This is the second story about how the ongoing doctor shortage in Red Lake, Ont. is affecting the people who live there. Follow this link to read the first story, on the impacts on the doctors serving the community.
It’s a sunny weekday in mid-September and the waiting room of the Goldcorp Regional Red Lake Medical Centre is eerily quiet..
The local family medicine clinic in the northwestern Ontario community is a bright, spacious modern building across from the Margaret Cochenour Memorial Hospital.
But these days, there are frequently too few doctors available to staff it, according to Dr. Daniel Gow, an emergency physician in Fergus, Ont., who works around 10 weeks per year in Red Lake and who has volunteered to help do physician scheduling there.
“If we have two physicians in all of Red Lake, they’ll be working back-to-back covering the emergency department. There’ll be no urgent care. There’ll be no primary care,” he said.
“So the clinic itself is what tends to suffer the most in this scenario.”
Red Lake, like many small towns across northern Ontario, has struggled with a doctor shortage that has grown dire since the start of the COVID-19 pandemic a few years ago.
Last year, its hospital was the first in Ontario in recent history to temporarily close its emergency room for 24 hours due to a lack of available physicians. Later on that summer, other hospitals across the province did the same.
Now the community is dealing with the fallout from a decision to cut funding the town’s physician complement from seven full-time-equivalents to six – the result of a province-wide review of physician staffing complements in towns with RNPGA contracts, a type of funding model under which doctors sign on to collectively provide needed services for a community. It prompted one doctor to resign, saying he wants no part of a collapsing system; and a second to announce plans to drop to part-time hours.
The remaining physicians have reduced their workload by closing the urgent care clinic that used to take place on Saturday mornings and informing the community that they will no longer respond to messages by phone or email.
At the same time, they are requiring patients to make telephone appointments for prescription renewals instead of simply processing phone or fax requests from the pharmacy.
Trying to book an appointment
Doctors’ work of filling out those prescriptions “off the side of their desks” doesn’t get captured by the Ministry of Health, possibly contributing to the perception that the community could make do with fewer doctors, explained Dr. Akila Whiley.
But appointments are hard to come by in Red Lake.
“There’s times you phone and there’s no answer,” said Debbie Kozie, a patient of the clinic who has lived in the town her entire life. “It’s like trying to win the lottery. You just keep calling and calling and calling till your call gets answered.”
The town currently has 4.8 full-time equivalent physicians serving it, according to a tally maintained by the chair of the community health care committee. But not all of them live in the community full-time, Gow said.
Some are part-time physicians such as Gow, who spend the most of the year away from Red Lake, while one full-time doctor is currently on leave, he said.
Speaking over Zoom, Gow displayed a copy of the October physician schedule on his computer screen.
For one week in October, two doctors will trade 24-hour emergency room shifts – during which a doctor staffs the ER by day and remains on call after hours – with just one other doctor stepping in on a Tuesday while someone else does rounds at the long-term care home.
When a third doctor is available in town, that person covers the urgent care clinic, Gow explained.
The staffing situation is so precarious in Red Lake that Gow doesn’t publish the monthly schedule until around two weeks prior to the start of the month, he said.
A stressful situation for all
That means the clinic can’t book doctors appointments more than a handful of weeks out because it doesn’t know when and if doctors will be available.
“It’s hard not to get angry, “said Drew Cook, who grew up in Red Lake and has lived there much of her life.
“You go to the app, and you try and book an appointment on there, and every time you go to that app, it’s no appointments available, no appointments available. Then you go to the phone. It’s busy, busy, busy. Then you get through and it’s, ‘Sorry, we have no appointments this week.'”
Sitting in a gazebo overlooking the lake at the tourist resort she operates with her husband about 15 minutes south of Red Lake on Highway 105, Cook repeats the questions and concerns that she says come up in conversation with other community members.
Is the clinic being managed properly? Are the older doctors in town driving the young ones away? What are they doing to recruit more colleagues? Why are they only looking for doctors with experience? She asks.
Some of those questions derive from incorrect information, said Dr. Akila Whiley, a physician who has worked in the community for approximately three years.
The Red Lake physicians are still taking on medical residents on a case-by-case basis, but the reality is that it takes time to train a new doctor, and the depleted pool of existing doctors doesn’t always have that time, she explained.
The doctors she knows who have left the community have done so because the workload was unsustainable, she said. And besides, she said it shouldn’t be on the doctors themselves to recruit and retain their colleagues.
Asking for medical help in the grocery store
But Whiley knows people are frustrated, she said. She hears about it from them all the time.
“Like [at the] grocery store [they’ll say], “Oh. I wish I could have booked an appointment with you. I have this rash.’ And they show the rash in the grocery store. Constantly.”
She’s especially concerned about the front-line staff at the clinic, who face the brunt of the anger, she said.
The clinic has placed a sign by the reception desk warning people that abusive behavior won’t be tolerated, but staff say it happens anyway.
“We get a lot of grief from people,” said Kayla Barnes, a billing clerk and co-manager at the Goldcorp Regional Red Lake Medical Centre. “I just wish that people would be a little more understanding – kind,” she said. “It’s a lot to handle some days.”
While the clinic sits quiet, the chair of the town’s health care committee, Dave McLeod is gearing up to find more doctors.
In November, representatives from the community will attend two conferences in Scotland and Ireland where they will attempt to woo hundreds of physicians trained overseas, including hundreds of Canadians who missed out on getting seats in Canadian medical schools, McLeod said.
The College of Physicians and Surgeons of Ontario recently made it much easier for physicians trained in the U.S., U.K, Ireland or Australia to come and practice in the province, and McLeod is excited by the opportunity the change presents.
“You go where the people are that are interested,” he said.
“And they’ve got to have an interest in other things than staying where they are if they go to an event like that.”
McLeod’s committee was formed around 13 years ago to consolidate physician recruitment efforts in the wake of its last critical doctor shortage, he explained.
He showed CBC News a piece of much-sought-after waterfront property on Red Lake – one of five that the town has set aside for the committee to use as a recruitment tool.
“It’s an attractive recruitment incentive,” he said of the plots of land, which are for sale only to doctors who want to settle in Red Lake.
McLeod bristles at the suggestion that the current critical physician shortage signals that it’s time to again rethink how the town does its recruiting.
Whiley and hospital CEO Sumeet Kumar have wondered aloud if its time to hire a professional physician recruiter, but McLeod said the physician shortage is a systemic problem, and he doesn’t want to spend piles of money hiring someone that he doesn’t believe would outperform his committee.
“There’s got to be a reason [why] a lot of these communities have recruiters and they still need doctors,” he said.
McLeod said he’s not happy that the town has found itself so short of physicians again but he is optimistic about the committee’s prospects for getting more of them doing primary care in the clinic regularly again.
“We were down to 2.5 when our committee was formed,” he said. “We’ve been through it once, and it’s a challenge, but our community will get through it.”