Survival mode.
That’s how Dr. Maurianne Reade describes the situation that she and her Northern Ontario family physician colleagues are in right now. Dr. Reade is a family physician with the Manitoulin Central Family Health Team who also works in the Manitoulin Health Centre where current healthcare needs far exceed capacity of those providing care.
Manitoulin Island has two hospitals providing emergency care for 10,000 patients at each site on an annual basis. The Mindemoya site has 13 inpatient beds, and the Little Current site has 14 inpatient beds and two obstetrical beds. Each site is seeing over 10,000 emergency visits per year and neither site has the capacity to take on patients if one hospital closed its emergency department. In Mindemoya, where Dr. Reade works, they are funded for six physicians to cover the ER, inpatients and clinic, however they have not been fully staffed for years.
“The hospital is only open because family doctors are spending a disproportionate amount of time in the emergency department and sacrificing time in their clinics and with their families to do so,” said Dr. Reade. It’s another Northern Ontario example of family doctors being stretched to fill significant gaps, in support of a system hanging on by a thread.
Each month, as the physicians look ahead to the emergency room coverage required, they are reminded of just how unsustainable their situation is.
In order to fill gaps and keep the emergency rooms open, locums (temporary doctors) are relied upon, however, when a locum doesn’t materialize family doctors can face a situation in which they are often working more than 60 hours in a week. This is not a sustainable solution and there is ongoing fear that it might be next month that the cross-coverage that local family physicians have been cobbling together for years finally falls apart.
Dr. Reade and her colleagues hear about emergency room closures elsewhere but explains that, in Northern Ontario, there isn't an option for closing that's safe for patients like there is in other parts of the province. There simply isn’t another hospital that can be reached by way of a short drive that can manage a surge in capacity. It could take 2-3 hours to drive to the next emergency room in the North – a potentially dangerous situation for a patient with life threatening illness or injury.
The gravity of the situation combined with a responsibility to one another, the community and patients is clearly causing the physicians moral injury.
“We are being asked to do the impossible. And we all have really high standards and want to provide excellent and safe care for our patients” Dr. Reade explains. “And people have been working in hopes that things will get better but there is also a recognition that this cannot go on.”
