A new report by the Institute for Clinical Evaluative Sciences, an independent health think-tank, shows that despite a marked increase in surgeries in all four areas over the past 10 years, some patients are still waiting longer than recommended. That's because supply hasn't kept up with demand as the population ages.

The report was requested by the McGuinty government, which was elected on a promise to reduce wait times. Respected neurosurgeon Dr. Alan Hudson was appointed to lead the drive, which includes giving more money to hospitals for surgeries in exchange for on-going information on wait times. By 2006, Hudson's team intends to post real-time waits by region on a website where patients and their doctors can compare queues across the province, and decide where to go for care.

Hudson's team will use the new report as a baseline to measure the effects of the drive.

Up to now, no one in Ontario — neither surgeons nor hospitals — has been responsible for wait times, Hudson said.

The Wait Times Strategy places that responsibility on the hospitals, which will get extra funds to reduce waits if they comply with the tracking plan. "You give me the cases, I give you the money," he said.

Health Minister George Smitherman applauded the report yesterday. He acknowledged wait times vary widely across the province and said the report will help the government fix that. "We seek to make sure that Ontarians, regardless of where they live, have relatively equal access to the services that we're able to provide," he said.

Patients who need services for which there is a backlog in their own area may have to travel to other locations until the province gets things "evened out," Smitherman added. "The trade-off for those people would be faster access to a surgery."

Critics said the report raises questions about the government's ability to keep its promise to cut wait times.

"The increases aren't necessarily keeping up with the demand ... the treadmill's going faster than this government," said Conservative health critic John Baird (Nepean-Carleton.)

"We actually could be falling further behind rather than reducing the waiting times and that's the real obscenity about the Liberal commitment. They had all the answers when they were in opposition."

The report, which looked at wait times from 2001 to 2004 for the four key areas, as well as CT and MRI scans, found:

Waits vary greatly by region for certain services and, in some instances, whether you live in a rich or poor area. For instance, the rate of radical prostatectomy — prostate removal — increased from 80 per 100,000 men in the poorest neighbourhoods to 135 per 100,000 in affluent areas. And in Ontario's northwest region, median wait times for a mastectomy, and large bowel resection — done in colorectal cancer cases, have been above the provincial average for the past three years.

Cataract surgeries more than doubled from 1994 to 2004, from 49,489 to 102,182. When adjusted for age and gender, the Toronto Central region had the lowest rate of cataract surgery at 862 per 100,000 people. Across Ontario, regional wait times ranged from 8 to 22 weeks.

The number of cancer surgeries increased by almost 50 per cent in the past decade. Radical prostatectomies increased at the greatest rate, 171 per cent. The smallest increases were in mastectomies at 22 per cent and hysterectomies at 21 per cent.

In the past 10 years, the number of CT scans done provincially increased threefold, while the number of MRIs increased sixfold. MRI scans of the extremities and spine increased the most during the past decade: tenfold for the former and by 1,057 per cent and 666 per cent. For this study, there was no data available on the average wait times for CTs or MRIs, but the health ministry should receive more information tomorrow. In 2003-2004, the median wait times for total hip and knee replacements were 24 and 33 weeks. Fewer than half of Ontarians had joint replacement surgery within the six-month recommended wait time benchmarks used by other provinces.

Last year, the median wait for coronary angiography — an X-ray taken using an injection of contrast dye — was six days. For an angioplasty, in which a balloon device is used to reduce or clear artery blockages, it was a median wait of three days. For bypass surgery — artery or vein grafts, usually taken from the leg, reroute blood around clogged arteries — was 12 days.

Don Wackley knows what it's like to wait. He waited for 1 1/2 years before his cataract surgery was scheduled. In the end, he had two operations and it only took about 20 minutes per eye to give him back his life.

A busy community activist who advocates for seniors, Wackley said waiting and not knowing where he was on the list was frustrating and stressful.

As his vision deteriorated, so did his ability to do his work. It got to the point where he couldn't see the small print in reports.

For a time he stopped playing the piano at local nursing homes because he couldn't read the notes on the page. "Everything was a strain," he said.

Since his surgeries, it's business as usual for the 74-year-old, who welcomed the report.

The one area where waits were relatively low is for some cardiac care services. That is largely thanks to the Cardiac Care Network, which was created more than a decade ago due to a public outcry after patients waiting for procedures like bypass surgery die while they waited.

This report is important because it draws attention to the problem of long waits for cancer surgeries, said Terry Sullivan, CEO of Cancer Care Ontario. Waits have increased because there's been an increase in cancer as the population ages and doctors complain there are constraints on operating room time.

Dr. David Urbach, a general surgeon at the University Health Network, thought the report was "good news" in terms of some of the province's cancer surgery wait times.

"People's expectations that patients are waiting months and months for a cancer surgery aren't really borne out," he said.

There are many factors why the median wait is 87 days for radical prostate surgery, for instance, said Dr. David Hodgson, a radiation oncologist at the University Health Network. Waiting for a biopsy, for interpretation of that biopsy by a pathologist, and then waiting by a doctor to see if a patient's prostate specific antigen (PSA) is rising — an indication if surgery is needed — are all factors, he said.

"When you add all these things together you get wait times that are substantially longer than for other cancer operations and you also see a lot more variation in wait times because of difference in the case mix," said Hodgson.

For breast cancer, a decrease in doctors using mastectomy, the removal of the entire breast, in some parts of the province may be because other procedures such as lumpectomies are being used instead, Hodgson added.

As for higher income earners, they may be more knowledgeable of treatment options in prostate cancer care and that may be why they are having more surgeries, said Sullivan.

It is harder to understand the regional variations in cardiac care, said Dr. David Alter, a cardiologist at Sunnybrook and Women's College Health Sciences Centre and a scientist with the Institute for Clinical Evaluative Sciences.

"We know it exists in Ontario and in Canada but the question is how much is driven by disease, by capacity and supply and how much is driven by individual physician preferences and referral differences?" he asked. "We have no idea."

Coronary angiography rates were lowest in the southwest end of the province and the Waterloo Wellington area and highest in the northwest and northeast.

"The good news is wait times are falling in cardiac care," he said. "We also have to remember that the stakes are high in cardiac care; patients die in the queue.

"While we are heading in the right direction, a sizable minority of folks are still waiting much longer than what we consider the maximum acceptable wait times to be. We still have some work to do. "

A striking difference in wait times was also found in the 905 hospital area, said Tariq Asmi, executive director of the GTA/905 Healthcare Alliance.

"Most rates of access to services are lower in the GTA/905 than they are in Northern Ontario."

When compared to other regions in the province on a per-patient basis, the GTA/905 receives 30 per cent less total health care funding, he added.