At the time of publication, this study is the first to examine thyroid surgery wait times. Our results from consensus data indicate a statistically significant difference between the actual and appropriate wait times for all thyroid surgical scenarios surveyed (except in the scenario of medullary thyroid cancer wait times). One of the possible explanations for inappropriately long wait times is because of the excellent prognosis associated with most types of thyroid cancer. Also, many patients with thyroid nodules do not have a diagnosis of cancer prior to surgery due to non-diagnostic FNAs. These factors contribute to a decreased sense of urgency when treating thyroid nodules and cancers.
We hypothesize that appropriate wait times for a diagnosis of medullary thyroid cancer do not differ significantly from actual wait times for several reasons. Firstly, medullary thyroid cancer has a low incidence (< 10% of all thyroid cancers) and therefore respondents likely have limited clinical experience to report with very low sample sizes. Secondly, given it’s a more aggressive thyroid malignancy, a known diagnosis is likely treated more promptly than other thyroid malignancies. The scarcity and severity of these cases justify prompt treatment.
Wait times for assessment of new consults also did not differ significantly between actual and appropriate. This finding may represent the fact that clinic time is more accessible than OR time. It appears participating physicians feel that they are triaging new consults appropriately and are able to assess these patients within an appropriate timeframe. We can therefore infer that the perceived bottleneck occurs when these patients are scheduled and waiting for surgery. This is not surprising given the widespread shortages in OR time, staffing, and resources.
The statistically significant negative linear regression between acceptable waiting times and a diagnosis of MTC at an academic institution (versus a community setting) could suggest that MTC, a more aggressive diagnosis, are more worrisome to those in the community setting than the academic institutions. This finding may be reflective of comfort level in managing a diagnosis of MTC; the larger centers are more likely to have increased experience with this pathology, which is possibly the cause of the difference in perceived urgency.
A similar negative regression was noted between wait times and age of surgeon. This finding could be reflective of the change in resource availability over the course of the older surgeons careers versus a differing of attitudes between generations. Finally survey participants who practice in either academic or community settings seem to expect shorter waiting times than those who practice in both; perhaps because those who practice in both settings have a better understanding of the resource limitations in each setting.
A study similar to ours was conducted on a much larger scale as part of the Canadian Pediatric Surgical Wait Time Project in 2011[15, 16]. This is an example of a national collaborative effort of a specialist group to address their wait times. Through workshops, specialists representing all pediatric subspecialties indentified all diagnoses they encounter, assigned a priority level to each diagnosis, and each priority level a corresponding target wait time. The consensus-based targets resulting from this project have been adopted as provincial standards in two provinces thus far, promoting some continuity in wait times among different provincial jurisdictions. When compared against current wait time data, they can be used by practitioners, institutions, and government to make informed decisions regarding patient triage and management, resource allocation, and sharing of best practices. This type of national effort can be used as an example for other areas of surgery, and in this case, for evaluating standardized thyroid surgery wait time targets.
The Wait Time Alliance (WTA) was formed by physicians in 2004 after the implementation of the 10 year plan to strengthen healthcare. They have contributed to many wait time reduction efforts, including the development of benchmarks for the five priority areas identified in the plan. Membership consists of multiple specialty societies across Canada, and recently expanded to include specialties beyond the initial five priority areas addressed in 2004. However, there is currently no representation for Otolaryngology- Head and Neck Surgery. Both the WTA and the government bodies are calling for membership and benchmarks across all specialty areas[6, 17].
Our study has several limitations. Firstly, response rate could not be calculated due to our inability to measure precisely how many CSO-HNS members are performing thyroid surgery. There is also a physician population within Canada of non CSO-HNS members who perform thyroid surgery, such as general surgeons, who were not accounted for in this study. Secondly, our results have been generated by consensus, and are not necessarily evidence-based. However, it is acknowledged that there is a lack of evidence-based literature in the study of wait times, and specifically wait times for thyroid surgery. Conversely, physician consensus provides valuable clinical context in the development of wait time benchmarks, an element that is not addressed in evidence-based studies. Wait time data can be difficult to interpret without considering the clinical context.