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MDs refuse emergency work Hospitals are struggling to find doctors to staff ERs Sep. 25, 2006. 08:43 AM QUEEN'S PARK COLUMNIST A crisis is brewing in Most public is the situation in The problem was addressed — but not resolved —
at a high-level meeting in The meeting was front-page news in But sources say Health Minister George Smitherman personally intervened this
summer when the hospital in St. Mary's, Ont., shut down its emergency
department for a 24-hour period and was set to close again over the August long
weekend, due to staffing shortages. Smitherman's office called around the province to find
fill-in staff, and Smitherman himself visited the hospital to thank the two
doctors who answered the call. Hospitals in Some hospitals have had to turn to the private sector for
help by contracting with Med-Emerg International Inc. — a sort of temping
agency for doctors — to fill gaps in the emergency department rosters. "It is a perpetual problem for hospitals to staff
emergency rooms," said Hilary Short, president of the Ontario Hospital
Association (OHA), in an interview last week. "There is a lot of
concern." David Bach, president of the In an email to his members last month, Bach referred to the
"known shortage of ER physicians" and added: "We continue to
advocate strongly to the ministry for the need for an enhanced focus on
recruitment and retention efforts for emergency medicine and improved working
conditions in all emergency departments across David Spencer, spokesperson for Smitherman, said last week
that the government realizes there is a staffing problem in emergency
departments but objected to use of the word "crisis" to describe the
situation. He said he preferred the term "pressure." A letter addressing the issue will be sent to senior
hospital administrators this week, said Spencer. "We are working quite
co-operatively with the OHA and OMA on it," said Spencer. Indeed, an "expert working group" composed of
representatives of the hospitals, doctors and ministry of health has produced a
joint report on the emergency department problem. The report — entitled Improving
Access to Emergency Care: Addressing System Issues — has not
yet been released. But a draft — dated in August — has been
obtained by the Toronto Star. The
report dismisses as "myth" the suggestion that overcrowding of
emergency departments is caused by "overuse by non-urgent patients and
seasonable outbreaks" of flu. Rather, the report attributes the problem to the lack of
acute-care beds in hospitals to accommodate seriously ill patients in emergency
departments. Due to cutbacks in the 1990s, says the report, the occupancy
rate for acute-care beds is now more than 90 per cent, which contributes to
"poor patient flow, including delays in admitting patients from the
emergency department." Some 96 per cent of British
patients now meet that target, says the report, whereas in The overall thrust of the draft report is that emergency
room crowding is a management problem that can be fixed with more efficient
procedures. Doctors acknowledge that overcrowding, with patients stacked
up in corridors, is a major deterrent to working in emergency departments. But they also say that remuneration is a problem, including
the lack of pay for being on call. "Other doctors (surgeons, internists, obstetricians,
pediatricians, etc.) are paid to be on call and carry a pager for the
hospital," said one emergency physician, who requested anonymity.
"The ER doctors have been providing this service free for years. ... The
goodwill of ER doctors is being stretched beyond the limit." But the government has heretofore been reluctant to top up
pay for emergency physicians lest a precedent be created for other categories. ***** |
