The “Severe” Physician Shortage in Rural Northwestern Ontario: 5 Proposed Solutions

More than a week after a shortage of available doctors shut down the emergency room in Red Lake, Ont., medical professionals are looking at possible solutions to the doctor shortage in northern Ontario .

The Northwestern Ontario Chiefs of Staff sent a briefing note to politicians and others interested in the issue, advising them of actions that could help.

Several doctors also spoke to CBC about possible short- and long-term responses to the problem.

Two people were transported from Red Lake to Dryden by ambulance during the Red Lake closure.

The chairman of the North West Council of Chiefs of Staff said what happened there is likely to happen to most smaller hospitals in the region over the next six months.

“It’s very serious,” said Dr Sara Van Der Loo.

Dr. Sara Van Der Loo says what happened in Red Lake will likely happen in every small hospital in northwestern Ontario over the next six months. (Submitted by Dr. Sara Van Der Loo)

The government and the Ontario Medical Association (OMA) have already acted on some solutions to the doctor shortage that area physicians had previously proposed — before Red Lake closed. These include:

  • Allow physicians in rural northern areas to work part-time. The previous Rural and Northern Physicians Collective Agreement (RNPGA), which covers much of Northern Ontario, has been criticized for requiring doctors to commit to full-time work. Critics said it was a deterrent to doctors looking north for better work-life balance. The brand new Medical Services Agreement, ratified by doctors at the end of March, allows part-time work under the RNPGA contract.
  • Make it easier for physicians to transfer a practice by allowing RNPGA contracts to overlap so that a departing physician can mentor a new one. The new medical services agreement allows for a three-month overlap.
  • Reassess the number of physicians needed in northern communities and adjust funding accordingly. Under the new Medical Services Agreement, the Department of Health and the OMA will establish a bilateral task force to complete a review by December 31 this year, with implementation scheduled for April 1, 2023. .
  • Increase the number of medical students in the province. Ontario has announced it will add 160 undergraduate positions and 295 postgraduate positions to medical schools over the next five years, including 30 new undergraduate positions and 41 new residency positions at the University of Ontario. Ontario Northern School of Medicine (NOSM-U).

Here are five other possible solutions to the problem that were offered by chiefs of staff and doctors who spoke with CBC.

1. Provide rural and remote emergency physicians with virtual, real-time access to specialists

One of the barriers to recruiting physicians to work shifts in rural and remote emergency rooms is physicians’ fear of being alone with a patient suffering from an illness with which they have no experience, according to Dr. Sarah Newbery, Associate Dean of Workforce Strategy Medicine at NOSM-U.

Dr. Sarah Newbery, associate dean of physician workforce strategy at NOSM-U, says BC is “the envy of the country” when it comes to supporting rural physicians . (Dr. Sarah Newbery/Twitter)

Northwestern Ontario could overcome that hurdle by implementing a system of real-time virtual access to on-call specialists, she said.

British Columbia has such a system, which doctors can access from their smartphones, she added.

“They are truly the envy of the country in terms of how they support rural doctors in this province.”

Setting up a similar system in Ontario would require leadership from Ontario Health, the provincial agency that coordinates the province’s health care system, Newbery said.

Ontario Health told CBC in a statement that it was “open to working with stakeholders to identify solutions to address emergency department closures in northern and rural areas.”

2. Funding for resident travel and accommodation to complete elective placements in rural and northern communities

Residents are learners who have completed medical school and undergo postgraduate training to become fully licensed physicians in their area of ​​specialization.

They can choose to do elective rotations to gain additional experience in areas that interest them.

But for now, they have to pay out of pocket for any travel and accommodation involved.

That can be a deterrent if the student is already paying rent for an apartment in southern Ontario, Newbery said.

“We know that one in five postgraduate residents who come to do an elective in Northern Ontario will return for future work,” said Newbery.

“So even if there are new funds needed to create the type of travel and accommodation grant that would allow residents to come, the money that the department would save in terms of locum positions and this type of crisis management that we find ourselves in now, would probably make that initial cost of taking care of travel and accommodation worthwhile.”

