Canada Faces Emergency Care Crisis for Third Straight Summer

The stressful scenes in Canadian emergency departments remain the same. Patients sit in waiting areas and hallways, hoping for a room. Doctors and nurses face staffing shortages and work on the brink of burnout. Hospitals burst at the seams and ambulances get diverted, ultimately affecting patient outcomes and the quality of care.

For the third summer in a row, emergency care in Canada reached crisis levels, feeling even more strained than the year before. In some rural areas, like Fort St. John, British Columbia, Canada, emergency departments closed because of staffing and capacity issues.

“Every year since the pandemic began, I have worked with new nurses. Most of our seasoned nurses have left. The nurses tend not to stay long,” Kerstin de Wit, MD, an emergency physician in Ontario and research director of emergency medicine at Queen’s University in Kingston, Ontario, Canada, told Medscape Medical News. Earlier this year, de Wit and colleagues published a study in the Annals of Emergency Medicine on Canadian emergency physician burnout.

“I am becoming numb to the sight of patients in chairs and stretchers in the corridor. This has become normal,” she said. “I worry less about the future of emergency medicine and the healthcare system because I have no control over it. Now, being an emergency physician is my job and no longer my career or profession.”

Calling for Change

Before they encounter yet another year of burnout for healthcare workers and insufficient care for patients in 2025, emergency physicians and their medical associations are speaking out — and asking for help. At the end of August, the Canadian Medical Association (CMA) issued a statement with recommendations for nationwide change, emphasizing the need not only for coordinated, long-term plans that can lead to lasting solutions but also for urgent action to stabilize the healthcare infrastructure this year.

“At the end of the day, seeing patients suffer breaks the heart of every physician, which contributes to burnout, especially when they’re not able to provide the care that they trained so many years to provide,” Joss Reimer, MD, CMA president and a hospitalist at Women’s Hospital in Winnipeg, Manitoba, Canada, told Medscape Medical News. “If we can fix these issues, we can see burnout go down and allow physicians to do the work they’re so passionate about doing.”

The CMA suggested the following five steps for governments to take:

• Increase capacity in healthcare systems by retaining, training, and credentialing medical professionals of all types.
• Invest federal funds in health capacity to increase access to care.
• Eliminate administrative pressures in the healthcare system.
• Establish team-based primary care to expand overall healthcare access.
• Allow pan-Canadian licensure to allow physicians to work anywhere in the country.

“Pan-Canadian licensure could be a huge relief because it would allow doctors to move around the country and respond when needed, which might help rural hospitals avoid closing,” said Reimer. “If someone who lives in Vancouver wanted to go to Saskatoon for the weekend to help, that could create a release valve for some of the pressure.”

The Canadian Association of Emergency Physicians (CAEP) issued a statement in support of CMA’s recommendations, saying the challenges in emergency care are “not just operational hurdles but also critical threats to the health and well-being of Canadians and the healthcare workers who serve them.”

Declaring that “the canary in the coal mine has died,” the CAEP shared its EM:POWER report earlier this year as emergency rooms nationwide called for help. The report covers a wide variety of urgent issues, including emergency physician resource planning, systems integration, and quality indicators, as well as broader questions around disaster preparedness, climate change, and diversity and equity concerns.

“The bottom line is that what we’re doing right now isn’t working,” said Michael Herman, MD, an emergency physician in Ottawa and a member of CAEP’s public affairs committee. “We need wholesale systems integration from all the players in our healthcare system, and we need all levels of government — municipal, provincial, and federal — working together to alleviate the strain on our emergency medicine system.”

Looking Forward

As the calls for change mount, it’s becoming more commonplace for medical professionals to feel discouraged, disappointed, and unheard as the same inadequate practices continue. In 2023, hundreds of emergency physicians across Canada signed open letters about their concerns and the inability to provide safe and timely care. So far in 2024, the overcrowding and understaffing are only growing worse.

“Although people have talked about solutions, none of them have seemed to change what we are feeling on the ground,” said Catherine Varner, MD, an emergency physician in Toronto and a deputy editor of CMAJ. In June 2023, Varner wrote an editorial for CMAJ about emergency care being in crisis “now and for the foreseeable future.”

“Looking at the editorial line by line, we’re in the same situation that we were in a year ago,” she said. “That’s what’s so disappointing.”

Because numerous factors are at play, it can be difficult to untangle the causes, effects, and next best steps to address the crisis in a practical way, Varner said. For instance, training and retaining medical professionals are crucial, she noted, but today’s working physicians have also pointed to concerns about the rapidly aging population and increasing complexity of patients. It’s become more common to diagnose cancer and other chronic diseases in the emergency department due to a lack of access to primary care, and more patients are arriving at the hospital with more severe symptoms and illnesses than in previous years.

“Emergency care serves as the front door of the healthcare system,” Varner said. “People want to feel that they are going to get the right care at the right time in the right place by the right provider, and the experiences of late that patients share appear to indicate they’re losing trust.”

Long-term care beds, community supports, and revitalized primary care can help offload hospitals and emergency departments, de Wit said, but these measures still won’t be enough without widespread, dramatic change.

“The Canadian population should be aware that the emergency department is no longer the safety net that it once was,” she said. “How long will it be until we see urban, city emergency department closures, and what will hospitals do when that happens?”

Reimer, Herman, de Wit, and Varner reported no relevant financial relationships.

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape Medical News, MDedge, and WebMD.