Evidence of meeting #11 for Health in the 45th Parliament, 1st session. (The original version is on Parliament’s site, as are the minutes.) The winning word was across.
A video is available from Parliament.
Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
Is the question “Why is it that care is not being delivered quickly in emergency care?” or “Why is the care differing among emergency departments?”
Bloc
Luc Thériault Bloc Montcalm, QC
I would say that patients who end up in the emergency room on weekends, for example, are patients who could receive the same service at a clinic. In a sense, there is a lot of congestion in the queue for emergency physicians, who should be providing specialized care in emergency cases. We were talking about waiting times, but these are often linked to the fact that there are no frontline services outside the emergency department.
Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
Okay. I understand better now.
Those low-acuity patients who could be cared for in a clinic—patients with sore throats, sprained ankles—are not the ones who cause the congestion in the emergency department. The reason for congestion in the emergency department is the backdoor problem. It's that, if all our beds are filled up—with patients with congestive heart failure, pneumonia, an old person who fell—then I can't bring a patient in from the waiting room to care for them for their cough, sore throat or sprained ankle, because there is physically no space, nor are there nursing resources to care for both patients at the same time.
Bloc
Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
Yes, absolutely.
Bloc
Luc Thériault Bloc Montcalm, QC
There is therefore a number of hours of waiting time that corresponds to the triage categories. Even if these people are not the ones causing congestion in the emergency room, they are still made to wait. The common perception is that if you go to the emergency room, you won’t be able to leave before having spent 16, 18 or 20 hours there. Instead, we could tell the person that if they arrive at 10 a.m. the next day, they will be able to go to the clinic and be seen.
How many emergency physicians are on duty at a hospital at night?
Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
It depends on the hospital, certainly. Since COVID, at our hospital we have two physicians overnight. We used to have only one, so, certainly, that's increasing. It depends, really, on where you're working. In a larger hospital, it will be more than that, and trainees as well.
Bloc
Luc Thériault Bloc Montcalm, QC
Are one or two enough? If there is only one emergency physician on duty in the emergency room at night, can we consider the emergency room to be truly open?
Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
Yes, I think so. I think we've done a really good job, in many emergency departments across Canada, of trying to match physician and nursing hours to when patients arrive. If you're matching patient arrival times to when physicians are coming on shift.... At our place, a very busy urban emergency department, we now have 16 shifts a day, so we match emergency physician arrival to patient arrival. It's just that, sometimes, by nighttime some of those patients have been waiting since the day because there's no place to physically bring them into the department.
Bloc
Luc Thériault Bloc Montcalm, QC
There shouldn’t be many trauma cases during the night, should there?
Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
That's when triage is helpful, as well as multi-tasking. It's very stressful.
Bloc
Conservative
Conservative
Helena Konanz Conservative Similkameen—South Okanagan—West Kootenay, BC
Thank you, Chair.
Thank you to the witnesses for coming and presenting to us today, which I really appreciate, on this very serious issue.
My first question is for Dr. Herman or Dr. Shouldice. As my colleague mentioned, we have severe, chronic closures of our local emergency room in the Okanagan. In fact, it was 40 times in 2024, and I believe it's more than 30 times so far this year. These are last-minute closures. You drive up. You're presenting with some illness, or your child is, and it has just closed—a last-minute closure.
What I want to ask you is this: What kinds of challenges do you think rural emergency rooms, in particular, are facing when it comes to staffing that would cause these last-minute closures?
Vice-Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
I think you've hit on a very important topic. Rural closures are increasing in frequency and duration, and it's very serious for the communities you've identified. You would hate for somebody who is potentially having a heart attack or a stroke to come to a place they're hoping to seek care and then have to be diverted away to another location. It's a very serious issue.
With respect to some of the challenges, again, I think it mirrors many of the other challenges we see across Canada, but I think it's especially pronounced in rural areas, where there's often less of a margin for error. In smaller communities, there's a smaller physician pool to draw from and a smaller nursing pool to draw from. There often can be difficulties in recruiting and retention in these areas. Oftentimes, these are areas where, if you're working in a rural emergency department, you may have to work a 12- or 24-hour shift, which is quite difficult for people to do, even in an emergency department that is not as busy.
