'Cautiously optimistic' no further hospital closures this summer, northern administrator says

Ontario has renewed funding that will help alleviate staffing pressures at rural and remote hospitals, but it's a short-term solution that's not addressing more critical shortfalls in the system, a doctor in northern Ontario says.

Tim Vine, North Shore Health Network (NSHN) president and chief executive officer, said the extension of the province's  COVID-19 Temporary Summer Locum Program will continue until September, following an announcement from the Ministry of Health Thursday. 

The ministry made the announcement just hours after the site in Blind River said it would be directing people to emergency rooms in the neighbouring communities of Thessalon and Elliot Lake due to staff shortages. 

That follows closures of the Thessalon site — four times in the past two weeks — due to shortages. 

But since the government announcement, Vine said there has been a "tremendous uptake" filling shifts throughout the summer.

"I'm cautiously optimistic that we will be able to avoid further closures," Vine said, noting the NSHN was able to secure 27 shifts, and an estimated 10-15 days of clinic coverage in communities that don't have primary care.

When asked why funding that expired March 31 wasn't renewed until June 1, The Canadian Press reported a spokesperson for Health Minister Sylvia Jones said it required "extensive consultations with key health-care sector partners including the Ontario Medical Association and Ontario Health."

Locum programs, explained

Ontario's series of physician locum programs help attract physicians to smaller northern hospitals by paying them a premium to work on a rotating, or locum, basis. That includes adequate coverage for travel time and expenses for remote communities, some which are not easily accessible even by plane, Vine said.

"A physician looking to come to one of our sites for a 48-hour stint in an emergency department would be looking at one day of travel on either side," Vine said. "For the most part, if doctors aren't working, they're not earning.

"They'd be giving up two days of pay to come and provide two days of service and then they would be largely out of pocket for those travel expenses."

Vine said the program makes it more feasible, from a financial perspective, for physicians to travel without giving up pay.

"This really levels the playing field for us to be able to attract the doctors that are in the system to come and provide coverage for us."

Creative solutions needed to address unsustainable system

But until there's more full-time help for those communities, and less reliance on locums, Vine said the system is "not sustainable."

"What mostly concerns me is that community members in Thessalon are not getting the level of service that other Ontarians are getting because they don't have consistency with their primary care," Vine said. 

"You might go in with a chronic ailment that needs to be monitored and it's going to be a different doctor pretty well every time you go in."

Without locums, or "travelling doctors," as Vine says, people go to emergency rooms to treat chronic illness, like diabetes.

"We know from a patient perspective, it is not quality care to provide episodic care of chronic disease in that setting. You don't have consistency." 

This really levels the playing field.- Tim Vine, CEO North Shore Health Network

But Vine said this may be the perfect opportunity to start a more robust conversation around solving some of these systemic issues.

"There was just a report by the OMA [Ontario Medical Association] released and Northern Ontario has right now vacancies for over 300 physicians," Vine said. "So we we need those and then we need some more."

Local medical schools can play a role in providing more help, as can an increased role for Registered Practical Nurses (RPNs).

The government can also free up residency positions in hospitals, to allow more foreign-trained health practitioners to gain the experience needed to be certified.

"The best time to plant a tree was 20 years ago, the second best time is today," Vine said. "So I think there is an urgency to start planting those seeds to expand the number of providers we have.

"But we also have to be really creative about using those nurse practitioners and physicians assistants, which take less time to train, and can be force multipliers for our physicians."