Sioux Lookout’s Meno Ya Win hospital started the summer with 56 open shifts in July and August, and only nine doctors in Sioux Lookout, already working full-time, to fill them.
The hospital has managed to stay open, often filling shifts at the last minute. But it's a daily scramble that amounts to “living on a knife’s edge,” says Dr. Laurel Laakso, chief of staff at Sioux Lookout Meno Ya Win Health Centre.
The Northwestern Ontario hospital serves 30,000 patients, the majority of them from surrounding Indigenous communities — including many from First Nations reserves that have no road access for most of the year.
The closest emergency room to Sioux Lookout is in Dryden, a smaller hospital, more than an hour away. Dryden is also the closest hospital to Kenora — another community whose emergency room has struggled to remain open.
So, doctors in Sioux Lookout feel they have little choice but to keep their ER running at all costs, Dr. Laakso says. “It's a very isolating thing where you feel like we have to stay open or there's nobody else, [and] without question, people will die.”
The hospital has been forced to become extremely efficient at figuring out its staffing, shifting physicians from clinics or from other areas to the ER, which often means reducing family medicine services and requiring doctors to cancel their vacations. Retired physicians have even been called in to help.
Another 20-40 per cent of shifts are staffed by locums — doctors working on temporary assignments — through HealthForce Ontario’s Emergency Department Locum Program (EDLP). The provincial government describes the program as a “last resort” for hospitals faced with closing their emergency rooms.
While the program is vital to keeping Sioux Lookout’s emergency department open, it requires paying doctors from Southern Ontario significantly more than the local physicians to convince them to come north. That pay differential “breeds some kind of resentment” among local doctors, Dr. Laakso says. So, the hospital has started an incentive program to entice local doctors to pick up extra ER shifts by matching the amount that EDLP locums are paid.
The hospital has also on occasion asked physicians to do double coverage, such as asking a doctor working in obstetrics to also work in the ER. However, there is the risk these doctors can then be called away to obstetrics without warning, leaving the hospital scrambling to replace them in the ER. Dr. Laakso describes the arrangements as “desperate measures” that are particularly stressful to doctors forced to juggle two very different types of care.
Sioux Lookout has lost physicians as a result of that constant pressure to do more and balance multiple jobs at once. “It’s hard to quantify the psychological burden that puts on people,” Dr. Laakso says.
“People worry about their [medical] licences. People worry about inadvertently harming somebody because they haven't been able to give [them] that attention,” she says. “As a physician, that’s a devastating fear. And to live with that stress, it’s not sustainable long-term.”
