Doctor shortage closes Red Lake, Ont., ER for 24 hours. Officials say it could happen elsewhere

For what's believed to be the first time in at least 30 years, a hospital in northwestern Ontario has had to close its emergency room due to a lack of available physicians. 

The Margaret Cochenour Memorial Hospital in Red Lake closed its ER for 24 hours from 8 a.m. March 26 to 8 a.m. on Sunday after exhausting all possible options for staffing the facility, said Sue LeBeau, president and chief executive officer.

During that time, two people had to be taken by ambulance to the Dryden Regional Health Centre, 216 kilometres away. 

Dr. Akila Whiley, the chief of staff in Red Lake, said the hospital had been relying on Band-Aid solutions to deal with shortages of available staff and had anticipated a closure as early as last November.

"I think we've just — we finally reached a breaking point as a group," said Whiley, who spoke to CBC News on Sunday after arriving home from vacation. 

"I feel emotional talking about it," she said, her voice trembling. "I had to take a step back because I would have gotten on a plane 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 only have so much we can give before you're just exhausted."

Physician shortages long a problem in northern Ontario

The town, over 270 kilometres north of Kenora, is allotted seven full-time equivalent physician positions under the current provincial funding system, Whiley said. 

It's currently operating with about 5.75, not all of whom work in emergency. 

Physician shortages are a long-standing problem in northwestern Ontario. But doctors and hospital officials say the pandemic has made the situation dire, due in part to increased competition for locums and to big-city physicians giving up their secondary practices in small towns. 

What happened in Red Lake will likely happen at every small hospital in the region within the next six months, said Sara Van Der Loo, chief of staff at Atikokan General Hospital and chair of the Northwest Regional Chief of Staff Council.

"There have been quite a number of near-misses in the last few months where we've had some very near-closures," Van Der Loo said.

"We've all just barely averted closures in Sioux Lookout, in Dryden, in Kenora, in Atikokan, in Red Lake, in Geraldton."

ER close to closure 'too many times to count'

The chair of the Fort Frances and District Physician Recruitment and Retention Committee wrote a letter to Kenora MPP Greg Rickford and Thunder Bay-Rainy River MP Marcus Powlowski on Jan. 18, calling the state of physician recruitment and retention in the region a crisis. 

"Physicians are burnt out, resignation letters have been submitted, and unfortunately, others are being written," Dr. Marc Ruppenstein wrote.

The local emergency room has come close to closure "too many times to count," said Todd Hamilton, who is the physician recruiter with the committee. 

"Only through the local physicians juggling their schedules, changing vacation schedules, adding six hours onto an already 12-hour day — that's the only reason a lot of these ERs remained open," Hamilton said. 

Hospitals are running out of options, and it's approaching time to appoint a task force to address the issue, he added. 

An NDP motion calling on the Ontario government to fund and implement a plan to deal with the shortage of health professionals in the north was defeated in Queen's Park on Tuesday, with Progressive Conservative MPPs, including Health Minister Christine Elliott and Kenora MPP Greg Rickford voting against it.

"I was kind of disappointed to see northern MPPs from the government side oppose us," said Keewaytinoong NDP MPP Sol Mamakwa. 

"Health care should not be a partisan issue."

The Ford government did announce an expansion of the Northern Ontario School of Medicine (NOSM) on March 15, adding 30 new undergraduate positions and 41 new residence spots over the next five years. 

"That's an important step," said Dr. Sarah Newbery, a rural generalist physician who serves as NOSM's associate dean of physician workforce strategy.

The province has also created incentives for locums to work in northern Ontario, she said.

In addition, the proposed new physician services agreement, which doctors in the province voted on last week, includes a salary increase for rural northern physicians, provisions to renegotiate the number of doctors working in a given community, and new rules around succession planning that will make it easier for doctors to hand over practices to other physicians, she added.

But, Newbery said, more could be done. 

That would include reducing the barriers preventing residents from southern Ontario from coming to work in northern Ontario. 

It could also include creating a regional locum workforce, she said.

Newbery said the workforce could include offering virtual support to physicians practicing in rural environments so they can access the support of specialists in real-time.

Some doctors said they'd need these supports, along with access to travel and housing accommodations, in order to feel confident working in rural and remote emergency rooms. 

Solutions proposed

Hamilton suggested rural medicine should be made its own specialty and compensated accordingly. 

He also said the government should consider subsidizing education for physicians who commit to serving in the north.

"The military can offer to cover tuition for physicians in — whether it's NOSM or any other medical school in Ontario —and they can get a five- to seven-year return-of-service from the family physician, so I don't understand why they can't do it for a rural community," he said.

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.

Right now, he explained, there are three medical students who trained in the United States who are interested in working in northern Ontario. The college would issue them a restricted licence and require three other physicians to supervise and mentor them for one to two years.

"In towns like Rainy River and Emo, we only have one doctor or two doctors. So how do you have three physicians supervising or offering supervision?" he asked.

He also questioned why supervision couldn't be offered virtually.  

Regardless of the solutions adopted by the government and the college, Van Der Loo said emergencies caused by shortages of doctors need to be dealt with at a regional level. 

"Fixing the problem needs to not fall to the local physicians, because the pressure is starting to get to all of us … you end up working more than you should. And there's a huge risk of burnout."