MANITOULIN—While doctors at both hospital sites of the Manitoulin Health Centre (MHC) say that Island hospitals are not on the brink of closing their emergency departments, which is the case for several Northern Ontario hospitals, family doctors locally and throughout the North are currently working around the clock to help keep them open. The Ontario College of Family Physicians (OCFP) and the Ontario Medical Association Section on General and Family Practice (SGFP) are calling for quick and immediate action to support those family doctors and their patients.
While the Northeast Manitoulin and Manitoulin Central Family Health Teams (FHTs) have both been approved for funding additional doctors for each team, (although not enough in the case of the Mindemoya Hospital), another problem is trying to recruit doctors to hospitals that have such busy emergency departments. It is felt these workloads dissuade potential doctors from moving to Northern Ontario.
“We are not doing okay,” Dr. Maurianne Reade, a family doctor with the Manitoulin Central FHT and the MHC in Mindemoya, stated flatly. “We are desperate for help. We’ve got our schedule and our shifts are covered (in the emergency department) up to the end of September. But it is at an inhumane pace work. It is not sustainable.”
“And it may get more challenging to get more funding to get enough people to continue to help work this fall,” said Dr. Reade.
Dr. Steve Cooper, a physician with the Northeast Manitoulin FHT and an OMA board member, said, “we are not one of the hospitals that are looking at their emergency departments being closed. For the remainder of the summer we have shifts filled. But we are definitely short of doctors and nursing staff.”
Dr. Anjali Oberai of Wawa, in an interview with CTV News last Wednesday said, “I know it’s a crisis. It’s frankly dangerous for our emergency departments to close for hundreds of kilometres from the next emergency department. No community should have to be in that position where if you have an emergency your local emergency is closed and it’s 100 kilometres, 200 kilometres to get to the next emergency room.”
If there is not another hospital that can manage a surge in capacity that can be reached by way of a short drive it could take two to three hours to drive to the next emergency room in the North, which is a potentially dangerous situation for a patient with a life-threatening illness or injury.
Dr. Reade said neither MHC hospital site has the capacity to take on patients if one hospital closed its emergency department.
To fill gaps and keep the emergency rooms open, locums (temporary doctors) are relied upon, however, when a locum doesn’t materialize family doctors can face a situation where they need to take time way from their clinics.
“The situation is critical as many Northern communities are struggling to ensure ER shifts are covered while facing significant population increases in the summer months. In the North, family doctors are relied upon to staff ERs,” said the OCFP/OMA SGFP in a release.
“Family doctors face unique and extraordinary challenges in the North. In other parts of the province, the next nearest hospital may be 20-40 minutes away. In the North, if an ER closes, the next hospital could be more than two hours away, leaving patients with life-threatening illness or injury dangerously at risk,” the release continues.
“For family doctors in the North, closing an ER is not an option,” says the OCFP/OMA SGFP. “But keeping them open means they are taking on more shifts than is reasonable to expect. Family doctors always put their patients first, but many of these doctors are doing the impossible right now.”
“Across the North, hospitals are struggling to get temporary doctors to cover shifts for many reasons, including inexperience with the demands of working in a Northern emergency room. Without the support of these temporary doctors there remain significant scheduling gaps, some hospitals regularly face gaps of 40-50 shifts in the ERs every month. These shifts are often then filled by family doctors in order to avoid a closure,” the release continues.
“Adding to the crisis, when family doctors must take extra shifts to keep an ER open, they cancel their primary care clinics. There is already a shortage of more than 200 family doctors in the North, leaving patients in almost every community without adequate access to a family doctor.”
Dr. Anne McDonald, of the Northeast Manitoulin FHT told The Expositor, “in terms of the number of doctors in Little Current, we currently have six positions allowed and filled with an expected retirement in the next year. We have been trying to recruit for some time to fill this position with no success.” She explained the doctors’ responsibilities include the ER, hospital in-patient unit and hospice suite, two nursing homes (Wiikwemkoong and Little Current) and travel to Wiikwemkoong Unceded Territory, Whitefish River First Nation and Aundeck Omni Kaning First Nation. “We also service Sheguiandah First Nation at our Little Current site. In Little Current two doctors also deliver babies. We call that family medicine with obstetrics.”
