after-hours reserved for emergencies. In such a tight window, Kaplan-Myrth says general surgeons typically receive more operating time than gynecologists.

“Ontario’s priority is hips and knees,” she said. “And so the orthopedic surgeons who have a much higher volume, they are getting the operating room time and the gynecologists are told, ‘We’ll find time for you here and there, where we can.’”

An added fallout of that, according to Leyland, is gynecologists in training “don’t get a lot of operating time,” he said. “So over time they lose confidence in their own ability to do these surgeries.”

Last week, the Ontario government announced a $125 million expansion to reduce surgical wait times for orthopedic patients. Ema Popovic, a ministry spokesperson, told CBC that the expansion would also open up “operating time for other specialities such as gynecological cancer surgeries, where nearly 80% of patients are currently seen within target wait times.”

When asked, the ministry did not directly address 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 backlogs

Dr. Jonathan Solnik says surgeons from five Toronto-area hospitals are already leveraging after-hours operating room time at Women’s College, an ambulatory hospital, to do gynecological procedures faster.

Solnik, a clinician lead of the program at Women’s College, says the initiative, which is funded by the province, matches patients to the surgeon with the shortest waitlist.

“Think of it like a bicycle wheel or a spoke-and-hub concept,” Solnik said. “Instead of all the referrals coming to me where that definitely overloads my system and then people wait longer to see me, they’re distributed to a group of qualified comparable specialists such that no one office gets overwhelmed.”

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

Kaplan-Myrth argues a broader shift is needed in how Canada’s health-care system views women’s health.

“It can be life and death,” she said. “Women having to wait longer for surgery means that there are more complications, there are lost hours of work and there are so many women patients who are either perimenopausal or post-menopausal and they’re aware that they should be taking control of their health but then we fail them.”