NOSM-U President and CEO Dr. Sarita Verma said her institution intends to take a leadership role in seeking funding and using its existing relationships with other organizations. other universities to make the proposal a reality.

3. Ensure that replacements traveling to the region bring a resident from their home institution

As part of the University of Toronto’s Rural and Northern Initiative, locums associated with the U of T family medicine program bring residents with them to the North when they go there to practice.

Replicating the program with other schools shouldn’t be difficult, Newbery said.

“Again, it’s really about matching travel and accommodation. And then, from my perspective, following those residents and looking at what the return on that investment is.”

4. The College of Physicians and Surgeons of Ontario should facilitate the licensing of international medical school graduates who wish to work in the North

When some international medical graduates, or IMGs, arrive in Canada for the first time, the CPSO issues them a restricted license and requires them to work under supervision for a year or more.

The physician recruiter for Rainy River District said he recruited a U.S.-trained physician around 2015 and authorities had to appoint three other physicians to take on those mentoring and supervisory roles.

“Doctors are already busy. The reason we’re in this kind of situation is that they’re overworked,” Todd Hamilton said.

Some communities don’t even have three doctors, he says.

Todd Hamilton, the physician recruiter for the Fort Frances and District Physician Recruitment Retention Committee, said officials needed to hire three physicians to oversee and mentor a U.S.-trained physician who wanted to work in the area. (Submitted by Todd Hamilton)

A spokesperson for the College of Physicians and Surgeons of Ontario said supervision guidelines are set nationally by the Federation of Medical Regulatory Authorities of Canada, but there is room for flexibility.

“We certainly make exceptions for a supervisor supervising multiple physicians and for remote supervision,” Shae Greenfield said in an email.

That wasn’t Hamilton’s experience, he said.

There should be a clear pathway for doctors coming to work in the North that responds to the realities of the region, Van Der Loo said.

It shouldn’t be up to doctors to find the right person to talk to about overriding the rules.

5. More Incentives and Return of Service Obligations to Bring Physicians North

Hospital recruiters and chiefs of staff across northwestern Ontario are calling for more arrangements that trade in free or discounted tuition, debt relief, or other opportunities for new graduates in medicine for a tour of duty in a rural northern community.

“The military can offer to cover the tuition of doctors – whether it’s NOSM-U or any other medical school in Ontario – and they can get a five to seven year return of service from the family doctor, so I don’t understand why they can’t do it for a rural community,” Hamilton said.

Ontario currently has return-of-service programs requiring foreign-trained physicians to work in underserved communities as a condition of obtaining unrestricted licensure in the province.

Part of the problem with these programs, according to Newbery, is that most communities in Ontario are now classified as underserved, meaning doctors don’t need to travel as far as northern Ontario. to work in an underserved community.

“We may need to create a bit of an improvement for this kind of program for Northern Ontario,” Newbery said.

Asked if the Department of Health would increase return-of-service agreements to bring doctors up north, a spokesperson pointed to the department’s existing incentive programs, but did not directly answer the question.

Verma, however, expressed doubts about the effectiveness of return-of-service programs.

“People will use them as ways to come and get their residency training … and then people will just say, ‘Well, I’m done with my training now,'” she said. “They’ll get a bank loan and say, ‘Here’s the $500,000 I owe you. Bye. “”

The system needs an overhaul

Verma told CBC the province needs to review its health human resources planning system and take a holistic approach.

Currently, she said, it has multiple agencies with dozens of programs running different elements of the system.

“You can imagine what a disconnected and very chaotic system it is,” she said.

“We need mathematicians who are really smart in business modeling. …. We need an integrated, consistent and predictable system that is well funded over a long period of time.”

Dr. Sarita Verma, dean, president and CEO of NOSM-U, says physician return-of-service agreements don’t always work well for northern communities because some physicians are simply buying their way. (EMNO-U)

When asked if anyone was taking the initiative to review the provincial system, Verma replied, “Not yet, because we only became a university on Friday.

NOSM-U, which was previously linked to Lakehead and Laurentian universities, aspires to become an influencer in the area of ​​northern health policy, she said.

“In the meantime, nothing prevents the government from giving us a few million dollars to create a political institute. You know? I mean, if you ask me, that’s what I want.”

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