Waiting for treatment has become a defining characteristic of Canadian health care. In order to document the lengthy queues for visits to specialists and for diagnostic and surgical procedures in the country, the Fraser Institute has—for over two decades—surveyed specialist physicians across 12 specialties and 10 provinces.

This edition of Waiting Your Turn indicates that, overall, waiting times for medically necessary treatment have in-creased since last year. Specialist physicians surveyed report a median waiting time of 21.2 weeks between referral from a general practitioner and receipt of treatment—longer than the wait of 20.0 weeks reported in 2016. This year’s wait time—the longest ever recorded in this survey’s history—is 128% longer than in 1993, when it was just 9.3 weeks.

There is a great deal of variation in the total waiting time faced by patients across the provinces. Ontario reports the shortest total wait (15.4 weeks), while New Brunswick reports the longest (41.7 weeks). There is also a great deal of variation among specialties. Patients wait longest between a GP referral and orthopaedic surgery (41.7 weeks), while those waiting for medical oncology begin treatment in 3.2 weeks.

The total wait time that patients face can be examined in two consecutive segments.

From referral by a general practitioner to consultation with a specialist. The waiting time in this segment increased from 9.4 weeks in 2016 to 10.2 weeks this year. This wait time is 177% longer than in 1993, when it was 3.7 weeks. The shortest waits for specialist consultations are in Ontario (6.7 weeks) while the longest occur in New Brunswick (26.6 weeks).

From the consultation with a specialist to the point at which the patient receives treatment. The waiting time in this segment increased from 10.6 weeks in 2016 to 10.9 weeks this year. This wait time is 95% longer than in 1993 when it was 5.6 weeks, and more than three weeks longer than what physicians consider to be clinically “reasonable” (7.2 weeks). The shortest specialist-to-treatment waits are found in Ontario (8.6 weeks), while the longest are in Manitoba (16.3 weeks).

It is estimated that, across the 10 provinces, the total number of procedures for which people are waiting in 2017 is 1,040,791. This means that, assuming that each person waits for only one procedure, 2.9% of Canadians are waiting for treatment in 2017. The proportion of the population waiting for treatment varies from a low of 1.7% in Quebec to a high of 5.7% in Nova Scotia. It is important to note that physicians report that only about 11.5% of their patients are on a waiting list because they requested a delay or postponement.

Patients also experience significant waiting times for various diagnostic technologies across the provinces. This year, Canadians could expect to wait 4.1 weeks for a computed tomography (CT) scan, 10.8 weeks for a magnetic resonance imaging (MRI) scan, and 3.9 weeks for an ultrasound.

Research has repeatedly indicated that wait times for medically necessary treatment are not benign inconveniences. Wait times can, and do, have serious consequences such as increased pain, suffering, and mental anguish. In certain instances, they can also result in poorer medical outcomes—transforming potentially reversible illnesses or injuries into chronic, irreversible conditions, or even permanent disabilities. In many instances, patients may also have to forgo their wages while they wait for treatment, resulting in an economic cost to the individuals themselves and the economy in general.

The results of this year’s survey indicate that despite provincial strategies to reduce wait times and high levels of health expenditure, it is clear that patients in Canada continue to wait too long to receive medically necessary treatment.