this post was submitted on 05 Oct 2023
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Number of Canadians who give up and leave ERs over wait times has increased fivefold (www.ctvnews.ca)
submitted 1 year ago by [email protected] to c/[email protected]
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The number of Canadians who visit emergency departments across the country only to give up and leave before they receive any care has increased more than fivefold, according to new data collected by CTV News.

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[–] [email protected] 50 points 1 year ago (1 children)

This is a symptom of a twofold problem. First, additional staffing and resources for ERs would help to reduce wait times, but I think the more important issue is lack of primary care, which would help patients avoid needing to go to the ER in the first place.

I'm not much of a fan of the way the article is written. Of course there are going to be some cases where a LWBS has serious complications, but locally (and anecdotally), our ER seems to operate more as a walk in clinic at times, and doctors will often see more patients there than they would in a typical clinic day. I feel like the non-emergent visits are likely a considerable part of the 6.8% LWBS rate, and could be offset by a better supply of family physicians. Unfortunately, at least in Saskatchewan, that would require a government willing to do anything whatsoever to help the healthcare system.

[–] [email protected] 11 points 1 year ago (1 children)

What action(s) would the government take to help the supply of family physicians? (disclaimer: I'm asking out of ignorance and curiosity. I solemnly swear I am not a conservative sea lion or provocateur).

[–] [email protected] 17 points 1 year ago (1 children)

It's unfortunate you have to make that distinction, but thank you.

It's definitely a complex issue, but I think a few things could help in my experience as the spouse of a physician in rural SK with an engineering background.

  • Pay parity - rural family physicians provide many of the same services as urban ER docs would, but are paid considerably less, while having worse work-life balance. Family docs can also do just one year of ER residency add-on and work solely in emergency medicine. This makes family practice much less attractive and incentivizes many family docs to pursue subspecialties. One of Regina's hospitals' ERs are staffed fully by family doctors, and we've had 2 of our 14 doctors leave recently to work in non-primary care specialties, with another also pondering leaving, effectively saying, "I can make more money, see less patients in a day, and have better work-life balance just an hour down the road, why should I stay here?" With this, family physicians have considerably higher overhead compared to really any other specialty. Clinic rent, clinic staff, clinic equipment, an EMR subscription, IT equipment all adds up. Work in a hospital and you have none of that. We also just had a health authority administrator ask the doctors here, who practice privately, to pay for scheduling software for the hospital. It's insulting, really.

  • Support and scrutinize education - there is med student and residency education opportunities throughout many rural sites in our province, but there's become a lack of supports around those positions. Lack of housing for electives, stagnant med school intake and family residency spots. If you want more doctors, you need to educate more doctors and provide the adequate support in order to do so. Less on the government side and more towards education, but there are also some residency programs and/or preceptors whose residents are consistently behind standards, yet there seems to be no oversight or corrective measures taken. This is more on substandard self-governance and entitlement of certain individuals, though.

If I had to boil it down, I'd say those who make decisions in government have a complete lack of understanding of the day to day operations and expenses of rural physicians. A government rep was flabbergasted when she heard that family physicians often have several hours of non-patient facing time in a day when she asked why clinics can't be open 8-5 in a recent meeting. A 6-hour clinic day would often produce 2 hours of paperwork, or you'd need to leave 1 weekday for paperwork if you worked the other 4 seeing patients. Yet, given this lack of understanding, they still refuse to pay doctors for their time to meet to discuss these issues.

[–] [email protected] 2 points 1 year ago (1 children)

Thanks for the response. If I'm understanding correctly, I too am completely flabbergasted that family physicians have worse work life balance than ER docs. That seems like the opposite of everything I've heard about practicing medicine (although I'm in the States, and get 90% of my info from Scrubs).

[–] [email protected] 2 points 1 year ago

Urban and rural can be quite different. Urban family docs can do mostly clinic, so a fairly regular 8-5 with maybe some evenings, because other people provide the other medical services.

A typical week for a rural family doc in my experience would be clinic about 3 days, maybe 9-3 seeing patients, but actually 8-6 because you have to round on your hospital inpatients first and have paperwork after seeing patients.

Another day would be a 24 hour ER shift, where you're seeing 60 patients because there aren't enough resources for a walk-in, some with a stubbed toe, some trying their best to die. You might get an hour or two to sleep if you're lucky. You'd often take the day after to recover, but it's not uncommon to get phone calls during the day from consults and such, so not really a great sleep.

On top of this, you can be on obstetrics call on your clinic days (or weekends) so if there's a baby to deliver, you're up, either delaying your clinic or keeping you working into the night. There's a fair bit of communication needed even when the doc isn't needed in the hospital, so your sleep is shit again.

Essentially, rural family docs do nearly everything in their service area and only the most serious stuff gets sent out. With an antiquated part of the bylaws of the College of Family Physicians saying family physicians must always be available for their patients, rural physicians get fucked around, while urban docs have the luxury of dedicated 24-7 ER to take care of that.

