Paul Dobrovolskis had just come back from vacation to his job in the emergency room when an official at the Greater Niagara General Hospital called with an ultimatum: Either go along with a new work schedule or leave.
"That was the final straw," Dr. Dobrovolskis recalls.
He decided he would go - but not quietly. In a letter of resignation circulated widely in the community, he declared that, because of constant cuts to its budget, the hospital where he had spent 14 years was "dying a slow death."
Similarly fed up, three of his colleagues followed suit, leaving just two-full-time doctors on the emergency ward's staff.
Their exodus highlights the depth of the discord within the Niagara Health System, a sprawling network of seven hospitals serving 434,000 people in a dozen communities. Doctors have passed a vote of non-confidence in its leadership, residents have protested in front of the Ontario Legislature and four municipal councils have called on the province to intervene.
But the conflict is more than just a tempest in a local teapot. It is classic example of the negative fallout from the fact that hospitals across Canada are on the front line in the battle to maintain the nation's health-care system.
Under pressure, hospitals are cutting services and redefining - critics say undermining - their traditional role as providers of one-stop care.
"What's getting lost amid the emotion is the reality …," counters Niagara Health's chief executive officer, Debbie Sevenpifer. "Medicine is more high tech, our population here in Niagara is older and sicker, and we have a national shortage of doctors and nurses."
She is referring to three leading reasons for the rapid increase in spending that saw health care account for $183.1-billion in overall spending last year. That amounts to $5,452 for every Canadian, and roughly 12 per cent of the gross domestic product - an all-time high and almost twice the 7 per cent seen in the 1970s.
This week, Statistics Canada announced yet another rise in life expectancy: Babies born from 2005 to 2007 will live an average of 80.7 years, up from 78.4 a decade earlier. That is very good news, except that governments, which picked up $129-billion of last year's tab, spend five times as much on caring for seniors as for the population as a whole,.
"We have a demographic tsunami headed our way as baby boomers get into the age where they'll be requiring more health care," says Deb Matthews, the Health Minister in Ontario, where health consumes 42 cents of every dollar in program spending.
Yet governments at all levels seem determined to avoid a public debate on how to sustain a system many Canadians appear to take for granted.
In a report this month, Parliamentary Budget Officer Kevin Page warns that, to cope with the changing demographics, the country must cut spending or raise taxes. The federal government will table its budget next Thursday and, despite pressure from such think tanks as the C.D. Howe Institute, says it has no plans to cut health spending. According to Mr. Page, it hasn't even begun to address the demands of its aging population.
Why? Perhaps because, as Friday's Ipsos Reid poll for the Canadian Medical Association shows, Canadians want Ottawa to attack the deficit - but only 16 per cent support cutting health to do so.
In contrast to the silence here, the debate rages in the United States, where President Barack Obama clashed with congressional Republicans this week during a live televised summit on how to fix their troubled system.
But the need to address health care becomes "more desperate by the minute," says Duncan Sinclair, professor emeritus and dean of medicine at Queen's University who led a restructuring of Ontario's system in the 1990s.
"The only comfort in all of this is, yes, we have to deal with it, but not as urgently as the United States," he says. "That's pretty cold comfort."
About 20 cents of every dollar the provinces spend on health comes from Ottawa, and federal Finance Minister Jim Flaherty has said the transfer payments won't be touched in next week's budget. They are slated to receive annual increases of 6 per cent until the fiscal year that starts on April 1, 2013.