Doctor shortage increasing reliance on locums
By Jon Thompson
Kenoraâ€™s physician shortage reached a breaking point this month when the emergency room was nearly closed for a weekend due to the physician shortage then the Lake of the Woods Hospital administration stopped staffing the ward between 11 p.m. and 8 a.m. permanently.
Orlo Mejia had a stroke two years ago. Had he not made it to an emergency room in under three hours, he wouldnâ€™t have survived. Today, he sits on the board of directors in the same hospital.
â€œWe need to do better,â€? he said at a recent board meeting. â€œI would not be here if not for the emergency department. It kills me, I guess, to think that (closing the ER) almost happened.â€?
Emily Goss took over as the chairman of Kenoraâ€™s Physician Recruitment and Retention Committee in January.
The committeeâ€™s focus has been on recruiting family physicians and nurse practitioners. She says their strategy â€œhas lots of irons in the fire.â€? Representatives will be recruiting at both campuses of the Northern Ontario School of Medicine where she sees great potential and have attended fairs in the past.
â€œItâ€™s like nailing Jell-o,â€? she said of the difficulties they have been having in recruitment. â€œThe doctors themselves have been more successful (in recruitment than the committee), and Health Force Ontario has been filling our ER for some time.â€?
â€œThe hospital has never brought it to us as an issue that we can have a role in but (hospital president Mark) Balcaen and his staff are dealing with that in their own,â€? Goss said.
Laua Kokocinski, senior director of Local Health Integration Network, has been working with the local hospital on the regional locum project, flying doctors and specialists called locums to Kenora to fill the gaps in scheduling left by the shortage. Ultimately, she said, the hospital is responsible for providing physician coverage.
â€œLocums have been helping for years,â€? said Balcaen. â€œLately it has become more necessary.â€?
Locums are now taking five to ten per cent of shifts each month with higher concentrations of work in the summer. Under the provincial funding formula, â€œunderserviced areasâ€? can approve up to eight shifts a month to be performed by locums. In the past four to six months, Balcaen described, there has been an increase in the number of doctors who are flown to Kenora to take emergency room shifts with car rental and accommodation also provided. In some cases, private recruiting firm MedEmerg receives an additional finderâ€™s fee for mobilizing support.
Brian Sinclair is the executive director for Health Force Ontario, the public agency coordinating recruitment. His emergency department coverage demonstration project covers the hospitals in Ontario with the greatest need, of which Kenora is one. He said â€œit would take an accountantâ€? to determine the real costs of using locums because theyâ€™re funded with several government departments.
â€œWhat we have here is a systemic issue where lots of groups own a piece of the solution. Fortunately in the Northwest, we have a strong (local health integration network), Shaun Visser, and the Lake of the Woods hospital is working very hard.â€?
Visser, the emergency department network lead, says doctors are working at 125 per cent and are burning out across the region. While Kenora is competing against â€œwell oiled machinesâ€? in the form of hired recruiters of Dryden and Thunder Bay, even those strategies are failing to attract sufficient help. Doctor shortages in Toronto, Ottawa and London are taking precedence due to their proximity to physicians and Visser sees â€œsimply too many holes to fill.â€?
â€œThere just isnâ€™t enough manpower,â€? he says. â€œWhat Iâ€™ve pushed for very strongly is a separate model for the north because if youâ€™re in a locum position and you want to work in these areas, weâ€™re not competitive.â€?
The Ministry of Health has agreed to strike a committee with Health Force Ontario and the network leads to address competitiveness in the region.