Centralized waitlists slash joint replacement wait times in Canada, study shows

Editor's Note

According to a May 2025 Canadian Medical Association Journal study, creating centralized waitlists for hip and knee replacements can cut surgical wait times without increasing costs or expanding OR capacity, CBC News May 20 reports. The study, led by David Urbach, MD, MSC, head of the surgery department at Women's College Hospital in Toronto, found that when patients are added to a regional queue rather than an individual surgeon’s list, wait times are nearly halved across the board.

In Canada, only two-thirds of hip replacements and just 59% of knee replacements are completed within the 26-week recommended window, the article notes, citing Canadian Institute for Health Information data. Most patients currently are referred by a family doctor to a single surgeon or physiotherapist. If surgery is needed, they join that provider’s waitlist, which can vary widely in length. Dr Urbach likened that system to grocery store checkouts—each person waits in a separate line, regardless of which is moving faster.

The article details three models tested using data from over 17,000 Ontario patients. The most effective was a fully centralized model that had everyone equally waiting for available providers. Patients entered a shared queue for both consultation and surgery, where they were assessed then assigned to the next available surgeon in their area. This centralized approach reduced wait times by up to 281 days in some regions, including from 257 to 146 days in Toronto and from 536 to 255 days in Ontario West.

Efforts to scale centralized systems are already underway in provinces like Quebec, Alberta, and Prince Edward Island. However, adoption is still a challenge. Some surgeons are hesitant to give up their individual referral streams, citing concerns about income and autonomy. Still, experts note a growing openness to the central-queue model, particularly as clinicians confront the consequences of long delays.