March 3, 2025

Dear Consultant Specialist Colleagues in British Columbia,

On behalf of the Neurology Section of the Consultant Specialists of BC (cSBC), I am writing to express our support for the cSBC’s advocacy efforts and to emphasize the critical need to address the escalating Waitlist Crisis in Neurology Care across British Columbia. With neurodegenerative disorders rising sharply and access to timely care deteriorating, we urge immediate action to optimize care efficiency to protect both patient outcomes and specialist well-being. 

British Columbia’s neurologists face unprecedented challenges as demand for care outpaces capacity. A significant driver is our aging population: 25% of British Columbians are now over the age of 65, leading to a surge in referrals for complex neurodegenerative conditions such as Parkinson’s disease (PD) and Alzheimer’s disease (AD). In some regions, patients endure wait times of 2-3 years for initial consultations, delays that irrevocably harm their prognosis and quality of life. Similarly, access for patients with epilepsy, migraine, multiple sclerosis, neuromuscular diseases and other neurological disorders has become increasingly constrained. Patients are left to navigate debilitating symptoms without timely specialist input.

Neurologists are best equipped to make the difficult diagnosis of functional neurological disorders (FND). Delays in this diagnosis are associated with poorer outcomes, increased specialist visits/healthcare utilization, and possibly iatrogenic harm, all of which might be obviated if wait times were reduced.  

These delays are not confined to urban centers. Rural communities face even greater disparities due to geographic barriers and limited specialist availability. Compounding the crisis, neurologists are overwhelmed with advice calls from frontline providers managing patients stuck on waitlists - a responsibility that strains clinical workflows and exacerbates burnout. With long wait lists many neurologists have had to limit their practice or close their practice to new referrals hoping that the patient can be seen by another sooner. The primary care provider then needs to spend more time trying to find another neurologist to assess the patient, or the patient presents to the Emergency Department (ED) as their symptoms persist unmanaged in hopes of seeking a neurologist opinion. 

In response, the Neurology Section has championed and created the 440 billing code. This code allows neurologists to provide immediate written advice to referring physicians, reducing delays for patients who would otherwise languish on waitlists. Feedback from primary care providers has been highly positive. However, its impact is limited by the current cap of eight billings per month. Expanding access to this code could immediately significantly reduce waitlists.  

Improving the quality of referrals would improve efficiency. Many referrals originate from virtual care services and lack important information. Expanding the 440 code could better support primary care, allowing referral questions that might be addressed without an in-person neurologist evaluation to be dealt with via comprehensive written advice, reducing wait times for those referrals that clearly require an in-person visit with a neurologist. 

We advocate for provincial tracking of waitlists and expanding fee structures that promote efficiency, including lifting restrictions on the 440 code. 

The Neurology Section stands with the cSBC in pushing for reforms that ensure timely, equitable Specialist Care. We are committed to collaborating with stakeholders to reduce wait times, enhance care efficiency and optimizing specialist practice.  

Sincerely,

Neurology Section – Consultant Specialists of BC