With millions of Ontarians already not having a family doctor, provincial medical leaders are warning the situation will only get worse in the coming years.
Dr. Andrew Park, president of the Ontario Medical Association, led a virtual media briefing on Wednesday to raise awareness about unsustainable workloads, emergency room closures, and the present strain on medical care in the province.
Park was joined by NOSM University dean Dr. Sarita Verma, NOSM University assistant dean Dr. Sarah Newbery, and Sioux Lookout's Meno Ya Win Health Centre chief of staff Dr. Laurel Laakso.
Around 2.3 million Ontarians do not currently have a family doctor.
“With half of the physicians in northern Ontario expected to retire in the next 5 years, this situation will only get worse,” Park said. “Patients face persistent inequities in the care that they receive and in the health outcomes compared to people living in other parts of the province.”
Park mentioned that communities in northern Ontario are actively recruiting for just over 350 positions — as of June last year, that number includes at least 200 family doctors.
Newbery said that these numbers — and the need — only continues to increase.
There are seven medical schools in Ontario but only NOSM serves the northern Ontario region.
“Over 50 per cent of our learners will stay in northern Ontario, which is a remarkable achievement for any medical school,” said Verma. “If they stay to do their residency, it’s almost 90 per cent. Over 400,000 people we have assessed have access to healthcare because of the existence of NOSM U but, as we sit right now, many more do still not have access to healthcare, so our work is hardly done.”
Newbery shared the startling statistic that the life expectancy for residents of northern Ontario is shorter than those in the south by two and a half to three years.
This is due to challenges faced in delivery of care and patients access to care, along with a “significant burden” of chronically ill patients and people suffering mental health and addictions crises, she added.
“Five of the seven public health units with the highest opioid death rates in the province of Ontario are five of the seven public health units in northern Ontario,” said Newbery. “We have a population that struggles with significant health needs. We know that patients all across the north want to receive their care as close to home as possible, they want their care to be provided by family doctors and local teams.”
Currently, in many communities, family doctors are acting as rural generalists providing everything from primary care to hospital-based care including in emergency departments.
“In our current healthcare workforce shortage that has meant for many of our physicians, that they have needed to make the choice between being in the office, seeing patients who need ongoing care delivered by someone who knows them well, or being in the emergency department to keep that service open because that’s also critically important for our communities,” said Newbery. “And that challenge for physicians has been a heavy burden to bear.”
“We need a way of ensuring all of us across the healthcare system are in the same canoe and paddling in the same direction,” said Newbery, “to serve and support the physician workforce strategy for northern Ontario.”
Laakso observed that the Meno Ya Win Health Centre is funded for twice as many full time equivalent physician positions as they have staffed.
“Without question, the family doctor shortage has hit us very hard here,” said Laakso. “Many patients tell me that primary care is so difficult to access in Sioux Lookout that it essentially no longer exists… it is a bit of a dire picture, for sure.”
Meno Ya Win relies on the emergency department locum program which is a HealthForce Ontario program that provides short-term emergency department coverage (one or two shifts — sometimes three to four if they can manage).
“Essentially, we have 40 hospitals across northern Ontario — five of [those] are larger urban centres — and I would say that… all 35 of the rest of the hospital-based communities relies on a locum program,” said Newbery.
Locum programs can alleviate strain on both hospital care and primary care services.
Even still, full-time physicians are pulling double-duty in Sioux Lookout.
“We have only narrowly managed to avoid emergency department closure on countless occasions over the last several years,” said Laakso. “And I think the main reason we haven’t closed here in Sioux Lookout is simply because we can’t… the impact to our patients, to the region, to our multiple partners… would be too disastrous.”
Sioux Lookout serves 31 surrounding First Nations, the majority of which are fly-in access only.
If the Sioux Lookout hospital were to ever close, Laakso said that those 31 fly-in communities would be left “stranded.”
“There is quite a bit of pressure to keep our doors open,” said Laakso. “It certainly is a challenge for us to be able to practice medicine and thrive in this kind of work environment – it puts a lot of stress and pressure on our physicians. Knowing as well that we’re only one community of many in northwestern Ontario facing these kinds of challenges also puts us on a little bit of a knifes edge because we’re also wondering if the next hospital down the road is going to close their doors and that’s going to contribute to a vacuum in the region as well.”
The Meno Ya Win Health Centre in Sioux Lookout is second only to the Thunder Bay Regional Health Sciences Centre in terms of the volume of patients they treat in their emergency department.
Though the need is apparent and health officials are ready to strategize with the province, this is not the first time in recent months that this strain on physicians and the healthcare system has been brought to the provincial government’s attention.
The Sioux Lookout First Nations Health Authority declared a state of emergency in September after an alarming rise in rates of self-harm.
The pressure is on with rising rates of self-harm across many northern First Nations communities and a lack of access to medical care for those even in more heavily populated townships or municipalities across the northern region.
“The local partners need to have a say in how those physician resources are deployed,” said Park. “And that’s a discussion that we need to have in a bilateral fashion with government, so we ensure that the communities are well-supported, they have the [room] to do the work that they need to, and they’re not burning out at alarming rates.”
Laakso pointed to the issues faced by Indigenous communities in the region as one of the many elements that makes treatment and care in the north so unique.
“We’re a very unique health system in northern Ontario,” said Laakso. “I think there needs to be a recognition that we need unique contracts and some flexibility in terms of how the incentive programs run.”
Newbery said there are a number of strategies that need to be implemented.
“Teams, locums, easy access to CPD [continuing professional development], easy access to virtual tools… we need to be thinking about… the numbers of physicians that we need to be able to meet the needs of the population and have a margin of capacity so that we’re not always only one doctor away from crisis. So, event that data planning, that workforce planning, understanding what it is that we need to meet the needs of the population is really important,” Newbery said.
“If we can create a broad strategy under which we can actually implement some of those initiatives and measure their effectiveness with a point of accountability where there’s responsibility for course-correcting when those tactics aren’t working or we need to improve our initiatives that will help us to move the needle.”
