ERs in rural Northern Ontario are on the brink of collapse, doctors warn | CBC News

Family doctors in rural northeastern Ontario say emergency rooms are at higher risk of closure this fall than ever. 

The warning comes at a time when many healthcare facilities in the region grapple with a deepening doctor shortage. 

Most big cities have doctors who specialize in emergency care.

However, in rural communities in the north, family doctors have their own clinics and are also responsible for providing emergency care. 

“It’s really a crisis situation in the north right now and a lot of family doctors in many communities are barely hanging on to keep their emergency rooms open,” said Dr. Anjali Oberai, a family physician in Wawa.

Her community, like many others in the north, rely on visiting doctors called locums to help cover emergency shifts.

Over the summer, the Ontario government offered an enhanced program to top-up funding to those traveling doctors to attract more locums to help out remote communities.

But, this program is due to end on September 30. 

The fast approaching deadline is striking some fear in family doctors across the region as they worry that other support for locum doctors is not enough to keep them returning to the north. 

Oberai said she is losing a colleague this September, which will leave her and her husband as the only two family doctors in that community.

There are meant to be seven doctors in that community.  

Oberai said she and her husband rely heavily on locums to support their practice and are not sure how they will keep their emergency room open.

She added that because of this shortage, she and many of her colleagues elsewhere are forced to make trade-offs. 

“Often, many family doctors are sacrificing their family medicine clinic time in order to support that.”

She said this has a negative impact on their patients on doctors’ ability to care for their patients, leaving many burned out.  

We have to set boundaries on how much we’re willing to work in the hospital to prevent an implosion of the physician health services.– Dr. Maurianne Reade, Family physician in Mindemoya, Ont. 

 For Dr. Maurianne Reade, a doctor in Mindemoya, it has long been difficult to get locums to work in the community, especially since the start of the pandemic.  

“It really has fallen to each of us who remain to pick up the shifts that would otherwise go empty.”

Reade said her community currently has five physicians although the full complement is six.” She believes they really need about eleven.

Reade says physically, emotionally and intellectually it’s an impossible situation that she and her colleagues can’t keep up, meaning they will have to make some tough decisions this fall to protect their own health. 

“We have to set boundaries on how much we’re willing to work in the hospital to prevent an implosion of the physician health services that we provide,” she said. 

She’s warning of emergency room closures in her community, but she is not the only one. 

Tim Vine, the president and CEO of Northshore Health Network, which is a three-site hospital on the north shore of Lake Huron, said they have no permanent doctors for the Thessalon site and rely entirely on locums there. 

“I have no locums that are booked past September 30, when the funding runs out.”

Vine said closures are a last resort but without the summer locum program, he’s very concerned. 

“As of October 1, we will be in a situation where we have to contemplate periodic temporary closures of not only the Thessalon Emergency Department but possibly our other emergency departments,” he said. 

“I don’t think any Ontarian is really excited about not being able to access emergency services when they need them as close to home as possible and certainly we are not excited about having to take that step because of the lack of physician coverage.”

Both Vine and Reade said it’s harder to recruit and keep doctors in northeastern Ontario because new doctors are just not willing to take the plunge. 

They added that, as more doctors leave, the more insurmountable the workload becomes. The quality of life for physicians declines, leading to little job satisfaction. 

Retaining medical students

The Northern Ontario School of Medicine was established to help with this crisis, but demand is growing. 

Dr. Sarah Newbery, a rural generalist in Marathon, Ontario and associate dean of workforce strategy with NOSM University, said that roughly 50 per cent of NOSM graduates actually stay in the north. 

“I think there is a magnitude of difference between the number of graduates that NOSM produces and the current needs.”

“As of June last year, we were actively recruiting for 350 physicians across the north, the need is probably actually greater than what we were recruiting for,” she said.

She added that if roughly 35 students, or 50 per cent of the graduating NOSM class stays in the north, it would take about 10 years to close the gap between what the school is able to produce and the clinicians who stay to satisfy the current need for doctors. 

Marathon, the community Newbery serves, is one of the areas in the region that has more than enough doctors.

Newbery is one of eight doctors in the community; the province considers six enough to meet the community’s needs.

She arrived in Marathon in1996 when the emergency department was about to close for lack of doctors.

She along with five other doctors decided to move the community as a group. 

That, Newbery said, has made all the difference in retaining physicians because they look out for each other and have a sustainable lifestyle.

Newbery says that helping doctors find time to spend with patients and have a better quality of life is crucial to solving this problem. 

Calls to action

To combat the physician shortage and keep the emergency rooms operating, the Ontario College of Family Physicians wants enhanced locum program funding to continue.

It is calling for more investment in recruitment programs to bring doctors to the north. 

It also wants the province to provide a strategy to ensure positive working conditions for existing doctors along with immediate peer support to help them through difficult times.

Response from the Ministry of Health

In a written statement the Ontario Ministry of Health told CBC, spokesperson Hannah Jensen said it is monitoring the success of the summer locum program and is working with its partners on how to support  emergency rooms beyond September.

She notes there are other programs providing support to locums. 

But as for the doctor shortage, Jensen said the province also added seats and residency spots at NOSM University with 14 undergraduate and 22 postgraduate seats, expanded the residency program and expanded seats at other medical schools. 

The ministry said it has also invested 32-million dollars for resident salaries and benefits, medical education and training along with allied health programs and the Remote First Nations Family Medicine Residency Program. 

The province supports 80 physicians through the Northern and Rural Recruitment and Retention Initiative (NRRRI), which provides grants to physicians who open a practice in rural or northern Ontario. 

She added that the province is breaking down barriers for healthcare workers outside the province to add 50 new physicians by next year to work in Ontario.

CORRECTION: An earlier version of this story said that Mindemoya had four physicians and needed a full complement of more than five. It has been corrected to show that there are five physicians in the community which needs a full complement of six. CBC regrets the error.