I think all of these contribute to difficulties in staffing these shifts. As mentioned, when there's a very limited resource pool, you have communities competing for that small number of physicians. I think one of the keys is growing the physician base you can draw from, as well as ensuring appropriate incentivization to practise in these communities and building up the supports around the physicians and nurses in these communities to make it a viable option for them to practise.
Conservative
Helena Konanz Conservative Similkameen—South Okanagan—West Kootenay, BC
Thank you.
The particular hospital I was mentioning was the South Okanagan General Hospital, but in the Okanagan and the interior of B.C., there are severe shortages, not even in the rural areas, that I think could affect this also. For example, Interior Health has reported the loss of seven obstetricians and gynecologists and four psychiatrists, as well as the closure of the Kelowna hospital pediatric ward. That's a community of 150,000 or more, I believe. Would that affect the smaller hospitals around there? For example, South Okanagan General Hospital is a drive of around an hour or an hour and a half from that hospital.
Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
I think these are really important and stressful times for any community. When we look across the country, very few emergency departments are fully staffed. Very few emergency departments don't have holes in their physician schedule. We draw on each other to fill those holes and work above and beyond what we have agreed to work.
CAEP is undergoing a redo of our 2015 study to look at health human resources, particularly physician resources across the country, using both quantitative and qualitative data: Why are you as a physician retiring early? Why are you stopping working in the emergency department? How long do you think you're going to work? That process is happening right now. I think it will give us a lot more of that information.
I think what we took from our EM:POWER report was that we really need some accountability for physician resources and for the delivery of health care across the country, and we need to look broadly at the health system—not just at an individual, siloed hospital but at the health system overall. I think that's one reason we're hoping to engage this committee to look at having a pan-Canadian approach to these health human resource problems.
Conservative
Helena Konanz Conservative Similkameen—South Okanagan—West Kootenay, BC
You mentioned burnout earlier. That's probably a very big aspect of these closures.
November 6th, 2025 / 12:55 p.m.
Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
Absolutely. I graduated from medical school in 2005. I've been in practice for a long time now. I'm firmly a mid-career physician, which is shocking to me some days. I've seen levels of burnout in our colleagues like we've never seen before. Since COVID, it's just been getting worse. I think a lot of people are leaving more acute care specialties because of that burnout. It's an important point.
Conservative
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you, Mr. Chair.
Before I start, if CMA is not able to chime in, can they submit their opening remarks?
Liberal
Sonia Sidhu Liberal Brampton South, ON
Thank you.
Dr. Shouldice and Dr. Herman, thank you for your 17 years and 11 years serving on the front lines. That's a long time.
In the last Parliament, we did a study on addressing Canada’s health workforce crisis. We heard then that there was an administrative burden on doctors and that the digital health era was coming. What is your view on digital health? Do you think it will ease the administrative burden and give the best outcomes for patients?
Perhaps you can both give your views on that.
Vice-Chair, Public Affairs Committee, Canadian Association of Emergency Physicians
We are certainly in an era of some exciting digital tools and digital programs, with certain artificial intelligence applications that have some potential for assistance. I think that any strategy, be it digital or otherwise, really needs to be done with the engagement of the physician and nursing workforce. Certainly in the past.... I think anyone who has worked with an electronic health record system can see that some of these systems are touted as being this panacea that will cure all of our ills, but it's a very top-down, imposed structure that doesn't necessarily work with the workflow of individual organizations or departments.
As with any of these strategies, I think it's important that they're integrated in consultation with the frontline providers who are delivering that care, to ensure that it actually meets the clinical needs and solves the problem for them. I'm certainly hopeful that some of these innovations can provide some benefit, but I think anything has to be given deliberately and carefully with the frontline providers in mind.
