Chronic doctor shortages and other healthcare challenges unique to region
by Lori Thompson, Local Journalism Initiataive Reporter
SUDBURY—Northern Ontario faces unique challenges in healthcare and the Ontario Medical Association (OMA) has released a 12-point plan to address chronic doctor shortages, the disproportionate impact of the mental health and addiction crisis, lack of high-speed internet availability and unreliable connectivity, as well as unsafe drinking water and inadequate healthcare facilities and resources in Indigenous communities. The Prescription for Northern Ontario was released October 25 in Sudbury as part of an overall strategy for improving healthcare in Ontario.
In a news conference, OMA President Dr. Adam Kassam said, “Providing equitable access to health care in Northern Ontario is a unique challenge requiring unique solutions. Prescription for Northern Ontario is an ambitious action plan containing 12 healthcare recommendations to address the unique challenges in the north, including a chronic shortage of doctors, especially in areas such as family medicine, emergency medicine and anesthesia; the profound and disproportionate impact of the opioid crisis and mental health issues including insufficient numbers of mental health and addiction care providers, especially those who help children; the lack of high-speed internet and internet connectivity which limits the availability of high quality virtual care; and unsafe drinking water and inadequate health care facilities and resources in Indigenous communities.”
“Access to health care ensures healthy populations, which is crucial to the economic health and vibrancy of rural and remote communities,” the report states. “Virtual care is limited by lack of high-speed internet and unreliable connectivity. It’s also hard to stay healthy when access to transportation, affordable food and secure housing are so limited. The social determinants of health – factors such as income, education, food security and housing – must be addressed, especially in the north.”
Northern Ontario spans almost 90 percent of the province’s geography but represents only six percent of Ontario’s population. Distance, weather and infrastructure (or lack thereof) present barriers to accessing healthcare services in Ontario’s north. According to the report, “The healthcare needs of northern Ontario are growing. A greater proportion of its population is over 65. There are more complex chronic illnesses and mental health and addictions than in other regions. The average life expectancy is 2.5 years lower than in the rest of the province. At the same time, the number of doctors dropped from 1,715 in 2018 to 1700 in 2019. Almost 100 generalist family physicians are needed in Northern Ontario’s rural communities.”
The Northern Ontario School of Medicine (NOSM) estimates more than 300 physicians are needed in the North, not factoring in retirements that may take place over the next five years. NOSM applauded the OMA for its report. “This is an unprecedented commitment from the OMA to healthcare in Northern Ontario,” said Dr. Sarita Verma, NOSM Dean, President and CEO in a release. “Our healthcare system was fragile before the pandemic, now it is on the brink of a crisis. We are grateful to the OMA for listening to doctors and creating a plan that will assist in advocating and changing the landscape of healthcare in the North for decades to come.”
Consultations for the plan took place over the spring and summer of 2021. More than 1,600 physicians and physician leaders provided input, as did 110 stakeholder groups (hospitals, nurses and other healthcare professionals, health charities and patient advocacy groups and many other health, labour and social service agencies participated) and almost 8,000 Ontarians from 600 communities responded through a public survey.
More than half of Northern Ontario respondents said the way health care is delivered in their communities has become worse as a result of the pandemic. More than half of respondents in communities from Sudbury to Thunder Bay gave the local healthcare system a C grade and more than a quarter gave it a failing grade. Wait times and the need for more doctors were identified across the North as top health care priorities.
“There’s no surprises in the plan,” Manitoulin Island family physician Dr. Stephen Cooper told The Expositor. “There were wait list issues well before COVID and now there’s a backlog from COVID. There are huge wait times at the Sudbury emergency department and even in our emergency departments here on Manitoulin Island.”
Dr. Cooper is chair of the Ontario Medical Association’s District 9, representing all physicians practicing in Northeastern Ontario.
We need improved home care and community care, he said. “(Hospital) wait lists are related to an inefficient home care system.”
For many years, there’s been a big push by the OMA to increase the number of physicians in Ontario and the numbers have gone up overall, partly due to training of more doctors and partly due to a more open door policy, said Dr. Cooper. “About one-quarter to one-third of physicians practising in Ontario have been trained abroad. However, the distribution is not even throughout the province. There is a deficit of, I think, 81 physicians across the North and that’s significant. It represents about 15 to 20 percent of practising physicians. There’s also a gap in specialists.”
There have been long waiting lists at some Island family health teams (FHT) and other FHTs have struggled to meet the needs of all their clients, although some new physicians should help address those wait lists, he said. People who are without family doctors and who need referrals to specialists can still obtain those through the emergency department. The problem, Dr. Cooper said, is lack of follow up. For example, someone with poorly managed diabetes may be referred for specialty care in Sudbury but when they return to Manitoulin, their diabetes may not be easily managed without a primary care physician.
This is a bigger concern for mental health issues. Dr. Cooper sees a fair amount of mental health patients in the emergency department. “We’ll get them a consult with a psychiatrist and set them up with a counsellor but ongoing maintenance is really the role of primary care.”
Regarding the push to integrate digital medicine, Dr. Cooper noted that Manitoulin has been fortunate to have already been doing that. “Being able to access patient records digitally allows physicians to provide better diagnoses and treatment plans,” he said. “It works well on the Island.”
Over the past 30 years, First Nations have seen improved access to healthcare within their own communities with much of the healthcare for First Nations on Manitoulin transitioning into Noojmowin Teg. There’s still a lot to do, Dr. Cooper stressed. A large part of First Nations funding still comes through the federal government so there are still many controls on what they can do with healthcare dollars.
He agreed the OMA recommendation for strengthening public health and preparedness is important. “We were ill prepared to deal with the pandemic,” he flatly stated. “We’ve known one was coming for a long time but yet despite that, we were caught short-handed.” With global attention on the pandemic and climate change, it’s starting to change how we look at the role of public health. “We’re realizing that we’re in this world together and we have to work together.”