ER docs on the other hand, at least from the ones I know in Regina, have usually a rotating 8 hour (sometimes 10 or 12) shift over a few days. So you'd work an afternoon, evening, then night shift three days in a row, then have a day or two off. Patients seen can be less because of better family physician and minor ER access, but the main thing is that when you're done your shift, you're done. You aren't going to get a call from a consult, or lab, or a request to do or assist in a procedure like a c-section. You can turn your brain off of work mode and not dread the sound of your phone's ringtone.

[–] [email protected] 29 points 1 year ago (4 children)

It's crazy that over the last decades, conservatives have fought tooth and nail against any foreign aid or immigration under the false assertion that "we need to take care of our own", meanwhile any time they have any freedom to do so, they decidedly "take care of our own" less and less.

And yet Doug Ford has a majority in Ontario, Tim Houston has a majority in Nova Scotia, Danielle Smith has a majority in Alberta, Scott Moe has a majority in Saskatchewan, and Bill Oliver has a majority in New Brunswick.

Who's voting for these troglodytes? Who's looking at the options of "a better future for real people, or a worse future for real people" and choosing the latter? Surely it's not all just in the name of bad memes and "owning the libs"... right?

[–] Bonskreeskreeskree 7 points 1 year ago (1 children)

They're idiots. The answer is idiots. People that will half ass argue "politics" with you for 110 seconds before cutting you off and saying "look I don't care about politics or follow it as closely as you". They're voting straight ticket. They're voting in every election. They only care about optics and identity politics. They don't fact check shit, they don't care about policy. They just care about sound bites and headlines.

[–] [email protected] 1 points 1 year ago

1984 and Idiocracy are more similar than one realizes as they both turned out to be prophetic.

[–] [email protected] 6 points 1 year ago

we need to take care of our own

They do mean this. "Their own" just refers to anyone living off of investment or property income, with a seven-plus-figure net worth. Context is important.

[–] Boxtifer 1 points 1 year ago

Could they perhaps say whatever they wanna say until they see financial numbers in front of them?

[–] [email protected] 19 points 1 year ago

I live in QuΓ©bec.

If you want to go to a walk-in medical clinic without an appointment and see a doctor for an emergency, you have to register for an appointment online on a government website. Yes. You take an appointment for a no-appointment walk-in clinic emergency visit.

You have to know when EACH clinic posts its schedule for the next day (none of them post at the same time btw) so you can log in and TRY to get an appointment. But the system is so clogged up that it's nearly impossible to get an appointment.

But I found a hack.

If you go to the emergency at the HOSPITAL - which doesn't require an appointment - you can ask at the triage if you can be given an appointment the next day at a clinic near your home. They apparently have a priority access in the appointment system and can give you one. This way you wait one hour tops, and you get an appointment to see a doctor. That's how I've done it the last couple of times.

In addition, in QuΓ©bec we used to have local neighborhood public clinics called CLSC. They used to be like mini hospitals with a few services like the possibility of getting X-rays for example. If you needed to see a doctor, your could walk in, register and within a few hours you'd have seen a doctor and got the prescriptions, services or references you needed and that was it. You would RARELY go to the hospital for an emergency thanks to this.

Over time these CLSC clinics were downsized, and defunded and basically reduced to only services that can be provided by nurses, like taking blood samples and vaccines and a few services for old people. This happened over time thanks to heavy austerity measures from the provincial Liberal party that was in power for about 15 years with a neo-conservative leader and then ending up with an actual doctor as the premier who rigged the system to enable doctors to have their own private clinics and giving all doctors huge pay raises before getting voted out.

[–] FReddit 18 points 1 year ago (1 children)

I'm in the U.S and have walked out a couple times.

In the longer term, I have a leukemia condition. It took five months to get an MRI and get someone to read the results. By that time the conditions had cleared up.

But there are a lot of conditions that can kill you in five months.

[–] [email protected] 11 points 1 year ago (2 children)

Meanwhile all conservatives want to privatize healthcare because they think Americans walk in, pay $100, and get seen within 5 minutes.

I try to tell them that they have the same wait times and pay thousands. At least in Canada we don't leave the ER with a bill. They don't listen, though.

[–] RememberTheApollo_ 1 points 1 year ago

But the US system is so much better because profit.

/s

[–] [email protected] 1 points 1 year ago

Because from their point of view that's how it works. They know rich people and rich people pay get seen or have the procedure quickly and pay alot.

[–] [email protected] 17 points 1 year ago

I bet Douggy and his Private hospital friends are dancing right now... on the 2B+ dollars that hasn't been spent.

[–] [email protected] 10 points 1 year ago

A part of our heritage

[–] [email protected] 3 points 1 year ago

At the least we need more walk-in clinics/urgent care with Nurse Practitioners, actually open and staffed. If you want to go really crazy make sure they have doctors, and if you are truely insane enough to fund a functioning healthcare system, make sure people have access to a family doctor to start with.