How a doctor in Red Lake, Ont., contends with that community's critical physician shortage

It's 9:15 a.m. at Margaret Cochenour Memorial Hospital in Red Lake, Ont., as staff crowd around the white board in the hallway across from the nursing station for their daily huddle. 

"Urgent care is not open again," one person reports with an exasperated emphasis on the word "again."

It has become a regular occurrence due to the shortage of available physicians in the northwestern Ontario community, which last year was the first in the province to temporarily close its emergency room due to a lack of physicians. 

Today, Dr. Akila Whiley is the doctor seeing those patients. 

She's seated at a workstation in an office area behind the nursing station with a pile of charts already on her desk. She wears a beige L.L. Bean knitted pullover and green scrub pants in place of the traditional lab coat.

"I've seen a few of the patients who would've likely been directed to the urgent care clinic," she said. "and all of them have something that requires treatment." 

Whiley is originally from Halifax, but she did her residency at the University of Toronto and discovered that urban family practice wasn't for her.

So when it came time to do a rural rotation, Whiley sought placements as far from Toronto as she could get. And you don't get much farther from Toronto than Red Lake. 

The picturesque town of around 4,000 people, situated on the shores of its namesake lake, is about 500 kilometres northeast of Winnipeg and more than 550 kilometres northwest of Thunder Bay. It's part mining town, part tourist destination for hunters, fishers and wilderness enthusiasts.

But Red Lake has continued to struggle to attract and maintain a full physician staffing complement, as factors that have long deterred doctors from practicing in the rural north – such as distance from family and friends – collide with newer deterrents. 

A lot of younger doctors are looking for a better work-life balance than the older generation had, Whiley said, and some find the workload in the community excessive. Whiley works at least 60 hours a week between direct patient care and on-call hours, she said. On busier weeks, that number is closer to 80.

A survey of family physicians conducted in 2019 by the Canadian Medical Association found that family doctors worked an average of around 48 hours a week, not including on-call hours, and put in an additional 111 hours of on-call time per month on average.  

However, a survey of all physicians, including learners and specialists, conducted by the Ontario Medical Association in March of 2020, before COVID-19 overwhelmed hospitals, also found that 66 per cent were already either burned out or burning out. And the numbers were higher in northern Ontario. 

Finding her calling in northwestern Ontario

Whiley arrived in Red Lake for the first time in the middle of a northern Ontario winter.

"My very first day of work, my suitcase hadn't made it, so I was wearing the same clothes for 24 hours," she recalled."I didn't have a vehicle, so I walked in like minus-40 weather from my accommodations to the clinic."

Yet, the moment she arrived to a full schedule of patients, she said, she knew she'd found her calling.

"All of a sudden, I had stepped into this realm where I had a lot of autonomy," she said. "I finally felt like I'd found … what was going to make me feel rewarded."

Around a year into her tenure, Whiley became chief of staff of the hospital.  

But it was around that time that doctors started leaving the community, as COVID-19 raveged the healthcare system. 

Some of the older physicians stopped working with patients face-to-face, reducing the number of doctors available for ER shifts, explained Dr. Andrew Gloster, another physician in the town.

Doctors who divided their time between communities stopped doing so.

"I do remember my colleagues… saying that it hasn't always been this way, you know? 'Stick with it. Things get better,'" Whiley said. "And so you really latch on to that."

But the 24-hour ER closure in March 2022 hit Whiley hard. It happened while she was on vacation – her first trip away with her family since starting university more than a decade earlier.

She'd booked the time off months earlier but still found herself scanning airfares and seeing if she could cut short her trip to save the day.

After the closure, Whiley resigned as chief of staff.

She said she felt personally responsible for it and still gets emotional talking about it.

"The work is emotionally taxing," she said of being a doctor.  "And I signed up for that. ... But giving of myself so much and not being able to …meet the needs, it's incredibly taxing ... and I don't think any of us signed up for this."

After the closure, physicians across northern Ontario stepped up lobbying efforts for both temporary and permanent solutions to the ER staffing crisis.

They have scored a handful of victories; there is expert peer support now for doctors working alone in rural ERs and funding for locums to bring medical residents with them on their northern rotations, and the College of Physicians and Surgeons of Ontario has made it much easier to license some foreign-trained doctors. 

'Reaching a breaking point'

But another initiative that had been seen as a beacon of hope proved to be the opposite for some towns. 

A province-wide review of physician complements in communities with Rural and Northern Physicians Group Agreements — a funding model under which groups of doctors agree to provide all the physician services for a community —  left at least two northwestern Ontario communities with fewer physician positions.

Red Lake dropped from seven full-time equivalent positions to six. 

It had around 5.9 full-time equivalent physician positions filled the month when the ER closed, according to a tally maintained by the chair of the community health care committee. 

"I remember opening the e-mail, and at that point – which is very telling – feeling almost so hardened that I couldn't even receive the information," said Whiley, who had just come through a period of trading 24-hour ER shifts with a single other doctor.

"Many of us gave it our all during COVID. And I think we're just reaching a breaking point now that you think to yourself, 'I have not considered myself at all in this.'

She announced that she would cut her hours to part-time effective Oct. 1 — though she has since postponed the effective date until the new year.

She wasn't the only one to cut her services.

On learning of the complement cut, Gloster, who had served Red Lake for 13 years, announced his retirement, also effective Oct. 1.

"It just drained me of all my energy," he said. "It was very disheartening."

Gloster took part in a video conference shortly after the announcement, in which doctors serving the community met with those who had made the decision.

"I was just explaining why we needed more doctors, not less," he said. "But they basically were sticking to their guns, that they had a formula, and they'd done the calculations, and this was their determination.  And so at the end, I said, 'Well, if you go through with this, I quit.'"

By the end of 2023, Red Lake is on track to have only around four full-time equivalent physicians, according to the numbers provided by the chair of the town's health care committee.

"The system is slowly collapsing," Gloster said.  "And the trouble with a collapsing system is that mistakes happen because there's not enough people to do an adequate job. ..and I don't want to be part of a collapsing process"

The hospital's new CEO, Sumeet Kumar, said he's hoping to organize a meeting with local stakeholders to talk about physician recruitment and find out what's worked and what hasn't in the past. 

Without more help, he said, the ER is in danger of closing again.

"At one point in the summer, in August, we would've shut for a straight five days," he said. 

"We were able to pay extra top ups ... from the base budget of the hospital to incentivize the physicians to come and to work for us for those five days. And Ornge helped us airlift that doctor from Durhan region just to keep the doors open."

Whiley leaves the emergency room for dinner. at around 4:30 p.m.

She'll be called back not long after to stitch up a patient and she'll be called again later that night.

She'll spend about two hours at home writing prescriptions, reviewing test results and doing other paperwork.She'll be on call all night, and will return before 8 a.m. to finish her shift.

Then she'll take the rest of the day off and do it all over again the following day.