A re-think is needed on the waiting time target for routine operations as 18 weeks is too long for some patients, the new leader of UK surgeons says.
Royal College of Surgeons president Clare Marx says the "one size fits all" approach needs reviewing.
The Patients Association has backed the call for a debate, saying it is unfair to apply waiting times rigidly.
But health officials say the 18-week target will not be changed and that fewer patients face very long waits.
Latest figures show that the NHS is hitting the target, but the number of people on the waiting list has broken the 3m barrier for the first time since 2008.
The target measures the period between a patient being referred by their GP and beginning their treatment.
In most cases that should be no more than 18 weeks. A similar target is in place in Scotland, while in Wales it is 26 weeks.
But in an exclusive interview with the BBC, Ms Marx says there are people, such as those needing a gall bladder operation, for whom the current waiting times are too long.
'Line in sand'
She argues delaying surgery can sometimes cost the health service money, and after many years of efforts to reduce waiting times it is now time to look again at how the target is working.
"I would like to think it would be sustainable - people don't like to wait. But we need to think is 18 weeks too long for some, and possibly could other people wait longer than 18 weeks?"
The first woman to lead the surgeons' professional body accepts that for many politicians the 18-week waiting target is a "line in the sand" that they believe should be defended.
"We actually think that having a target has been useful. However, just simply using it as a blunt instrument is not the way forward.
"The service as a whole could deliver care in a much better way throughout the whole week.
"That would enable us to actually ensure that we have more capacity for waiting time."
Her call for a debate over waiting comes as the health service faces intense financial pressures.
She wants doctors to become more aware of the costs of their decisions.
"One of the really good things is we've worked in a system that didn't ask us to think about money and that was probably a mistake. I don't think we have been good enough - we need to be educated in what things cost."
The Patients Association says its evidence suggests the current 18-week waiting time is unacceptable for some patients.
Chief executive Katherine Murphy said the time had come to open up the debate.
"Whilst we do believe a gold standard waiting time needs to be established, it is unfair and unjust for it to be applied to all patients. Clinicians must have the authority to treat patients quicker if their condition requires it."
Pressure on waiting times is growing as the number of people on the list has reached almost three million in England.
The Department of Health recently announced an additional £250m for the NHS to reduce backlogs.
Health officials say there is no plan to change the 18-week target, and point to a falling number of patients in recent years facing the very longest waits.
Labour also defended the target, describing its achievement as a historic moment for the NHS.
Shadow health secretary Andy Burnham said: "Treating people in a timely manner makes good healthcare sense as well as good economic sense."
Professor John Appleby, chief economist at The King's Fund, said: "The 18-week target has played a key role in reducing waiting times for hospital treatment to the historically low levels now experienced by patients.
"But it should not be a one-size fits all target. It is designed to enable urgent cases to be treated quickly, while allowing doctors flexibility to make appropriate clinical decisions."