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This story is part of CBC Health’s Second Opinion, a weekly analysis of health and medical science news emailed to subscribers on Saturday mornings. If you haven’t subscribed yet, you can do so by click here.
In mid-July, when Doug Moore’s daughter fell and injured her wrist on the family’s northern British Columbia property, he rushed the nine-year-old girl to the nearest hospital, only to find the emergency room already closed.
There was no prior notice of the closure, the Fort St. John resident said recently told CBC’s Daybreak North.
“When you have a nine-year-old child, and it’s 9:30 at night, and she’s tired, she’s in pain… I get really nervous, for my family and the people around us,” he said.
Northern BC has been hit hard by emergency closures again this summer. Between July 22 and 28, there was at least one interruption of ER service per day in the northern half of the province, provoking meetings in parts of the region.
The emergency room at the region’s largest hospital, which serves nearly 30,000 patients, is closed five times in just one week.
But the crisis is also playing out across the country and there is no clear solution in sight.
“We continue to see unprecedented numbers of emergency department closures,” said Natalie Mehra, executive director of the Ontario Health Coalition, an advocacy group that launched the headline grabbing count of closures in the province.
That 2023 report found that nearly 870 emergency departments had closed across Ontario that year — a record high — and Mehra said her team’s initial data for 2024 shows a similar trend.
“Until a few years ago,” she said, “we had never seen anything like this.”
Parts of Alberta, Quebec, PEI and beyond are also reporting ED closures, most often linked to staffing shortages. This persistent problem is leading to a flurry of potential solutions, from expanded locum programs designed to bring in temporary staff to virtual EDs that combine online assessments with in-person patient care.
Yet many medical experts warn that Canada’s continued emergency department closures are merely a symptom of larger problems in the country’s overburdened health care system, and that there is no easy fix.
“We’ve reached a tipping point where there aren’t enough people willing and able to provide the coverage,” said Dr. Gord McInnes, president of the emergency medicine section of Doctors of BC, a voluntary medical association representing physicians and medical students.
Staff shortages, lack of primary care
On the one hand, the problems facing EDs across the country are largely due to supply and demand: there is a constant influx of patients seeking care, and — especially after the pressure of the COVID-19 pandemic — an ongoing shortage of healthcare professionals available.
But McInnis stressed that the factors at play can be layered and difficult to untangle, and that they extend far beyond the EDs themselves. Patients’ needs are becoming increasingly complex as the nation’s population grows and ages, while the health care system is strained on multiple fronts.
“One of the big problems is the lack of primary care,” McInnis said.
Data from the OurCare Initiative suggests that the number of Canadians without regular access to a primary care provider, such as a family doctor or nurse practitioner, rose from 4.5 million in 2019 before the pandemic to an estimated 6.5 million last year.
So where are these Canadians going for both emergency and routine care? Other figures suggest they are increasingly ending up in emergency departments.
According to Statistics Netherlands (CBS), there were approximately one million more unplanned ER visits in 2022-2023 than the year before. the Canadian Institute for Health Information.
Pandemic burnout
Emergency care workers face their own specific pressures, partly related to pandemic-related burnout, which has led to an exodus of healthcare workers.
To combat this, several provinces are using locum tenens programs, where temporary doctors are hired to fill shifts and paid a surcharge for doing so.
In Ontario, an ongoing observer program first launched during the pandemic has been extended beyond its end date in March, but only until the end of SeptemberThe province also recently announced $10 million in financing to help more than 1,000 nurses train to become emergency nurses.
Last month, British Columbia Health Minister Adrian Dix said also told According to CBC News, recruitment efforts, hundreds of additional spots in nurse training programs and a locum program are helping to ease the staffing shortage in the province’s hospitals. Locums and incentives have helped identify and fill more than 1,100 shifts in the past three months.
A union representing Ontario health care workers has released survey data highlighting the stress, exhaustion and burnout hospital workers are experiencing — with many considering new career paths. The union is calling for more provincial funding to help ease the worsening staffing crisis.
Bottlenecks in the healthcare system persist
Yet several health care advocates agreed that these ER-focused efforts are only a stopgap measure and do not address the root of the problem.
A major issue is the bottlenecks elsewhere in the health care system, including the long-term issue of patients stuck in hospital beds while they wait for other forms of care in the community.
“We simply don’t have enough physicians and nurses to staff many of these services, and overcrowding poses challenges,” said Dr. Kathleen Ross, co-chair of the Canadian Medical Association (CMA), a national association representing physicians.
Those challenges are related to patients flooding emergency departments due to a lack of primary care, she explained, as well as backlogs elsewhere in hospitals.
“Can we move people into the ward? Can we give people access to care in the community? Is there home care support so that we can treat patients at home? All of these things intersect to get us to where we are today.”
For The National, a CBC News crew gets a unique opportunity to visit three emergency departments in rural Ontario, where they see how they are trying to care for patients and keep their doors open despite chronic staff shortages.
Are virtual ERs a solution?
In Newfoundland, officials are trying a different approach: Virtual ERs.
The province signed a multimillion-dollar contract with a U.S. company last November to provide virtual staffing for rural emergency departments. It is now being used at the 12-bed hospital in New West Valley, a city of 2,000 on the northeast coast.
The city’s mayor and former paramedic Mike Tiller admitted in a recent phone call with CBC News that the measure is controversial and has a detrimental effect on patients.
“When they go to virtual care, they could get a doctor from England one week, and the next week they could get a doctor from Canada. And there’s no continuity of care,” he said.
But it’s better than closing ERs altogether, Tiller stressed, because the initial virtual assessment fills a staffing shortage.
The approach may already be saving lives, he added: a patient who came to a hospital in the city with heart problems was quickly given life-saving drugs that dissolve blood clots, thanks to a virtual doctor working with the medical team on site.
“If the hospital was on diversion at that point, that person would have had to travel an extra hour and 15 minutes just to get the initial assessment,” he said. “And, you know, might not have made it.”
Doctors in several provinces are sounding the alarm about long waits and overloaded hospitals, amid rising respiratory illnesses and overworked medical staff. Some are even warning patients to stay away from the ER.
‘Pushing to the limit’
Others, such as Dr. Trevor Jain, spokesperson for the Canadian Association of Emergency Physicians in Charlottetown, questioned whether outsourcing care to a virtual doctor can even be considered a functioning ER.
“If you don’t have an emergency physician and an emergency department with enough staff to resuscitate the sickest Canadians when they need it most, there is no emergency department,” he said.
Jain said broader investment in emergency care is now needed as the crisis begins to spread from remote and rural areas to urban centres, which are also feeling the pressure of increased patient demand.
“If we don’t invest in emergency physicians, emergency nurses and emergency departments, we’re going to see more closures,” he said.
Ross, speaking for the CMA, stressed that there is no one-size-fits-all solution to such a widespread and persistent problem. Instead, it will take a combination of efforts to reduce the pressure on EDs themselves and to reduce the broader overcrowding in Canadian hospitals.
“It shows us how fragile the health care system really is, and how much it is being pushed to its limits.”
