ERs in rural northern Ontario are on the brink of collapse, doctors warn

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

The warning comes as many health-care 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 Sept. 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. That will leave her and her husband as the only two family doctors in that community, where there are meant to be seven doctors.  

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, Mindemoya, Ont.

For Dr. Maurianne Reade, who's 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 11.

Reade said physically, emotionally and intellectually, it's an impossible situation that she and her colleagues can't keep up with, 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's warning of emergency room closures in her community, but isn't the only one. 

Tim Vine, 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. 

"I have no locums that are booked past Sept. 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 Oct. 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 (NOSM) was established to help with this crisis, but demand is growing. 

Dr. Sarah Newbery, a rural generalist in Marathon and associate dean of workforce strategy with NOSM University, said roughly 50 per cent of the school's 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 that 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. Newbery, along with five other doctors, decided to move the community as a group. 

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

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

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.

Ministry of Health's response

In a written statement from the Ontario Ministry of Health, spokesperson Hannah Jensen told CBC 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 noted there are other programs providing support to locums. 

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 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 the province is breaking down barriers for health-care workers outside the province to add 50 new physicians by next year to work in Ontario.