'No one is really doing anything': Frustrations mount over rural ER closures

People in Cumberland County are expressing concern over the number of emergency room closures in the region and suggesting more should be done by the Nova Scotia Health Authority to recruit physicians and staff the emergency rooms.

Between May 1 and July 10, there were 65 closures — a total of 764 hours where emergency rooms had their doors shut.

A lack of family doctors, struggles to recruit new physicians and recent cuts to programs that brought medical graduates to the province have been cited as reasons for so many closures, which often happen during overnight hours.

"It's unfortunately not all that uncommon in some of our smaller emergency departments. It's less than acceptable to me," said Dr. Bill Lowe, head of family practice for the northern zone of the provincial health authority.

"We are significantly short family physicians all over the zone, but Cumberland County is particularly hard hit.... We need more physicians."

Lowe said the closures sometimes mean a 45-minute drive to the nearest emergency department.

"That's assuming that everybody has transportation — and many elderly patients don't have access to transportation. So it has an impact, there's no question, and one that we're quite concerned about," he said.

Difficulties with recruitment

Lowe said Pugwash has only one family physician who also works emergency shifts. There used to be two but one doctor recently had to restrict his practice due to health reasons. 

"It kind of leaves one family physician on his own and he's feeling very concerned and vulnerable right now," said Lowe, adding there has been difficulty recruiting for the area.

In 2015, the College of Physicians and Surgeons of Nova Scotia cancelled the Clinician Assessment for Practice Program (CAPP), which was aimed at bringing international medical graduates to under-serviced communities in the province. 

Lowe said Cumberland County has really suffered from losing physicians through that program.

Program cuts

Elizabeth Smith-McCrossin, the MLA for Cumberland North and Tory health critic, said a cut to a program for short-term physicians has also made staffing more difficult.

"It really provided good continuity of care for the patients. You could have locum coverage ... and it really helped ensure coverage so there was no gaps. But there's no locum program anymore and there's no one actually trying to provide this," said Smith-McCrossin, who is also a registered nurse.

She expressed concern that people in charge of staffing these areas aren't being held accountable.

"What the health authority has been doing in these situations is they'll blame it on the physicians. They'll say, 'ER department is closed, no physician available.' So the community will see that and go, 'Oh great, none of the doctors will work,'" she said.

'No one is really doing anything'

At the health authority's annual general meeting on July 6, Smith-McCrossin said she asked what was being done to address the problem.

"I was not given an answer," she said. "No one is really doing anything."

In an email to CBC News, spokesperson Margaret Angus said the health authority is "actively recruiting for approved positions across Nova Scotia" and that there were 66 vacancies in family medicine in the province.

"Over the past year we've invested in expanding our local, national and international recruitment efforts and have hired local staff in each zone to support recruitment," she said.

Frustrations with message from NSHA

Smith-McCrossin said she was so frustrated at the meeting that she actually had to "get up and pace."

"There was a lot of congratulating themselves on a job well done and patting themselves on the back ... and it's so far from the truth, it's so far from the reality of what people in Nova Scotia are experiencing," she said.

"In my riding, the ER is closed six days in a row and that's a real health concern. In the Pugwash area, the population triples, quadruples, from the months of June to September because of all the cottagers, so it's a big, big concern not to have the emergency department staffed."

Closures lead to more patients the next day 

Lowe said overnight emergency room closures often lead to more congestion in health care the following day — a problem for teams that are already short-staffed.

For now, Lowe said hopes are pinned on a possible Dalhousie University family medicine training zone in the area.

"One of the things that does seem to work with recruitment is training young family physicians in their communities, and many times, they'll elect to stay," he said.

"So we're hoping that's going to help us, but all we can do is hope."