The Red Lake Margaret Cochenour Memorial Hospital in Northwestern Ontario, in a remote small town about 330 miles (535 km) northwest of Thunder Bay, shut down its emergency department for 24 hours over the weekend of March 26-27 due to a lack of physicians. Residents experiencing medical emergencies had to travel about 130 miles to the nearest open hospital, in Dryden.
During the closure from 8 a.m. Saturday, March 26, to 8 a.m. Sunday, March 27, four emergency calls were made in the Red Lake area. One caller, whose emergency occurred Sunday morning near the end of the closure, was able to be admitted to Red Lake Margaret Cochenour. The others were transported by land ambulance to Dryden Regional Health Center.
“The consequences – as far as we understand them to be, with limitations of confidentiality – were inconvenient, but not life-threatening,” said Dr. Akila Whiley, the hospital’s chief of staff. “I think we got lucky that day.”
In the future, they might not be so lucky, Whiley said.
Hospital President and CEO Sue LeBeau thinks more shutdowns will occur, as physician shortages in Northern Ontario are leaving hospitals with limited resources. “If not at our hospital, then I would say definitely in Northwestern Ontario,” she said. “We have a number of sister hospitals who have had close calls, and this remains a concern.”
The 18-bed Red Lake hospital has the capacity to have seven full-time physicians on staff. It currently has less than six, meaning these doctors are constantly on call, LeBeau said. “They’re 24-hour shifts. And we have a number of our physicians who do strings of one-in-two and one-in-three calls for many days in a row. So it’s hard.” Commute times are also a challenge for their physicians who live out of town, she added.
LeBeau and Whiley agree that burnout, especially through the pandemic, has been a large factor in the physician shortages. “People have been asked to work under unique circumstances for a prolonged period, and just can’t really do it anymore,” Whiley said.
The hospital’s 24-hour shutdown, however, also sheds light on more systemic reasons for the region’s doctor shortages. “There is inequity in funding in how physicians are compensated for working in the north,” LeBeau said. “There’s insufficient consideration for the hardships related to travel. For physicians who want to live here, their partners may not be able to secure the employment that they could in a larger community, for instance.”
These inequities in accessing emergency services disproportionately affect Northern Ontario’s Indigenous communities, Whiley said. Nearly one in five people in the province’s North West region identify as First Nations, Métis, or Inuit, according to a 2017 report by Health Quality Ontario. First Nations and Métis people in Ontario face “significantly greater risk” of disease and illness, as well as less access to primary and specialist care compared to non-Indigenous Ontarians, the report stated.
“We have reserves or communities near to us that are not always adequately resourced in terms of health care,” Whiley said. A lack of resources on reserves means Indigenous patients often come to Red Lake and other hospitals in the region for care, she added.
Whiley recalled an instance earlier in the week when the hospital’s emergency department was full. All patients in the department at the time identified as Indigenous. “I think you could pretty broadly say that in Northwestern Ontario, any inequities will impinge upon the Indigenous community before any other group,” she said.
Member of provincial Parliament Sol Mamakwa, a Kingfisher Lake First Nation member representing the electoral district of Kiiwetinoong, has recognized the need to prevent emergency-room shutdowns. He is calling on Ontario Premier Doug Ford to provide staff and resources to northern hospitals to keep their emergency departments open.
“This government’s lack of funding for specialist supports, lack of fair pay, and lack of support for local medical residency programs have put these hospitals on the knife’s edge,” Mamakwa said in a statement March 28. “We can start to fix this problem — but only with a government that cares about Northern, fly-in, and First Nations communities, and is willing to invest in better health care.”
To achieve better care among communities in Red Lake and the surrounding areas, inequities must be addressed at their roots, LeBeau said. “Determinants of health matter. So whether they have access to housing or transportation or appropriate support, whether physicians have the opportunity to take the time to learn more about the impacts of colonization, for instance. Those things can’t happen when you’re just barely getting by covering emergency services or primary care.”
The Northern Ontario School of Medicine in Thunder Bay announced March 15 that it will add 30 spots for undergraduate medical students and 41 for postgraduate residents over the next five years, increasing its capacity by more than half. LeBeau hopes this will help increase the number of physicians in the north.
An Ontario Medical Association report last year said Northern Ontario would need 300 more doctors to end the shortage.
Still, Whiley and LeBeau fear shutdowns like the one March 26 will become more common in the region.
“This is likely going to happen again if nothing changes. So there needs to be room for innovative models of care, there needs to be room for creativity, and there needs to be some tangible support for physicians,” LeBeau said. “And that very much needs to consider the needs and capabilities, I think, of our Indigenous communities.”
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