Northwestern Ontario doctors call for reversal of staffing cuts amid pleas to prevent ER closures

A family doctor in Atikokan is among those urging the province to restore physician positions that were recently cut from northern Ontario communities. 

Dr. Melanie Rodrigues was responding to a statement from the Ontario College of Family Physicians (OCFP) and the Ontario Medical Association's Section on General and Family Practice that called on the province to act immediately to prevent emergency room closures in the region.

The OMA recently partnered with the province on a bilateral review of physician complements in the 38 Ontario communities covered by Rural and Northern Physician Services Group Agreements — a funding model under which doctors agree to collectively provide needed services for a small community. 

That review resulted in cuts to physician positions in at least two northwestern Ontario communities: Atikokan and Red Lake. 

"It's a bit of a raw feeling," Rodrigues said of the perceived contradiction between the OMA's words and actions.

"I mean, some advocacy is better than nothing, but it doesn't really ring authentic given the situation that we're in."

The statement from the OCFP and the medical association section says several northern Ontario hospitals are at risk of closing their emergency rooms (ERs), and family doctors are currently working around the clock to help keep them open. 

Staffing cuts 'offensive'

Atikokan currently has seven full-time equivalent physicians.  

But the complement review calls for that number to be reduced to five through attrition. 

Dr. Sara Van Der Loo, chief of staff at Atikokan General Hospital, said she was insulted by the decision.

"Essentially what they're saying to me is that we haven't been working hard enough, which is offensive to me, and also that we should work harder for less money," she said. 

"You can't run an office with less people, just because there are five positions instead of seven. And since my overhead comes out of my salary, that means I will make less money to do 30 per cent more work, which I find very offensive."

Van Der Loo said she has no intention of leaving the community she loves, but the staffing cut caused her to momentarily consider recruitment material from other towns. 

Rodrigues said she believes Atikokan weathered the pandemic as well as it did because it currently has a full complement of seven physicians who worked hard to keep services open.

"I see Atikokan as an example of what it looks like when a community is well cared for," she said.

"So in actual fact, I think we should be used as a model for how to staff other communities."

Removing physician positions makes it much harder for doctors to take holidays or enjoy a work-life balance, she said.

A spokesperson for the provincial health minister recently told CBC that the staffing review was "about right-sizing and providing service in communities where it is needed most."

The spokesperson said the review resulted in an overall increase in physician complements in rural and northern communities.

Neither the province nor the OMA provided CBC with the results of the review. 

Asked to respond to the perceived conflict between its call for more support for northern emergency rooms and its role in cutting physician staffing in some communities, the OMA provided CBC with a statement that says: 

"The OMA believes that every patient in Ontario deserves to have a family doctor. We are advocating strongly with the government to find ways to make this happen as soon as possible, especially in northern Ontario, where communities are actively recruiting for 350 physicians."

In their joint statement, the college and the OMA called on the province to fund recruitment programs, improve working conditions for physicians in the north and enhance locum supports to get doctors to places where they're needed.

Since early in the pandemic, the province has been providing extra funding to help attract locums to rural and northern communities, but that funding is set to end Sept. 30.

The chief executive officer of the Lake of the Woods District Hospital in Kenora said the change will disproportionately impact communities such as his, because the Kenora hospital relies on locums to keep its emergency department open and any closure would risk tying up the ambulance service. 

"I think in southern Ontario, where you have communities that are closer together and you have several hospitals that have emergency departments, you have a better potential of working together," Ray Racette said.

"Our closest emerg [ER] would be Dryden, which is an hour and a half away. Thunder Bay, you know, they're six or so hours away, which in the south would be like driving from Toronto to Montreal."

Kenora has not yet had to close its emergency room, but it has shut its intensive care unit on multiple occasions due to staffing shortages.

Racette said he wished he could access more locums in order to ease the pressure on local physicians.

"They're stretched beyond stretched," he said. 

In a written statement from the Ontario Ministry of Health, spokesperson Hannah Jensen told CBC it is monitoring the success of the locum program and is working with its partners on how to support emergency rooms beyond September.