At the Sioux Lookout Meno Ya Win Health Centre, a hospital in northern Ontario, keeping the emergency department open is a constant struggle.
"We pull all the stops, we do everything we absolutely can to stay open, so it really does amount to living on a knife's edge just trying to keep things going," according to the hospital's chief of staff, Dr. Laurel Laakso.
Pulling out all the stops can mean having doctors work double coverage so the hospital can keep both its ER and obstetric unit running, asking staff to stay and work up to 16 hours, digging into the hospital's base budget to incentivize locums or temporary doctors to cover shifts or having an off-site doctor provide virtual care.
"It's been a number of different things that we've had to employ, and it really is piecemeal and trying to shift physicians around, moving retired physicians into primary care, taking physicians from primary care into the emergency department," said Laakso, a panellist at a media briefing hosted by the Ontario Medical Association (OMA) on Wednesday.
The OMA is calling on the provincial government to create a physician workforce strategy to tackle the shortage of doctors in rural and northern Ontario, saying it is threatening the closure of ERs and leading to burnout of family doctors.
"Work with us to build a comprehensive physician workforce strategy so we can attract more doctors to the north and support them so that they will stay here," said OMA President Dr. Andrew Park.
Park told The Trillium that while such a strategy would cover the whole province, "there's a specific lens and there's some specific consideration certainly for the north because of how disproportionately the human resource challenges are that impacted the north versus the rest of the province."
He said data on "what is needed where" would need to be part of this as it is currently "very unclear."
"Part of the workforce strategy has to understand what physicians are where and what kind of services they're providing, and we don't really have a great sense of that," he said, adding that it's also important to look at population movement to help anticipate future needs "and be prepared to fill those, because by the time you realize what the needs are, you're behind."
Other ways to tackle the health care crisis in the north include ensuring family doctors are part of larger care teams with nurses and other providers like social workers, improving access to the internet so virtual care is an option for those needing access to care and reducing the time doctors spend on administrative tasks, said Park, speaking from Thunder Bay.
Dr. Sarah Newbery, associate dean of physician workforce strategy at the Northern Ontario School of Medicine University, agreed with these strategies, saying it's important to have a "margin of capacity" when determining population needs so "we're not always only one doctor away from crisis."
She said that as of June 2022, more than 360 doctors were needed across northern Ontario, and while numbers are still being finalized for this year, the need has increased.
Some communities only have family doctors, who also end up delivering care in hospitals, said Newbery, a family doctor in Marathon, Ont., which is about 300 kilometres east of Thunder Bay.
If those communities are dependent on temporary physicians who don't make it because their flight was cancelled or the highway was closed, it sometimes leaves local physicians with difficult choices, including whether to see patients in their offices or help keep the ER open.
"What goes through the mind of the physician in the community is, 'I'm exhausted.... If we're going to keep the emergency department open, it is going to have to be me. Who am I to say I'm too tired? Who am I to say I can't reschedule my primary care clinic,'" she said.
Newbery said what could help address these challenges is thinking more about "locums as our retention tool for physicians in practice."
"We need that robust pool of locums, not because we want to increase the itinerant workforce, but because we want our physicians in communities to be able to have a break when they need it," she said.
Newbery added that if a broad strategy is created and any initiatives are implemented, there should be a way to measure effectiveness and change course if needed.
For its part, the government said it's been taking steps to build up the workforce in northern and remote communities.
"Since 2018 we have grown our health-care workforce by over 63,000 new nurses and 8,000 new physicians, but we know more needs to be done, that’s why earlier this year our government launched Your Health," said Hannah Jensen, a spokesperson for Health Minister Sylvia Jones, in an email.
Jensen highlighted the addition of 14 undergraduate and 22 postgraduate seats at the North Ontario School of Medicine, the expansion of a training and reimbursement program to include coverage of travel and accommodation costs for medical residents doing an elective in northern Ontario and the expansion to more communities of the "Peer to Peer Emergency Department" program that gives doctors around the clock access to virtual support from emergency doctors across the province. She said there are also grants for doctors who open a practice in these areas and more funding for additional primary care teams.
