'At the breaking point': Doctors call staff shortages in rural, northern Manitoba a crisis

Doctors Manitoba has serious concerns about the stability of health care in rural and northern Manitoba this summer, saying more hospitals than ever could have ER closures or reduced operating hours.

"I've been at this a long, long time and I've never, never been as concerned as I am now about the stability of our hospitals and our emergency rooms to provide the care to our patients," Dr. David Cram, a rural physician for 36 years in Souris, told reporters on Friday during a news conference.

Chronic physician shortages in rural areas are not a new problem, Cram said, but in his three decades, he has never seen so many ERs closed or only open part-time.

"And it's not just doctors [where the shortage is]. It's nurses, it's paramedics, it's lab staff and now it's even cleaning staff and kitchen staff."

Cram has gone through a lot, but said "it's getting harder and harder. Everyone is at the breaking point and frankly, I don't know how much longer I can continue to do this."

Manitoba has 68 hospitals and health centres in rural and northern communities but only 27 (40 per cent) of the emergency rooms are anticipated to be open 24/7, Doctors Manitoba said.

Meanwhile, 23 ERs (34 per cent) are anticipated to operate part-time, with reduced hours or temporary suspensions, and 18 ERs (26 per cent) have been closed for more than a year and are not expected to reopen at all this summer.

"There are hundreds of physicians all working to offer high-quality care because we are deeply committed to the rural and northern communities we serve, but severe staffing shortages are making it difficult to maintain our health-care services in many hospitals right now," said Dr. Nichelle Desilets, a physician in Neepawa since 2015.

To support and guide Manitobans seeking care this summer in those regions, Doctors Manitoba has launched a website called Rural Care, with information about rural and northern ERs.

It is designed to help people understand how to access rural care, including how to plan ahead and what to do in a medical emergency, Doctors Manitoba president Candace Bradshaw said.

"It can be difficult to know if a local ER is open 24/7, open with reduced hours or periodic closures, or even just closed 24/7," she said.

The site was created with advice from a team of rural and northern physicians, said Doctors Manitoba, which plans to update the resource weekly over the summer.

Asked at what point the health-care system will pass its breaking point, Bradshaw said Doctors Manitoba has been too busy "with patchwork and putting out fires" to determine that.

"This is a conversation that needs to happen with us and with stakeholders, with the province and with Shared Health," she said. She hopes to meet about that "so we don't have to stay in this constant state of crisis."

Recruitment, retention plans needed

The province needs to step up with a comprehensive recruitment and retention plan to mitigate the tenuous state of emergency services and medical care in rural and northern Manitoba, Desilets said.

"Doctors want to be part of solving this challenge. Over the summer, we'll be assembling best practices and working with our partners towards offering constructive recommendations to stabilize and improve the situation," she said.

The shortages are hard on doctors and nurses, not only because of the workload, but because they work in small communities, which means they are extremely close to patients and their families, Desilets said.

"When we know there is a service disruption coming up … we feel it really deeply because we're really ingrained in our communities. It weighs really heavily on us."

In an email to CBC Friday afternoon, a spokesperson for Shared Health said the province can't confirm the data of Doctors Manitoba regarding the expected ER closures, saying the regional health authorities are responsible for the operation of emergency departments in rural and northern Manitoba.

Efforts are underway across the province to support measures to ensure reliable hours and service levels for emergency departments and urgent care centres, the spokesperson said, citing a 2019 clinical and preventive services plan.

Cram said many rural and northern health facilities are often one shift away from needing to close, "so things can change quite quickly … and it certainly has a domino effect."

He urged people to "please plan ahead" by knowing the closest and second-closest ERs and be up to date, as much as possible, on their hours.

Physicians in rural communities not only work in their offices but also run the ERs and hospitals alongside the nurses, he said.

"So if you add to the critical shortage we [already] have, if a doctor that becomes ill and has to leave, or a doctor decides to relocate or [take] a simple well-needed vacation, you can see that this will lead potentially to a closure of a hospital or emergency room."

Souris is going to lose one of its doctors to relocation, so the ER will be closed two days each week, Cram said. 

"You can imagine the impact this has on patients that rely on that hospital for care. Can you imagine if the Health Sciences [Centre in Winnipeg] had to close for a day?"