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Stanton Territorial Hospital in Yellowknife, N.W.T., is shown on Tuesday, August 23, 2022. As hospitals and other health-care facilities across Canada begin to grapple with worker shortages, the North is facing longstanding challenges recruiting and retaining staff. The Northwest Territories and Nunavut are no strangers to staffing gaps and service disruptions where many communities have limited health-care resources and are often reliant on locum staff from southern Canada. Added pressure from the COVID-19 pandemic and a shrinking national workforce has only exacerbated the issue. Dr. Courtney Howard is a long-time emergency physician in Yellowknife who worked her last shift at Stanton Territorial Hospital in July before pursuing a masters in public policy. She said COVID-19 amplified staffing challenges at the hospital with many health-care professionals working extended hours and unable to take vacation time. “We’ve gone from a situation of kind of cheerful strain to one of real worry that we won’t be able to meet the basic coverage to keep people safe and systems functioning,” she said, adding doctors who don’t usually work in the emergency department helped to keep it open. THE CANADIAN PRESS/Emily BlakeEmily Blake/The Canadian Press
It was late June, and the largest hospital in the Northwest Territories was running out of options for keeping its emergency department open through the summer.
There were nine shifts in July and 38 in August and early September during which no ER doctor was scheduled to work at Yellowknife’s Stanton Territorial Hospital, a facility that serves all of the NWT and western Nunavut.
The reason? Nearly all the permanent ER doctors were on discretionary leave, including parental leave, and not enough short-term, locum doctors were willing to fill in for them at the standard rate.
So the territory made a bold, last-ditch pitch: It put the empty ER shifts on an auction block and asked locums to name their price. How much money would it take to persuade them to change their summer plans and fly to Yellowknife to cover the emergency department?
That answer will remain a closely guarded secret, according to Claudia Kraft, the territorial medical director for the Northwest Territories Health and Social Services Authority. She won’t reveal the territory’s standard rate for ER locums, never mind the highest bid she accepted to fill a shift.
“It’s such a fiercely competitive market that no one’s sharing,” Dr. Kraft said, “because the moment we do, it gets price matched.”
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What she will say is that the plan worked. Nineteen doctors bid for shifts, 11 of whom came to work at Stanton. The ER stayed open, but at a cost that was about one-third higher in August than is typical for that month.
The summer shift-bidding program in Yellowknife was a creative local solution to a national shortage of ER doctors that even its architects hope they never have to repeat. The program underscored just how dire the straits have become for remote and rural hospitals that can’t find enough permanent doctors to work in their ERs full-time.
“We certainly run the risk that if we continue this race and this bidding war, we’re going to turn emergency medicine into a gig economy, like Uber,” said Aimee Kernick, the president of the Canadian Association of Emergency Physicians.
Many Canadian hospitals, health authorities and provincial governments find themselves upping the ante on bonuses and incentives in an increasingly desperate fight for the precious time of ER locums.
In British Columbia, for example, the Island Health authority recently offered nearly $4,000 for a 12-hour Sunday ER shift at a hospital on Salt Spring Island, according to an e-mail viewed by The Globe and Mail.
The CAEP, in co-operation with other medical organizations, published a report in 2016 that predicted Canada would be short just more than 1,500 emergency physicians by this year – a figure some now consider an underestimate.
In July, The Globe and Mail reported as part of its Secret Canada: Your Health project that more than one-third of Canadian ERs reported at least one temporary closing since 2019 because of staffing shortages. The vast majority were in rural and remote communities.
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“We have been having increasing pressure on staffing in a number of areas over many years,” Dr. Kraft said. “And I think, like most places across the country, it’s been particularly noticeable since the COVID pandemic.”
In Stanton’s case, as the summer drew closer, it became clear that not enough ER locums were willing to step in at the territory’s official, undisclosed rate. Health leaders in the territory explored contingency plans, including virtual ER coverage.
Stanton’s ER nurses, among others, were “appalled” at the prospect of the territory’s only trauma centre relying on remote doctors to cover the ER, said Courtney Howard, the president of the Northwest Territories Medical Association and a locum ER doctor at Stanton. (She lives in Yellowknife but chooses to work as a locum to allow flexibility for research, advocacy and medical leadership roles.)
The medical association, which represents doctors, as well as the Union of Northern Workers and the College and Association of Nurses of the Northwest Territories and Nunavut, co-signed a letter denouncing the contingency plans.
Not long after, on July 7, the territory formally launched the shift-bidding process.
The territorial health and social services authority advertised the plan on social and mainstream media and sent e-mails to locums who had worked in the territory before. The e-mails included the dates of shifts Stanton was looking to fill and a form to submit a bid. Alberta Health Services spread the word to its roster of locums, too.
The plan stipulated that locums who committed to shifts at Stanton before the advent of the bidding process would be paid the same as the highest bidder for that shift, so as not to punish those who booked early.
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Dr. Kraft said that although there were a few outlier bids, most were reasonable. “There were even some people who wrote to me specifically to say, ‘I feel really uncomfortable about this. You’re sort of implying or suggesting that we’re all mercenaries,’” Dr. Kraft said.
Dr. Kraft explained to reluctant doctors that, along with keeping the ER open, the bidding process would help the territory better understand the market rate for ER locums, a number that is hard to ascertain when so many hospitals keep their rates and bonus structures close to the vest.
Dr. Howard and Dr. Kraft both said the shift-bidding process brought some terrific new locum doctors to the North and exposed them to the joys of emergency medicine in Yellowknife.
However, both emphasized in separate interviews that they would prefer to attract and retain more permanent ER doctors.
As for putting future ER shifts up for bids, Dr. Kraft said, “My hope is that we never need to do something like this again.”
