Canadians in Calgary face surging wait times for MR scans – but are all those exams really needed?

Average waits at hospitals in Alberta are up 20 percent from a year ago. The average is now 18 weeks to get an appointment at a public facility. In June, 2015, it was 14.9 weeks.

To top it off, there has been a 13.5 percent bump-up for non-urgent scans just since the beginning of 2016.

“Specifically, there has been a steep increase in the number of follow-up MR scans, resulting in longer waits for elective/non-urgent patients,” Alberta Health Services (AHS) spokesperson Colin Zak emailed to the Calgary Herald.

This comes at a time when actual non-urgent procedures have held steady, Calgary-zone diagnostic imaging chief Dr. Richard Walker told the paper, stating that “we’re working with physicians to ensure the right procedures are being done for the right reasons.”

The AHS has 30 MR scanners.

One of the reasons for the bump in usage could well ring a familiar note with U.S. health care providers. “Too often, family physicians or primary care doctors are prescribing MRs as a first course of action,” especially when patients insist from frustration or out of pain, Jennifer Zwicker, health policy director for the University of Calgary’s School of Public Policy advised.

Fully a third of MRs that may be unneeded stem from complaints about lower back pain.

In fact, a 2015 study of MR usage by Alberta and Ontario researchers found that over half of MRs on patients with low back pain were “inappropriate or of questionable value,” orthopedic surgeon Dr. Nick Mohtadi, a clinical professor at the University of Calgary and Director of the Acute Knee Injury Clinic, noted in the Globe and Mail at the time.

That came to about 13,000 unnecessary lower back MRs a year in Alberta alone. Mohtadi's own examination at the Acute Knee Injury Clinic in Calgary found that only a third of those with knee injuries who received MRs really needed them.

“Two-thirds of the knee-injured patients who had an MR could have been accurately diagnosed using other more readily available and significantly less expensive techniques and tools. Provincially, this translates to about 4,000 knee MRs annually,” he wrote in the paper.

Putting a bottom line on this misallocation of resources, he concluded, “In these two areas alone, there may be 17,000 unnecessary MRs every year in Alberta, representing a cost exceeding C$15 million.”

The lack of restraint by doctors and health care providers – too often under mounting pressure from well-intentioned but arguably over-Googled patients – leads to overuse that puts substantial financial burden on both the health care system and these patients, as well.

A single lower back MR runs the public health system about C$1,000. A knee MR costs about C$550.

“Long waits have spawned a thriving private MR business in Alberta,” Mohtadi observed. “Next-day private MRs are available at a cost to the patient ranging from approximately $750 to $2,450. This generates no value to patients if the MRs they purchase are unnecessary.”

The core problem, he advised is a combination of a “system gap” and a “knowledge gap.”

“The system gap is in the form of slow access to specialty opinion and the absence of guidelines that would help primary care providers know when an MR should be requisitioned,” he stressed, adding, “The knowledge gap relates to lack of training in how to accurately diagnose knee injuries, lower-back pain and other common bone and joint conditions without expensive tests.”