This is the first of a two -part series that looks at what is needed to provide emergency care in the central region of Manitoulin in Ontario.
The scarcity of a family doctor in the northeast of Ontario has caused some emergency rooms to be closed, but what can be less known to the public is how many others are frequently on the verge of darkening and be closed due to the lack of doctors.
Hospital measures to avoid closing include increasing rates to attract locums, temporary and medical visitors from other areas, some of which are offered $ 250 per hour to cover emergency shifts.
Locum’s remuneration depends on a complex balance of contributions to provincial programs that are related to hours, demands and levels of care and, increasingly, financial incentives for rural and remote work.
In the northeast of Ontario, the ERs in communities such as Thessalon and on the island of St. Joseph have temporarily closed last year, which forced patients to the north coast of Lake Huron to go later to obtain urgent care.
However, on the island of Manitoulin, about 2 and a half hours to the west of Sudbury, in the two hospitals that make up the Manthoulin Health Center in Little Current and Mindemoya, there have been no closures.
Paula Fields, Manitoulin Health Center President and CEO, He said that does not mean that they have not approached several times, and she hopes that at some point they will face a crisis that will trigger a temporary closure.
More recently, said Fields, a place that was reserved for a week canceled due to personal emergency. Seven local doctors, in what is supposed to be a team of more than 13 years, joined to fill and kept the doors open.
Fields said he is not sure that the general public is aware of the precarious nature of emergency medical care.
In the emergency room on a winter day, Karlee Demera was looking for help for her son, without realizing the closing threat.
“I have two children and I can’t even tell you how many times we have been here,” he said. “And we have recently lost our family doctor, so we have no other place where to go now.”
While the small site of the Hospital Lojera along with about seven local doctors, the brother site of the smallest community of Mindemoya Mindemoya has just over three. However, he is seeing the same number of visits in his emergency room as in little current, between 12,000 and 13,000 per year.
Locums duplicate rates doubled
Dr. Kevin O’Connor has lived and worked in Mindemoya since 2008.
He was eighteen months ago, he said, the doctors of the family health team in their community gave the province an ultimatum.
He said they worked 60 hours a week in the emergency department and put another 60 to 80 hours watching patients at the clinic.
O’Connor said they said the “powers that are” that local doctors would reduce two ER shifts per week, according to their contract, with the locums necessary to cover the rest of the time, but if the locums could not be found, the Emergency room would have to close.
The result, he said, was the province committed to duplicating the rate by Locums at $ 250 per hour to attract them to complete in the emergency room so that it could remain open.
O’Connor said that the money do not renew the money, although it does not qualify for that rate per hour, in advance, obtaining it retroactively, only if the emergency room remains open for a period of time.
However, he added that there are structural problems within the system, especially since less graduates of the School of Medicine choose family medicine and less choose rural practice.
The full -time rural generalist feels ‘caught’
“In general, people like to make more money and work less,” O’Connor said. “And sometimes they do not like the extreme stress of working in an emergency room in a rural area, which only for its nature is isolated and lacks support.”
He is happy that, for now, the locums are completing the schedule and that the emergency room remains open, but said the pressure remains high.
“People want a balance between work and life. I even want it and feel it, in a way, a little trapped, because I know that if I leave here, there will be many people without a doctor and there are many people who trust you about you “, said. “I consider it? All the time.”

His colleague, Dr. Maurianne Reade, said that local doctors inevitably work more than two shifts in the emergency room per week due to the uncertainty of obtaining Locums.
He said that due to waves in patients or diseases among doctors, he never feels sure they don’t call her unless she leaves the city.
You take into account how people are in terrible situations looking for services and how your colleagues are looking for a break that they cannot get if it does not help.– Dr. Shady Tadross
Recently, Dr. Shady Tadross signed to provide Locum coverage in the Mindemoya ER on a basis of two weeks and two weeks.
His practice is in Mossissauga, but has been moved to help his colleagues and patients in rural areas.
Tadross said he has not been at home in three months, covering shifts in the northeast of Ontario and Newfoundland.
“It is difficult, and has an impact on my family, but you take into account how people are in terrible situations looking for services and how your colleagues are looking for a break that they can’t get if they don’t help.”
As for permanently relocating Mindemoya, he said he would consider him after fulfilling his family’s obligations in southern Ontario.
Lori Oswald, Executive Director of the Family Health Team of Central Manitoulin, is also the punctual person between Locums and the Government, and helps comply with contracts and organize coverage.
The increase in the locums rate is a solution, he said, but not the best solution.
She feels that the situation is increasingly unfair to doctors who undertake to live in the community, describing it as “moral injury” that are responsible for maintaining the lights on despite not receiving the same remuneration as visiting doctors.
On the other hand, O’Connor said it does not see it as a moral problem, but only a solution for a system that has been broken down.
He said that a review is needed to attract full -time doctors to rural areas and make sure their needs are satisfied so that they can have a balance between work and life, something that does not see what happens soon.
Patient issues that run out of locums
Some patients in mathemoya are very aware of the precarious nature of urgent medical care.
Dave Clark, 72, said he and his wife recently lost their family doctor.
Clark said they have been in the emergency department about six times in the last 12 months, receiving good attention, often from Locums, but wonders how long it will last.
“How deep is that resource?” He wondered. “How many of those people are out there? I think that at some point that will become a finite resource. We are going to run out of people, doctors to work for us. Then we will be in significant danger.”
The Ontario government recently announced that it will put $ 1.4 billion new funds in the medical care system to link two million people with family care suppliers in the next four years.
In Mindemoya, O’Connor is not committed, and says that he has not yet seen any detail of how it will be achieved.