No Relief in Sight for Canadian Emergency Rooms: Report

Canada’s emergency rooms are in crisis now and for the foreseeable future, according to a new report from the Canadian Medical Association Journal (CMAJ).

Published Monday, the report says the summer season will be “precarious and exhausting” for emergency care providers, predicting “dire consequences” for patient outcomes and healthcare worker wellbeing across the country.

Following a “dramatic” increase in April 2020, emergency department visits returned to baseline volumes by the summer of 2022. Despite the return, the report says the capacity of emergency departments to provide care has been “outstripped,” meaning patients are subjected to longer stays.

“In addition to other contributors, the inability to move admitted patients from emergency beds has resulted in crowding and increased wait times and prevented the delivery of timely and effective care. These problems are plaguing Canada’s healthcare system,” the report says.

“This perpetual cycle is not news to most people in Canada, as it is pervasive, has lethal consequences, and will continue to exhaust Canadian emergency services and providers.”

The report highlights measures put forward by federal and provincial governments, such as the recruitment of healthcare workers internationally.

In British Columbia, for example, the province is attempting to alleviate its shortage of nurses by making it easier for internationally educated nurses (IENs) to get registered and licenced.

The initiative was announced in April 2022 under former Premier John Horgan.

Speaking at a press conference at the time, Health Minister Adrian Dix said nurses trained abroad often wait years to get registered and licenced in what he called a complex, costly, and lengthy process.

The move is supported by the BC College of Nurses and Midwives, the Nursing Community Assessment Service, and Health Match BC.

The province also spent $12 million to provide bursaries for IENs, streamline the application process, and launch a marketing campaign to promote BC as a “desirable destination” for healthcare workers.

Federal government spending billions on BC healthcare

Nearly one year after the IEN initiative was announced, Health Canada reached an agreement with BC to spend billions on the province’s healthcare services.

Providing details in March, Health Canada said BC will receive more than $27 billion in federal funding over a decade. This includes $3.32 billion for a bilateral agreement focusing on shared healthcare priorities, and $273 million through the immediate, one-time top-up to address urgent needs.

The announcement came weeks after the federal government said it would invest more than $198 billion into Canadian healthcare over a decade, including more than $42 billion for provinces and territories to improve healthcare services.

Officials said the investments will particularly help paediatric hospitals, emergency rooms, and long wait times for surgery.

“Every morning I’ve been told I will get surgery, but it’s always the same news,” a patient at Burnaby Hospital told Coastal Front.

The individual, who asked not to be named, broke his arm Saturday and is still waiting for the routine procedure.

He described his treatment – or lack thereof – as “demoralizing,” highlighting that another individual has been there for five weeks with a broken hip.

The patient also waited two hours for paramedics to arrive.

“Every corner of BC is suffering from unprecedented staffing, recruitment, and retention issues,” reads a 2022 statement from Ambulance Paramedics and Emergency Dispatchers BC.

“We do not have enough paramedics and dispatchers to meet the call volume and demand for service. We have never seen our ability to respond to patients in their time of need be in such peril.”

Nearly a year later – amid an aging population, worsening illicit drug toxicity crisis, and more – the problems have no solution in sight.

911 call volume increasing

E-Comm says the volume of requests for emergency services is already exceeding numbers from the heat dome in 2021, which broke more than 100 provincial temperature records. During the heat dome, several 911 callers were told there was no ambulance available to help. In at least 50 instances, paramedics took longer than 30 minutes to arrive. In more than a dozen instances, 911 callers were put on hold for “an extended period of time.”

Currently, E-Comm has seen a 21% increase in 911 calls in the first five months of 2023, relative to the same period last year. May was the busiest month in E-Comm’s history, and the company is predicting high call volumes throughout the summer.

“Despite increasing demands for emergency services, we have continued to meet our service level targets for emergency response this year, thanks to the heroic efforts of our staff who work tirelessly around the clock to keep our communities safe,” said Oliver Grüter-Andrew, President & CEO of E-Comm.

Lack of access to primary care

As for access to primary care, the BC College of Family Physicians said last year that one million British Columbians are without access to a family doctor and remain unable to get one.

Nearly half of those who do have access to a family doctor are worried they will be lost to practice closure or retirement, according to a poll released by the college.

Attempting to alleviate pressure on the primary care front, Dix broadened the role of pharmacists, allowing them to issue and renew more prescriptions for those without a family doctor.

The Ministry of Health and Doctors of BC also announced $118 million in interim funding for family doctors last summer.

“When we announced these stabilization measures, we identified approximately 3,480 family doctors who have their own practices and 1,100 family doctors working in walk-in clinics,” said Dix at the time.

“I am pleased to share that the first 3,164 family doctors across BC will receive an initial distribution of funds worth $107 million in stabilization payments to help ensure patients maintain continued access to primary care services.”

The ministry also signed contracts with 54 new family doctors last fall to provide full-service primary care across the province.

Those who signed will receive a $25,000 signing bonus on top of their base $295,457, as well as medical training debt forgiveness of up to $50,000 for the first year and up to $20,000 for years two to five.

They’ll also receive a $75,000 payment intended to be put toward overhead costs for their host clinic.

The incentives are part of BC’s Health Human Resources Strategy to “improve access” to healthcare.

An example of BC’s demand for primary care physicians and just how lucrative the job can be was displayed in Britain last year, where the United Kingdom’s Royal College of General Practitioners advertised a job in BC paying a £316,000 salary, which translates to more than $425,000 Canadian.

Regarding the NDP’s aforementioned actions, opposition leader Kevin Falcon called them “meaningless,” and says they’ll fail to improve outcomes.

“The Health Minister needs to do the right thing, accept responsibility for his appalling record of failure, and step down,” said Falcon.

In 2003, there were 437,000 British Columbians unattached to a primary care practitioner. That number had doubled by 2017, when Horgan became premier.

Despite the incessant bureaucratic finger pointing and injection of billions into BC's withering healthcare system, the crisis continues degenerating.