What’s Going On?

Examples of this epidemic of Canadian ED closures are not hard to find. Manitoba’s rural EDs collectively closed for 80,000 hours in 2023, four of them indefinitely.² In that same year, Ontario reported 1,200 closures of hospital EDs and other departments due to staff shortages. The Ontario Health Coalition of community grassroots organizations has been working to mobilize physicians willing to travel to different sites in need.

In British Columbia, CTV News reported on June 6, some hospitals are offering qualified doctors bonuses of hundreds of dollars, up to $4,000—per shift—to pick up some extra ED shifts in hospitals that need it.³ Northern British Columbia has been hit by ED service disruptions again this summer, prompting public rallies calling attention to the closures.⁴

A Domino Effect?

Ken Milne, MD, MSc, CCFP-EM, is a staff physician at Strathroy Middlesex General Hospital in Strathroy, Ontario, and the creator of a podcast called “The Skeptics’ Guide to Emergency Medicine.” He said every Canadian deserves timely and appropriate access to emergency medicine, but the system is not currently meeting that need.

“In Canada, most of our country is rural, and the ED closures are almost always in rural areas,” Dr. Milne explained. If staff call in sick, there’s no one to replace them. “But the closure of an ED can impact surrounding facilities, with their own fixed number of staff, turning into a domino effect and making it harder for people with emergency needs to get the help they need.”

In addition, he said, physicians are getting older and withdrawing from night work and high-intensity shifts. Meanwhile, medicine has gotten more complex for general practitioners, and patients’ expectations have also changed. “So how do we micro-allocate scarce resources? You’ll always have a challenge in rural areas. But people coming into the field now rightly want a team-based work environment where they can also have a life away from work.”

Emergency medicine is a heterogenous specialty in Canada. Some emergency physicians are board-certified after completing a five-year emergency medicine residency. Others do a one-year emergency medicine fellowship following family medicine training. And some family physicians in rural settings serve as generalists, combining clinic work, hospital wards, and ED shifts, possibly also doing anesthesiology and visiting patients in long-term care facilities. They may seek additional training in advanced trauma life support, advanced cardiac life support, pediatric advanced life support, and neonatal resuscitation, along with self-directed learning.