Behind ER doors: How this northeastern Ontario hospital is using non-financial incentives to recruit doctors

This is the second in a two-part series looking at what it takes to deliver emergency care in the central Manitoulin region in Ontario. You can find Part 1 here and in a link below.

While rural northeastern Ontario hospitals compete financially for visiting temporary doctors to keep their emergency rooms open, some are casting about for other ways to ease the burden on local doctors to prevent burnout.

At the two-site Manitoulin Health Centre in Little Current and Mindemoya, where each location is operating with half the provincially mandated number of local doctors, president and CEO Paula Fields admits the system is fragile.

In Little Current, they're operating with about seven doctors but are funded for 13.5.

"We're one physician illness or nursing illness away from closing the doors," Fields said.

"We're extremely concerned over our physicians, and our nurses, and their schedules, work-life balance, and their well-being, as well as ensuring that we provide quality care and timely care to our community."

To that end, Fields said the board has worked to co-ordinate with First Nations and municipalities to fund a full-time physician recruiter.

It's only been a couple of months and no physicians have signed on yet, but she is hopeful.

Nurses 'working tirelessly'

The shortage extends to nurses as well.

"We're seeing an increase in sick leaves within our nursing team because they're working tirelessly to staff the hospital," she said. "We have a heavy dependence on agency nurses at this time just to keep the doors open, and that is challenging."

Agency nurses are from outside companies and generally get paid a higher wage than nurses employed by a hospital.

Fields said they are trying strategies such as applying for nurse practitioners to work in each emergency department.

As well, she said, teaching nurses are being brought in to support junior nurses in an effort to raise their skill levels, and they've been putting in place medical directives for nurses so they don't always have to wake an on-call physician at night.

Fields would also like to reduce the administrative burden on doctors.

Dr. Anne McDonald is one of the lead physicians in Little Current.

She's from the area and a graduate of NOSM University who has chosen to practise close to home where she has family.

But she said it is difficult to try to do everything, and admitted that sometimes she is not able to follow up on patient care as much as she would like, having to delegate or do piles of paperwork and cover the emergency shifts instead — efforts that also eat into her family time.

"Certainly there are some emotional consequences to doing those kinds of things," she said. "It doesn't make you feel very good sometimes, but you know in your heart that you're doing the right thing to keep the hospital open."

McDonald welcomes having locums —  temporary, visiting doctors from other areas — to pitch in at the emergency room, and noted that for a few months after the Mindemoya site started paying their locums $250 an hour, their pool of locums dried up, putting more stress on local physicians.

So eventually, she said, they raised their rate to match Mindemoya's.

That's not something all hospitals can do.

Tim Vine is president and CEO of the Northshore Health Network, with emergency rooms at facilities in Blind River, Thessalon and Richard's Landing.

He said they can't offer as high an hourly rate as the Manitoulin Health Centre because the funding formula is largely based on the volume of visits to the emergency rooms.

Vine said their hourly base rate is a little over $100 an hour.

'Race for scarce resources'

"It kind of creates a bit of competition, a structural competition within the way that those rates have been established by the ministry with the unintended consequence of there being kind of a race for scarce resources," he said. "And those of us who are at the lower payment end of the spectrum find it a little bit more difficult to find locums, and as a result of which, we've had closures."

While most emergency rooms teeter on the brink of closing if a locum physician cancels last minute or a local doctor becomes ill, help may be coming.

The Ontario Ministry of Health has begun fast tracking the certification of internationally trained doctors with the program Practice Ready.

In Little Current, Dr. Victor Fagbuyi is one such doctor.

Fagbuyi came to Ontario from rural Nigeria six or seven years ago, and has worked as a clerk in a medical office and even as a personal support worker (PSW), an experience he said has prepared him to practise as a doctor in Canada.

"That's probably one of the most, I would say one of the best, experiences I've had because the theory of medical practice in general, especially when it comes to patient centredness, is at the core of medical care in Canada," he said. "That was my first experience with it. And I think it's an experience that I can't really take away from my overall experience of my health-care experience here in Canada. So I think everything came together to help me do what I'm doing right now."

Fagbuyi chose Little Current for his mandatory three years of service in a rural area to complete his program, but said he intends to stay because he likes the community and the people with whom he works.

Another Manitoulin Island community, Gore Bay, also recently became home to an internationally trained doctor looking for a small community practice.

Last month, the Ontario minister of health announced $1.4 billion in new funding to connect about two million Ontarians to primary care.

The details of how that will be done have not yet been revealed.