“My current practice size is over 900 patients which is close to what some full-time family physicians in Toronto might have without all the other clinical responsibilities,” said Dr. McDonald. “I am struggling, like many of my colleagues, to provide what I feel is appropriate wait times and equitable care to my patients. This is despite a fantastic allied health team including nurse practitioners, physician assistants, registered nurses, registered practical nurses, pharmacist, social worker, and front desk staff at our clinic.”
“Our glimmer of hope is that a recent complement review of our contract was completed by the Ministry of Health and the OMA. Many Northern communities, including our site, have received an increase in full-time physician jobs allowed,” said Dr. McDonald. She pointed out Manitoulin Central FHT, the Gore Bay Medical Centre and Assiginack FHT have also been allowed an increase in doctors.
“The challenge will be to recruit to our sites (amongst the competition for family doctors everywhere) and the ever-specialized skillset required of rural Northern family doctors,” said Dr. McDonald. She explained the ministry has been advertising with extra incentives in weekly email blitzes for locums on behalf of communities. “The last email I received this week we were listed as one of 14 Northern Ontario communities continually looking for last minute locums so our local doctors can have a break.”
“We are very grateful to all the municipalities as well as MHC’s ongoing contributions to our recruitment efforts in the form of monetary support for our part-time recruiter, Craig Matheson,” continued Dr. McDonald. “In Little Current, we’ve had some success with increased locums in the last year, but no real interest in any permanent positions which we have been advertising already for some time.”
Dr. Reade told The Expositor, “Little Current currently has six positions, and Manitoulin Central FHT is funded for six but have 4.75 (full-time doctors). We actually need 11 (in Mindemoya Hospital), but with all the efforts to recruit doctors we can’t even get someone to take the sixth position because there is too much work, when you look at all the responsibilities and things we have to do. It’s using all our time to keep the hospital running.”
“What often happens is that we have to work 60 hours a week to keep the hospital running,” said Dr. Reade. “We have temporary locums, and are incredibly grateful for them, but we need more help. The province needs to put together a variety of strategies for short-term locums and long-term doctors so we can have a sustainable workload and we can recruit other physicians. It is hard to persuade anyone to join us when they find out how much work is involved.”
“We have received approval to add 1.5 more doctors, which is nice, but it is not nearly enough,” said Dr. Reade. “What it means is that a doctor will never take a job with us. An additional 1.5 doctors on top of the six we have been allowed for is 7.5 doctors but there is still way too much work for the doctors even if we had this many.”
“We continue to be thankful for the respect and support we receive from the community, the MHC and the hospital auxiliaries. This respect and support is needed from the province,” said Dr. Reade.
In a separate contract from the Northeast Manitoulin and Manitoulin Central (FHTs) both the Gore Bay Medical Centre (GBMC) and Assiginack FHT have received approval from the province for additional doctors to add to their staff complement. Currently the GBMC has two contracts, one shared by Drs. Robert Hamilton and Shelagh McRae, and one for Dr. Chantelle Wilson. “Now the recommendation is that we are allowed to have five contracts,” said Dr. Hamilton.
Dr. McRae said the increase approval, “is wonderful but getting additional doctors here through recruiting is going to be the issue. Nation-wide and provincially, there is a shortage of doctors.”
“The fact that we have received approval for three additional doctors is good news, and hopefully we can attract doctors here,” said Dr. McRae.
Sandra Pennie, executive director of the Assiginack FHT said, “we have received approval from the ministry for an additional doctor contract position.” Drs. Mike Bedard and Steve Daniel had been sharing one contract. “This is wonderful news for us. We’re very excited about all of this.”
The OCFP/OMA SGFP feel the current doctor shortage is currently tenuous and unsustainable, and that government and healthcare leaders can take steps to stabilize the situation. They are calling for “the province to immediately enhance locum program supports to ensure temporary doctors are available where they are most needed right now. Longer-term rethinking of how locums are used in the North is necessary; urgently fund recruitment programs to bring new physicians to the North; retention is critical. Implement a comprehensive strategy and ensure positive working conditions to retain the remaining physicians in the North and provide immediate peer support for family doctors in these difficult conditions to maintain their mental health and wellbeing.
Algoma-Manitoulin MPP Michael Mantha said, “the announcements of additional doctor positions looks great on paper, but it doesn’t materialize with feet on the ground and doctors in emergency rooms.”
“What is needed is a true recruitment plan and repayment programs from the provincial government to provide incentives to bring doctors to rural areas,” said MPP Mantha. “This is what we hear from everyone in the health care field, that we are in a crisis situation. This government needs to response to it as a crisis.”
