Residents of Rainy River are grappling with the news that all of their primary care physicians have posted their resignations.
The doctors, which oversee the emergency room, clinic and long term care facility, issued a statement to the community last week, notifying patients that they could no longer provide safe and adequate emergency care under current conditions, and because their clinic practice and emergency responsibilities can not be separated, due to their Ministry of Health funding model, they would be closing their practices.
Dr. Caron and Dr. Jilkina will complete their duties on September 30. Dr. Joe Ennett will be doing his best to keep the clinic open until November 30, to buy the Ministry of Health and Riverside Health Care some time to find replacements. A locum who has been instrumental in serving the township for the past two years will also be stepping in to help where he can, noted Ennett.
The mass resignation is a result of severe, long-term burnout, clashes with administration, a funding model which hasn’t adapted to the changing times, and past requests for assistance going unmet, said Ennett, who has served the community for 13 years.
“We love this place. We’ve given our life to this place. But the docs are burnt out,” said Ennett, fighting back tears. “We’re tired. But we’ve stayed, because we know that if we leave, that there’s probably no-one to replace us. We haven’t left because we care about the community.”
The mass resignation sent a shock through the township, and inspired Gayla MacMillan to launch a change.org and paper petition, intended for the Ontario government and hospital board members, calling for the hospital to remain open.
“Many people will lose their jobs if the hospital and clinic close. We as a town and surrounding towns will be without medical care. This puts more stress on Fort Frances hospital, which is barely able to handle what they have now and to take on more will only jeopardize the lives of many,” states the petition.
“Without emergency care here we face hours of ambulance rides for proper care. This is not acceptable, it would not be acceptable in southern Ontario and it is not in the north,” Richard Trenchard commented, on the petition.
The resignations have already caught the attention of all levels of government. The situation is a high priority for the province, which oversees healthcare.
“Together with leadership at Riverside Health Care Facilities, our government is developing a plan to address health human resource strain across the Northwest. Northerners deserve care when they need it in a convenient and safe location,” said MPP Greg Rickford. “We are actively collaborating with our healthcare partners to ensure that the highest standards of patient care are consistently met. Keeping the emergency department open is a priority for our government, as it provides crucial services to the people of Rainy-River and the surrounding area.”
Riverside Health Care has also stated its commitment to the facility’s continued operation.
“Riverside is committed to all the communities in the West End of the District and to the Rainy River Health Centre. Maintaining hospital emergency services in Rainy River is our top priority. We are working across the organization to address the loss of physicians in the community and the resulting impact on hospital services,” said a statement provided to the Times. “Riverside Health Care is committed to providing sustainable health care services for the communities that we serve.”
Health care in Rainy River has always presented a unique and challenging situation, said Ennett. The doctors don’t live permanently in Rainy River – each one travels in for a week at a time. During their rotation, they work around the clock, covering the clinic, hospital and long-term care, with the support of a collaborative nursing staff. They use banked vacation to add a locum to that rotation. When a patient goes to the Rainy River emergency room, the doctor may be seeing a patient in the clinic, but through communication and collaboration with nurses, doctors have been able to make the best use of time and resources.
For a time, it worked. The emergency room would only see maybe 2-5 patients a day. But today, it’s easily 10-20 patients, putting considerable strain on the system.
“The workload has increased and it’s put the pressure on. You can’t be in two places at one time,” said Ennett. “It’s been harder to keep up with clinic volume, because we have to be in the emergency department.”
Adding to that, are strained services across the west end, which adds pressure to the facility. Emo has an urgent care clinic, under the care of just one contract doctor, resulting in more emergent cases being sent to Rainy River. With just three acute care beds, the hospital can quickly become overwhelmed, said Ennett. The hospital was recently caring for eight patients at one time, when an ambulance arrived with more. The doctor on duty was forced to send them away; there wasn’t a single stretcher left to take them.
“Many days, we’ll wolf down a sandwich for five minutes, then spend our time seeing patients from other places, because they had no place to go,” said Ennett. “The volumes have been increasing. It has really become a difficult situation the last four or five years.”
Having a single doctor on for a 24/7 week-long rotation also puts added pressure on nursing staff, said Ennett. The emergency room is budgeted for one RN to be on at all times – a situation which made many nurses nervous. The medical team agreed it could be dangerous – particularly at night. The team repeatedly requested a second RN for the facility from Riverside, but was allegedly denied, due to funding constraints. The doctors approached the Ministry with a compromise, which would see the emergency room closed during its slowest times of 8 p.m. to 8 a.m., allowing both RNs to work 12 hour day shifts, said Ennett.
At first, the Ministry seemed open to the idea.
“And then the talks stopped,” he said.
That was the breaking point for one of the doctors. When the Ministry eventually came back and asked for 14 hours of emergency service, it was already too late – the wave of resignations had begun.
A perceived lack of support from the administration and board may have pushed doctors over the edge, but for Ennett, the very foundation of the Rainy River funding model is problematic.
Doctors aren’t employed by Riverside – they hold contracts with the Ministry of Health, and are granted hospital privileges through Riverside to serve the local population. In Fort Frances, the doctors own the corporation which operates the clinic; they manage it themselves. The hospital is managed by Riverside. Rainy River falls under a rural funding model, which makes doctors in the clinic responsible for keeping the emergency room open. In a lower volume ER, it works. But Rainy River has become too busy.
“I think that’s becoming an impediment to attracting people, because doctors don’t want to come and be responsible for keeping the emergency department open,” he said. “It’s become a model that isn’t sustainable, and it’s hard to attract talent.”
Many doctors want one or the other – to open a family practice, where they care for their patients in the office, or to be hospitalists.
Attracting young doctors is also a challenge, noted Ennett.
“I think it’s a general statement, not just in medicine, that young people want a more balanced life,” he said. “When I was young, I worked 80 to 100 hours a week, 50 out of 52 weeks of the year. But that generation is gone.”
Ennett feels for the situation to improve, and for doctors to be attracted to the town, the Ministry needs to consider a model which separates the clinic from the hospital. And one that adequately funds doctors, who currently make a fraction of what doctors in other towns across the region are paid.
A healthier work culture and support are key, he said – from both senior administration and the board, which Ennett feels lacks representation from the west end of the district. None of the board members are currently from Rainy River, despite a major facility located in the town, he noted.
Although Riverside does not employ doctors, they echoed the need for change at the Ministerial level.
“Riverside Health Care is not a party to the agreement for physician services in Rainy River. We encourage the Ministry to address much needed changes to the existing agreement to best meet the needs of those providing care in our communities.,” Riverside said in a statement.
The province did not respond to questioning about the current funding agreement.
