Temporary emergency room closures in rural Canada have recently reached alarming levels. Since 2019, these facilities combined have closed for more than 1.14 million hours in total. That mind-boggling number comes out to about 47,500 days’ worth of lost service. It poses significant risks to accessing essential health care, particularly in rural communities. Canadian communities are reeling from the impacts of these shutdowns. The situation is particularly dire in provinces like Newfoundland and Labrador and Nova Scotia.
In Newfoundland and Labrador, the ER in Bonavista experienced significant closures. It was closed in total for 215 days throughout that time span. These sudden closures have pushed regional health officials to intervene with extreme action. The provincial government is sweetening the deal with six-figure bonuses to lure more doctors to the Bonavista ER. Right now, the ER is counting on only four contracted physicians to provide consistent coverage. More recent indications point to closures in Bonavista dropping to one or two a month for the vast majority of 2024.
Not so in Nova Scotia, which has taken a markedly different path. Instead, they turned nine emergency rooms into urgent treatment centers that don’t treat life-threatening conditions, don’t take ambulances and treat patients only by appointment. This dramatic shift puts the quality of emergency care not only in the path of these communities’ residents but in jeopardy.
This has all been exacerbated by an ongoing exodus of healthcare workers from rural communities. As of 2022, the share of nurses practicing in rural areas dropped to an all-time low of 9.6%, a decrease from 11.1% ten years prior. Dr. Aimee Kernick from the Canadian Association of Emergency Physicians commented on this trend, stating, “To protect ourselves and preserve our ability to keep working, money is not enough any more.”
Rural towns like nearby Thessalon, Ontario, with just over 1,200 residents, can’t compete and have a difficult time attracting permanent staff. Health advocates have been watching this urgent crisis with concern. Dr. Kernick discussed how these small towns are becoming more and more difficult places to live and raise a family. “We are still struggling with staff shortages, physician shortages, nursing shortages,” she said.
Manitoba’s Interlake region has been hit hard by this crisis. For the fourth consecutive year, Doctors Manitoba cautioned residents to prepare for potential disruptions in rural ER services during the summer months. The closures have been especially severe in this region, one of the most affected by the national staffing shortage.
Mary-Jane Thompson, a resident of Thessalon, spoke passionately about her experiences with local healthcare. “When I had a stroke in 2003, it was Thessalon Hospital that saved my life,” she reminisced. My husband experienced his own heart attack in 2013. Because of the care he received at Thessalon Hospital, he was stabilized enough to survive and is alive today. Her testimony highlights the lifesaving importance of these facilities.
Even as they confront unprecedented and ongoing challenges, many of the most astute experts believe that radical changes are needed—for the better. Steven Lewis, an adjunct professor at Simon Fraser University, believes that certain small communities might benefit from permanently closing struggling ERs. This narrative focuses on the needs and difficulties delivering healthcare in rural, low density areas. It further proposes making us rethink the level of service provided in these areas.
Dr. Sarah Newbery emphasized the need for effective recruitment strategies tailored to rural needs. “How we recruit to rural towns needs to be different than it was 30 years ago,” she said. “We’re not going to recruit Wilfred Grenfell any more.” Grenfell is a folkloric figure in Canadian health care. His story highlights the obstacles that contemporary health systems must navigate to attract qualified professionals.
The impact of these cuts goes further than access to acute, short-term medical treatment and highlights broader systemic problems within Canada’s healthcare structure. John Norman pointed out that “it’s a national issue,” noting that there are “literally a thousand health facilities across the country that do not have enough staff.”
The hard truth communities all over rural Canada are staring down. They’re optimistic that new solutions will keep them laid up from HOPEful giving them the access to life-saving emergency care. Local leaders and healthcare practitioners have been advocating for greater investment in rural health resources. They’re looking for new approaches to help mitigate their challenges with staffing shortages.
