Emergency rooms across Northern Ontario’s rural hospitals are in “dire” need for more physicians and funding as doctors struggle to keep emergency rooms open through the summer trauma season.
Communities across Northern Ontario have been recruiting for a goal of 350 physicians, including 200 family physicians, according to a calculation done in June, 2022, by the Northern Ontario School of Medicine University, said Dr. Sarah Newbery, the university’s associate dean of physician work force strategy and a rural physician in Marathon, Ont.
Dr. Sarah Giles, a family doctor in emergency medicine in Kenora, Ont., said physicians’ resiliency has “taken a hit” since the pandemic as many confront burn out and moral injury, a term used to describe the distress health care workers experience when they cannot provide adequate care for their patients.
“The doctors in Kenora in the ER – we do not look forward to summer,” Dr. Giles, who worked as a locum, or temporary physician, across the world before settling in Kenora in 2020, said Monday.
As of March, 2022, more than 2.2 million Ontarians were without a regular physician, up from nearly 1.8 million in March of 2020, according to data released earlier this year from Inspire Primary Health Care, a network of family-medicine researchers.
Across Northern Ontario, where many rural physicians must act as both primary and emergency physicians, doctor shortages are leading to added stress on emergency rooms. Family physicians are working overtime to keep emergency rooms open, closing down family practices in response and putting additional strain on emergency rooms as patients struggle to access ongoing and critical care.
“They feel like they’re not getting the care they deserve,” Dr. Giles said. “We can’t necessarily give them the care we want to give and it just feels like every day you’re failing because nobody’s happy.”
Kenora’s emergency room is currently operating full-time with 13 physicians when it has previously operated with 22. The majority of those doctors work primarily as family physicians also covering multiple disciplines, including hospitalist, obstetrics and long-term care. Many of these doctors are working overtime, Dr. Giles said, in order to keep the emergency room open despite the cost to other forms of care.
“They’re drowning and you just see all of your colleagues struggling to keep their head above water,” she said. “I often say if I could put half of them on stress leave, none of them would ever take it. It’s a really tough gig these days.”
Dr. Newbery said the role of the family physician in rural settings is very broad. Many operate across the “silos of health care,” as majority are the only physicians in their community.
“We are responsible for the primary care services that are delivered in our office setting together with our family health team and we’re responsible for the emergency department 24-7-365 and all of the in-patient care,” she said.
Dr. Giles said, to her knowledge, the emergency room in Kenora has never closed, but that is only because of the “super human efforts” of her colleagues. She said the hospital has become heavily reliant on locum doctors, who are difficult to retain. Independent travel, or temporary, nurses have also become a regular on every shift.
Dr. Newbery said although emergency rooms across Northern Ontario have not seen the same level of closures as Southern Ontario where emergency centres are closer together, what has not been taken into account is the cost of keeping emergency rooms open has on family physicians.
“Local family physicians are working beyond what they likely should in order to keep their emergency room open,” Dr. Newbery said. “We know that when the emergency room closes, for the majority of emergency departments at least in Northwestern Ontario, it’s an hour or more to the next nearest emergency room.”
The closest hospital to Kenora is in Winnipeg, a two and half-hour drive across the provincial border. However, due to provincial jurisdictions, the closest tertiary care centre Kenora can refer patients to is Thunder Bay, a five-and-a-half-hour drive away.
Kenora had a memorandum of understanding with Winnipeg to send “life and limb” cases to Winnipeg’s overstretched system, but that agreement has expired and is currently awaiting renewal from an agreement with the Ontario Medical Association, Dr. Giles said.
Wawa, Ont., is facing a similar crisis as their existing three family physicians, who service 6,000 patients in the area, are about to decrease to two physicians come September. The next closest emergency centre is a two-and-a-half hour drive away in Sault Ste. Marie.
“It’s distressing and it’s hard and we really want to make it work,” said rural physician Dr. Anjali Oberai, who will be one of the remaining physicians alongside her husband.
Dr. Oberai said traditionally there have been six or seven physicians in the community, but around four years ago doctors who began leaving the community became harder to replace due to sustainability of working conditions.
“I’ve been here for 25 years and we’ve never been in a situation that’s as acute and dire as it is now,” Dr. Oberai said. The hospital operates now with locums, but she said there is concern about how long they will be able to continue with level of support they have now.
“It’s very unpredictable, both for us and I think also for our community and patients,” she said. “It’s not super nice to be called the day before, ‘Sorry, your family medicine appointment’s going to be cancelled because your doctor has to manage these other xyz things.’ ”
Many of these patients wind up in emergency rooms in order to see their family physicians, but this “runs counter to the direction that the province wants to go, which is the right place at the right time for the right service,” Dr. Newbery said.
More strain on emergency rooms also makes it more difficult to cover emergency room shifts and overall makes work in emergency medicine less attractive to prospective physicians, Dr. Newbery said.
Retaining physicians in Northern Ontario long-term is necessary, Dr. Newbery said, in order to recruit more physicians to live in rural medicine. This means better financial incentives and making the work in Northern Ontario more attractive by improving work conditions and supports.
Dr. Giles said ensuring better baseline pay for local physicians in Northern Ontario is also necessary to make sure physicians are receiving a competitive pay to what is offered to locums or physicians in other jurisdictions.