Access to specialists in BC: When you don’t know what you don’t know

As I doom scroll through my news feed, I begin to wonder who isn’t on diversion. Is it pediatrics in the North, internal medicine/ICU on the Island, and obstetrics in the Interior? Or is it pediatrics in the Interior, internal medicine/ICU in Vancouver Coastal, and obstetrics in Fraser? “All of the above” got me through medical school, so that’s probably the right answer.

I check the call schedule. Neurology: blank. Respirology: blank. Hematology: blank. Good thing I’m just a physician; I would hate to be a patient right now.

Over the last few years, we have seen a growing number of specialist service interruptions and closures across BC. It is often our rural communities that are first or disproportionately impacted. We saw rural ER and maternity diversions years before this became a common urban issue. Hospitals, health authorities, and call groups struggle to piece together services. Strategies have included incentives to attract locums, virtual care, and task shifting onto other specialists and primary care. When these fail, we take our sick, vulnerable patients and put them in an ambulance through a mountain pass or use expensive flight resources to transport them far from home. Diversions are bad for our patients, our health expenditures, and our carbon footprint.

To address the evolving specialist crisis, we must understand the magnitude of the problem. A Doctors of BC and Consultant Specialists of BC joint survey in 2024 estimated that 1.2 million BC residents are waiting for an outpatient specialist consultation.[1] This estimate was generated using self-reported data from approximately 900 specialists. As of 1 May 2026, there were 142 unfilled psychiatry postings on Health Match BC.[2] While a health services researcher may question using these rudimentary measures to determine access to specialists, they would be hard-pressed to find good sources of data.

We need high-quality data on specialist distribution and wait times, intraprovincial referral patterns, and deferred care due to access limitations. Estimating specialist wait times at the provincial level is a daunting task, as there is minimal interconnectivity between EMR systems, and there are numerous parallel referral paths, both within and across health authorities. This can lead to duplicate and unnecessary referrals and inefficient care. Pathways is an excellent resource containing specialist wait-time information, but these data are self-reported. EMR systems can be leveraged to report on wait times for individual specialists, likely by triage priority, but the process will be different depending on whether you use Med Access, Accuro, or one of the 15 or so other systems used in BC.[3] Creating a standardized method to extract wait-time data across all EMR systems can be done, but if the responsibility to generate these reports is left in the hands of individual physicians, it will never happen.

The Medical Services Plan Information Resource Manual: Fee-for-Service Payment Statistics reports on physician numbers.[4] For example, in 2024–2025, there were 103 fee-for-service otolaryngologists practising in BC. Of these, 45 were in Vancouver Coastal Health, and two were in Northern Health. This speaks to the supply, but what about demand? Does Northern Health have 4% of the otolaryngology needs of Vancouver Coastal Health? The Canadian Institute for Health Information (CIHI) reports data on specialist counts by province.[5] CIHI data are readily available and allow for comparisons to be made between provinces and territories, but the data often lag by years and do not include standards for what should be considered an acceptable distribution. We need benchmarks for acceptable access, and these will vary by specialty, subspecialty, subsubspecialty, and reason for referral.

We have some building blocks to understand the gaps in specialist access, but we need a better process to extract and analyze these data, and we need definitions of acceptable access. This shouldn’t be based exclusively on comparators with other regions and must reflect the access that is needed to support the health of our population. This necessitates a collaborative effort from physicians, the Ministry of Health, health authorities, allied health professionals, and patients. We have a shared responsibility to improve access to specialist care in BC.

We need a collaborative, data-driven approach to addressing gaps in specialist care. Once we fully understand the magnitude of the specialist access crisis in BC, we can stop using Band-Aids for bullet holes and develop a comprehensive provincial strategy to enhance access to specialist care.
—Denise Jaworsky, MD, PhD, FRCPC

References

1.    Doctors of BC, Consultant Specialists of BC. 2024 specialist waitlist survey results. Accessed 1 May 2026. www.doctorsofbc.ca/sites/default/files/documents/2024-specialist-waitlist-survey-results.pdf.

2.    Health Match BC. Find a job. Accessed 1 May 2026. https://applicants.healthmatchbc.org/JobsBoard/HMBC/Default.aspx.

3.    Doctors of BC. Provincial EMR strategy member survey 2022: Summary of results. 2022. Accessed 1 May 2026. www.doctorsofbc.ca/sites/default/files/provincial_emr_strategy_member_survey_2022.pdf.

4.    BC Ministry of Health, Health Sector Information, Analysis, and Reporting Division. Medical Services Plan information resource manual: Fee-for-service payment statistics 2024/2025. October 2025. Accessed 1 May 2026. www.llbc.leg.bc.ca/public/PubDocs/bcdocs/340499/340499_msp_information_resource_manual_2024_2025.pdf.

5.    Canadian Institute for Health Information. Supply, distribution and migration of physicians in Canada, 2024 – data tables. In: Physicians. Accessed 1 May 2026. www.cihi.ca/en/physicians.