A new Canadian study shows centralized waitlists for hip and knee surgeries can drastically reduce delays—without needing more doctors or ORs.
Central Waitlists Could Drastically Reduce Surgery Wait Times, Study Shows
A new study is shedding light on a practical solution to one of Canada’s long-standing healthcare issues: long wait times for joint replacement surgeries. According to research published in the Canadian Medical Association Journal, centralizing waitlists for hip and knee replacements could significantly reduce delays—without increasing healthcare budgets or adding more operating rooms.
How It Works: Patients Share a Common Line
In most of Ontario today, patients are referred by their family doctor to a specific orthopedic surgeon. The problem? That surgeon might already have a long waitlist, while others nearby may have availability.
Dr. David Urbach, head of surgery at Toronto’s Women’s College Hospital and lead author of the study, compares it to standing in line at a busy grocery store.
“It’s like waiting at one checkout while another opens with no one in line,” Urbach said. “A centralized system would let patients move through one common line, cutting down wait times across the board.”
The Study: Three Models, One Clear Winner
Researchers analyzed data from over 17,000 patients across Ontario who were referred for hip or knee replacement in 2017. They compared three referral systems:
- Direct Referral: Patients are referred to a specific surgeon, who manages their own waitlist.
- Shared Surgery Pool: Patients are assessed by one surgeon but assigned to the next available one for surgery.
- Full Centralized Model: Both assessments and surgeries are assigned through a central system pooling all available specialists.
Model 3, the fully centralized system, consistently delivered the shortest wait times—cutting delays by up to 281 days in some regions.
Wait Time Reductions Across Ontario
In regions like Toronto, average wait times dropped from 257 to 146 days. In Western Ontario, the reduction was even more dramatic: from 536 to 255 days. Importantly, these gains were achieved without new funding, infrastructure, or staff.
The study confirmed that most of the delay comes after the initial consultation—during the wait for surgery. A centralized queue allowed higher-priority cases to be served more efficiently, improving equity and access across regions.
Changing the Culture of Surgical Care
While the benefits for patients are clear, adoption among surgeons has been mixed. Some fear losing control over their referrals or their patient rosters.
“Surgeons are understandably cautious,” Urbach said. “But the system isn’t about taking autonomy—it’s about working as a team to help patients faster.”
Dr. Olufemi Ayeni, president of the Canadian Orthopaedic Association, believes a shift is underway.
“There’s growing openness,” Ayeni said. “Surgeons don’t want to see patients suffering on long waits. It even raises concerns about increased opioid use.”
Already Working in Parts of Canada
The idea isn’t purely theoretical. Centralized referral systems are already reducing wait times in provinces like Quebec and Alberta, and e-referral networks in Ontario have shaved 54 days off orthopedic surgery delays, according to Dr. Mohamed Alarakhia of the eHealth Centre for Excellence.
Prince Edward Island has also begun implementing centralized management for joint replacement surgeries under Health PEI.
A Solution Hiding in Plain Sight
The study’s authors believe the answer to Canada’s orthopedic backlog is within reach—if more regions adopt shared-care models and centralized waitlist management.
“We don’t need more surgeries—we need smarter systems,” Urbach said. “If we can align incentives and create true team-based surgical care, patients will suffer less, and outcomes will improve.”
