Emergency departments in northern and rural Ontario hospitals are facing potential closures after the provincial government ended a physician recruitment program.
On March 31, Ontario’s temporary locum program expired. The provincial government started the program during the COVID-19 pandemic to provide support to understaffed hospitals. The province’s Ministry of Health paid physicians a bonus to cover temporary shifts in rural and northern emergency departments. Typically, this involved physicians from urban centres travelling to smaller communities to cover shifts.
“We will usually have visiting physicians coming for almost 20 shifts a month,” says Melanie Goulet, the physician recruitment coordinator at Notre-Dame Hospital in Hearst, Ont. “There is a large need for extra funding to make sure that we do keep our emergency department open.”
The shifts could range from days to months. For a 12-hour shift, Goulet says the ministry was paying locum physicians at her hospital approximately $72 per hour on top of their regular earnings.
But now the temporary locum program is in limbo. The ministry is currently negotiating with the Ontario Medical Association to create a permanent program. But in the meantime, recruiters such as Goulet are unclear on how they should move forward. Goulet says the ministry has advised hospitals to continue covering emergency department shifts with locum physicians, but there’s no word on funding for these physicians.
Goulet had a locum physician cover several days worth of shifts at the beginning of April, right after the program expired. “I don’t know what to tell her,” she says. “The conversation of saying, ‘Hey, by the way, you might not get this extra funding, or, if you do, we don’t know what it’s going to look like, or how long it’s going to take.’”
Goulet adds that the ministry has not made it clear whether these locum physicians will be retroactively paid once a permanent solution is in place. “For almost four or five years now, they’ve been renewing the program every six months or so, and now, all of a sudden, they don’t,” she says. “Why not extend the temporary locum program for another two, three months until they have something permanent.”
Like much of northern and rural Ontario, Hearst is experiencing a physician shortage. Prior to COVID-19, the Notre-Dame Hospital had nine physicians. Retirements have wittled that number down to five.
Sixty-one per cent of the town’s population is without a family physician, and since there aren’t any walk-in clinics, most patients come to the emergency department for treatment, which is staffed by three of the town’s five physicians. The next biggest hospital is in Timmins, a three-hour drive away.
While the shortage hasn’t forced Hearst to close its emergency department, many other communities have. Between July 2022 and June 2023, Ontario’s Auditor General reported that there were 203 temporary emergency department closures due, in part, to a lack of provincewide staffing strategies. Prior to 2020, unplanned emergency department closures were rare.
Goulet says that Notre-Dame Hospital’s emergency department has no expectations of closing. But without the temporary locum program there is the risk of local physicians burning out from too many shifts. If the ministry doesn’t create a permanent solution soon, the hospital may have to front the costs of locum physician bonuses itself—technically ministry money, but it would put the hospital’s budget in a greater deficit.
“We’re just hoping that they won’t wait another six months before releasing information about a permanent program,” says Goulet.
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