Rural hospitals in Ontario are facing critical staffing challenges in their emergency departments (EDs), relying heavily on the Temporary Locum Program. This program encourages physicians from metropolitan areas to fill temporary gaps in rural communities. In doing so, it prevents vital services from falling into disrepair. The program’s short-term status alarms advocates, who question what long-term sustainability looks like.
The Temporary Locum Program has been extended—but not always, and not always in timely manner—many times past the actual statutory expiration. The ultimate aim has always been to convert into a permanent art space. This will help provide more stable physician coverage in rural and northern Ontario. Interestingly, the Ministry of Health is currently reported to be in open, ongoing negotiations with the Ontario Medical Association (OMA). Now, they’re looking to make this transition to a permanent aspect of the new Physician Services Agreement.
As hospital administrator Ann Fenlon argued, the need for this assistance is urgent. We can’t operate a 24-hour emergency department without outside emergency physician support because we’re so understaffed,” she said. Fenlon stated how scary the unknown is, and that we need to keep our physicians present. In other words, “Obviously, we’re going to keep booking them … we don’t want to shut our emerg,” she said further.
The Temporary Locum Program is designed to address short-notice staffing gaps, but that makes it difficult for hospitals to plan for the long-term. Then, hospitals turn around and race to get their emergency rooms covered. This type of go-reactive approach opens up the door to recurring service interruptions.
Melanie Goulet, another administrator, expressed exasperation at some of the strictures of the program. Against that backdrop, we’ve got one physician. She’s been floating around Hearst for nearly two weeks and I honestly don’t know what to tell her,” she reflected. Goulet pointed out an important gap in that connection. Policy players making decisions are increasingly disconnected from the practitioners charged with dealing with the programmatic consequences on the ground. So as much as they say they are clear, I don’t think they really realize what’s going on,” she added.
The Emergency Department Locum Program is another program the ministry provides. It is not the same as the Temporary Locum Program and has different criteria. This distinction makes it even more difficult for hospitals to keep consistent staffing in place.
To these staffing shortages, hospital leaders like Fenlon are careful even as the tide turns in negotiations between labor and management in hospitals nationwide. We have always known that the program was temporary, and that’s evident by the name of the program,” she said. They’ve had four years to come up with a more permanent band-aid.
Rural areas are particularly dependent on locum physicians. Recruiting and retaining doctors in these regions has been an enormous task. Few hospitals can say it’s easy to keep their emergency services open. This is largely due to a stark shortage of medical professionals who are willing to practice in these remote locations.
Hannah Jensen highlighted how central the program has been. It puts the power in their hands to help hospitals better control their physician coverage. Hospitals can continue to schedule whatever amount of physician coverage they want. We’re working with Ontario Medical Association to make the temporary locum program a permanent fixture under the new Physician Services Agreement,” said Jensen.
