As Associate Dean of Physician Workforce Strategy at the Northern Ontario School of Medicine (NOSM), Dr. Sarah Newbery understands the struggle that doctors in Northern Ontario face each time they decide to take one more shift to keep their emergency room from closing, even when they’re past the point of exhaustion.
She and many of her colleagues use a term for it: moral injury.
The term was originally used to describe the devastating physical and mental effects on wartime soldiers who committed or failed to stop atrocities. For doctors, the moral injury comes from the guilt they feel at the thought of not being able to provide life-saving care to a patient in need.
In tightly-knit Northern communities, doctors feel strongly connected to their patients, Dr. Newbery said. She lives and works as a family doctor in a Northern town of Marathon, with a population just over 3,000. “The people we treat are our neighbours, they are our kids’ hockey coach, they may be health care teammates from x-ray or lab, or maybe they work at the grocery store. We have relationships with them because we share a community.”
If the local ER closes its doors, patients are often forced to drive up to two hours to reach the next hospital. So when hospitals are short-staffed, many family physicians choose to work extra shifts instead of letting the ER shut down and risk having a patient suffer a serious — or fatal — illness or injury.
“The notion that the ER is closed because “I just couldn’t do one more shift” is a big burden for a doctor who also lives in the community,” Dr. Newbery said.
The effects on physicians can be dire. One family doctor took five extra shifts in a very short time just to keep the ER open, while another was the ER doc for more than 100 hours straight catching sleep and meals where he could. Another said her colleague has a panic attack every time she enters the ER. Yet many physicians choose to keep ERs running even when their own emotional and physical health is at stake.
“It’s challenging to navigate without guilt when we have to draw a line,” Dr. Newbery said.
This moral injury explains why doctors in the North sometimes burn out and why some are struggling with the choice to leave for other communities.
With no clear action from leaders to resolve staffing problems, Dr. Newbery is concerned about whether the challenge of moral injury will make it difficult to attract more doctors to the North in the future. “I worry about the way in which rural practice may come to be seen as unstable and unpredictable,” she said. “What does that mean for recruitment? We have really terrific medical learners at NOSM U who want to be rural physicians. We need to be able to show them how great rural practice can and should be.”
This situation is tenuous and unsustainable, but it doesn’t have to be this way. A rapid response from government and healthcare leaders could help to stabilize the current crisis. The Ontario College of Family Physicians (OCFP) and the OMA Section on General & Family Practice (SGFP) are calling for:
- 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.
- Provide immediate peer support for family doctors working in these difficult conditions to maintain their mental health and wellbeing.
Read our full statement here.