“I’ve been doing this work for 30 years,” Dr. Milne said. “I love rural medicine. I was raised on a farm. I’ve worked in 30 rural Ontario hospitals via Health Force Ontario. I also love practicing up to the limit of my skill set,” he said. “But the job certainly has changed. People are living longer, and medicine is much more complex. It’s getting harder to stay up to date on all the advances.”

What Are the Answers?

One solution to chronic staff shortages, Dr. Milne said, is to grow your own—drawing on people born and raised in the community. That involves decentralized training, ideally combining nurses and physicians together, and placing doctors-in-training back in their home communities. Northern Ontario School of Medicine University and the Centre for Rural Health Studies at Memorial University of Newfoundland have both developed programs aiming to entice more doctors to choose rural careers by exposing them to rural medical practice.

Other efforts have included provincial locums programs in Ontario and British Columbia to connect physicians with departments in need; the growing availability of on-demand virtual clinical support from remote physicians; and the greater use of nurse practitioners, physician assistants, and community paramedics in the ED. The Canadian Association of Emergency Physicians (CAEP)’s EM-POWER, a comprehensive task force report on the future of emergency care in Canada issued in March, proposes a roadmap to a redesigned, integrated framework for emergency care.⁵

A regionalization strategy for utilizing scarce rural emergency services, which has been explored by CAEP as well as by groups in Nova Scotia and Alberta, could link facilities and services in a more systematic way, pooling the resources of several rural hospitals located not too far from each other and struggling to stay open. Depending on driving distances, they could designate one as the center of excellence in emergency medicine for the region, said Alan Drummond, MD, a family physician who has practiced emergency medicine in Perth, Ontario (population: 6,000) for 40 years.

Dr. Drummond has been president and public affairs committee chair for CAEP, actively involved in provincial and national politics, and a widely published and outspoken voice trying to bring attention to this brewing crisis in Canadian emergency medicine. A decade ago, CAEP put out a position paper predicting a shortage of 1,500 emergency physicians in Canada by 2025, “if we didn’t start planning for the near future, which is now on us,” he said.⁶ In Canadian politics, health care is a vote loser. “So, the alternative is keep doing what we’re doing now, which is precisely nothing,” he said.