For what is believed to be the first time in at least 30 years, a hospital in northwestern Ontario had to close its emergency room due to a lack of available doctors.
Margaret Cochenour Memorial Hospital in Red Lake, Ont., closed its emergency room for 24 hours from 8 a.m. March 26 to 8 a.m. March 27 after exhausting all possible options to staff the facility, the city said. President and CEO Sue LeBeau.
Meanwhile, two people had to be taken by ambulance to the Regional Health Center in Dryden, 216 kilometers away.
Dr Akila Whiley, chief of staff at Red Lake, said the hospital had relied on dressing solutions to deal with shortages of available staff and had planned to close as early as last November.
“I think we just – we finally hit a breaking point as a band,” said Whiley, who spoke to CBC News on Sunday after returning from vacation.
“I feel emotional talking about it,” she said, her voice shaking. “I had to take a step back because I would have flown out and come back. But it’s just – I can’t do it anymore. … These people deserve so much better. And we all want to be able to do better, but we have but little to give before you are simply exhausted.”
When an emergency department is closed, the “blue H” traffic signs are covered.
There is not another emergency room within 250 km for the citizens of Red Lake.
Physician shortages are a long-standing issue in Northern Ontario
The town, located more than 270 kilometers north of Kenora, Ont., is allocated seven full-time equivalent physician positions under the current provincial funding system, Whiley said.
It currently operates with around 5.75 people, not all of whom work on an emergency basis.
Physician shortages have been a long-standing issue in Northwestern Ontario. But doctors and hospital officials say the pandemic has made the situation dire, in part because of increased competition for locums and doctors in big cities abandoning secondary practices in small towns.
What happened in Red Lake will likely happen to every small hospital in the area over the next six months, said Sara Van Der Loo, chief of staff at Atikokan General Hospital and regional board chair. Northwest Chiefs of Staff.
“There have been a number of near misses over the past few months where we have had near closures,” Van Der Loo said.
“We all barely avoided closings in Sioux Lookout, in Dryden, in Kenora, in Atikokan, in Red Lake, in Geraldton.”
Emergency room close to closing ‘too many times to count’
The chair of the Fort Frances and District Physician Recruitment and Retention Committee wrote a letter to Kenora MLA Greg Rickford and Thunder Bay-Rainy River MLA Marcus Powlowski on Jan. 18 calling it a crisis the state of physician recruitment and retention in the region.
“Doctors are exhausted, resignation letters have been submitted, and sadly more are being written,” Dr. Marc Ruppenstein wrote.
The local emergency room has come close to closing “too many times to count,” said Todd Hamilton, who is the committee’s physician recruiter.
“It’s only thanks to local doctors juggling their schedules, changing holiday schedules, adding six hours to an already 12-hour day – that’s the only reason many of these ERs have stayed open,” said said Hamilton.
Hospitals are running out of options and it’s time to appoint a task force to fix the problem, he added.
An NDP motion calling on the Ontario government to fund and implement a plan to address the shortage of health professionals in the North was defeated at Queen’s Park on Tuesday – Progressive Conservative MPs, including the Health Minister Christine Elliott and Kenora MLA Greg Rickford voted against it.
“I was a bit disappointed to see the northern MPs on the government side opposing us,” said Keewaytinoong NDP MP Sol Mamakwa.
“Health should not be a partisan issue.”
The Ford government announced the expansion of the Northern Ontario School of Medicine (NOSM) on March 15, adding 30 new undergraduate positions and 41 new residency positions over the next five years.
“This is an important milestone,” said Dr Sarah Newbery, a rural GP who is associate dean of medical workforce strategy at the school.
The province has also created incentives for locums to work in northern Ontario, she said.
In addition, the proposed new medical services agreement, which doctors across the province voted on last week, includes a wage increase for rural doctors in the North, provisions to renegotiate the number of doctors working in a given community and new rules regarding succession planning that make it easier for doctors to transfer practices to other doctors, she added.
But, Newbery said, more could be done.
This includes reducing barriers that prevent residents of southern Ontario from coming to work in northern Ontario.
It could also include creating a regional back-up workforce, she said.
Newbery said the workforce could include offering virtual support to physicians practicing in rural settings so they can access specialist support in real time.
Some physicians said they would need these supports, along with access to travel and housing, in order to feel confident working in rural and remote emergency rooms.
Hamilton suggested that rural medicine should become its own specialty and be compensated accordingly.
He also said the government should consider subsidizing the training of doctors who sign up to serve in the North.
“The military can offer to cover the tuition for doctors – whether it’s NOSM or any other medical school in Ontario – and they can get five to seven years back from the family doctor, so I don’t understand why they can’t do it for a rural community,” he said.
Additionally, Hamilton said the College of Physicians and Surgeons of Ontario needs to make it easier for doctors with foreign qualifications to practice in the province.
Currently, he explained, three US-educated medical students are interested in working in Northern Ontario. The college would issue them a restricted license and require three other doctors to supervise and mentor them for one to two years.
“In towns like Rainy River and Emo, we only have one or two doctors. So how do you have three doctors supervising or offering supervision?” He asked.
He also asked why supervision could not be offered virtually.
Regardless of the solutions adopted by the government and the college, Van Der Loo said emergencies caused by the shortage of doctors must be dealt with at the regional level.
“Fixing the problem should not be left to local doctors,” she said. “Because the pressure starts to get to all of us…you end up working more than you should. And there’s a huge risk of burnout.”