Month: December 2024

Missing psychiatric drugs causes unique problems because of the nature of the nervous system. Nerve signaling relies on neurotransmitters, small molecules that pass between neurons to initiate electrical transmissions. Receptors on the receiving neuron bind the neurotransmitter, and the number of receptors controls the strength of the signaling. Psychiatric drugs often change the amount of neurotransmitters present, and in response, the body will either increase or decrease the number of neurotransmitters to maintain a steady state. When people do not take their medications, the neurotransmitter levels return to their initial states, but the receptor levels lag. The result is either an extreme excess or deficiency of signaling, which can lead to severe physical and mental suffering and even psychosis. In surveys, non-adherent patients describe “complete insomnia and crushing anxiety,” having “a full-blown panic attack but spread out over several days,” and being on “a roller coaster from hell.” An Australian man suffering from non-adherence withdrawal “want[ed] to commit suicide just to end the internal torment.” In Canada, psychiatric drugs are the most frequently missed class of medication.   

Emergency Signage. Free to use under the Pexels license.

The majority of Canadians hold the opinion that healthcare in this country is struggling. Most Canadians do not believe they will have access to good medical attention. Unprompted, 66% of Canadians will volunteer wait times as a reason for failures in the healthcare system. They are right. According to government trackers, hospital wait times usually sit between two and six hours, although they can run as high as twenty hours in extreme cases. Physicians are overstretched and low on morale, compromising care across the board. Estimates based on data from the U.K. suggest that 15,000 people may die per year as a result of long waits. Wait times are a complex problem with many contributing factors. Hospitals are understaffed and lack beds and other infrastructure to ensure efficiency. Many hospitals still use faxes. Many people spill over to hospitals because of a lack of primary care. For numerous reasons, people do not fill or do not take their prescriptions, leading to emergency interventions. Studies on missing medication often claim it to be a global reason for unnecessary medical strain. Hospitals are forced to intervene in what should be preventable conditions. These interventions strain emergency rooms and represent a broader failure of policy. Single-payer pharmacare promises to bring everyone onto drug insurance, lower the cost of medications, and relieve pressure on the clinical system.   

It is a common misconception that this country has universal health care. In reality, Canada has universal clinical care. Provincial services cover the vast majority of surgeries, emergency visits, annual checkups, and other aspects of clinical care up to a federal standard. Within the clinical setting, the province covers drugs administered during treatment. Outside of clinical care, pharmacare coverage in Canada is similar to healthcare coverage in the United States. Private plans cover much of the population. Public plans cover some marginalized populations and select medications, although the degree of coverage varies across provinces. For example, Ontario’s Drug Benefit program covers those in assisted living programs and those under 24 years of age from the province’s index of approved medications.

The Ontario Drug Benefit program works with three other provincial programs—Ontario Works, the Ontario Disability Support Program, and the Trillium Drug Program. These programs provide coverage for poor people, people with disabilities, and specific high-cost medications, respectively. British Columbia has a similar system, although the province subdivides its programs differently and has a slightly different drug index because, until recently, there has been no federal standard for approved drugs. Public pharmacare schemes like these account for 45% of national drug expenditures. Out-of-pocket and private plans—accessed independently or through employment—account for the remaining portion of pharmacological coverage. 20% of total spending is out of pocket, and 35% goes through private insurance companies. 

Out-of-pocket spending and insurance status are predictors of medication non-adherence: when patients do not take their medication as they and their physician have agreed to. Non-adherence is primary when the patient never fills a prescription and secondary when the patient deviates from their plan in some other way. The patient may stop taking the drugs altogether, take their drugs after a planned time, or ration their drugs. 

Close-up Photo of Medicinal Drugs. Free to use under Pexels License.

Subtypes of non-adherence rates make the subject tough to research. Meta-analyses are the best tools for measuring population trends, as they allow researchers to collate more data, but they also rely on shared definitions in scientific literature. If an initial study only examined primary non-adherence, the researchers cannot group it with another study that examines secondary non-adherence. Frustratingly, in this area of research, both studies might describe their focuses as just non-adherence. Because definitions of non-adherence are not standard, specific data on the burden of non-adherence in Canadian emergency rooms are difficult to verify. This also makes searching for individual studies challenging because search results do not match to search terms. We need to use international figures on non-adherence factors and healthcare burdens. What data exist are variable. What is clear is that deviating from the course of treatment can have devastating side effects. 

For people with diabetes, supplemental insulin saves lives and preserves people’s well-being. Over decades, high levels of blood glucose damage nerves and blood vessels in the body. Fine capillaries in the kidneys and eyes are often affected. In the kidneys, the glomerulus, a capillary ball that allows filtrate to pass from the blood and into the channels of the kidney, becomes damaged and incapable of fluid exchange. This diabetic nephropathy is a common condition among diabetic people. Carried to extremes, it will lead to kidney failure and death. In the eyes, damage to the vascular network leads to bleeding around the retina, the receptive field of the eye. Bleeding in the eye and a lowered blood flow cause blindness over time. Damage to nerves results in a lack of feeling, often in the feet. Low blood flow from capillary damage makes tissue vulnerable to infection, infections people fail to notice because of nerve damage. These infections spread and turn into diabetic ulcers—large, open, festering sores penetrating to the bone—resulting in amputations and sepsis. Fortunately, the recent Pharmacare Act came into effect in October of 2024, which will work to provide universal access to diabetes medications. Hopefully, this will reduce the incidence of diabetic diseases.  

In developed nations, cardiovascular medications are among the most commonly skipped. These medications often act to reduce levels of cholesterol in the blood. Cholesterol builds plaques in blood vessels, obstructing blood flow and stiffening arteries that need to be supple to manage changes in blood pressure. If the obstruction is in the blood vessels supplying the heart muscle, the person will be at risk of a heart attack. If medical workers catch the heart disease in time, the person may have surgery to create an alternate route for blood. A surgical team would cut the sternum (breastbone) open, harvest veins and arteries from around the body for macabre plumbing, and stitch and slam large needles into the heart to establish bypass, all as part of an hours-long effort. These patients are lucky. The onset of their disease was slow enough for healthcare workers to intervene. Others are less fortunate. Cardiovascular disease is the leading cause of death in developed nations. 

Doctor Operating on a Patient. Free to use under the Pexels license.

A variety of sources, including the Canadian government and independent studies, estimate that between 5-15% of the population is medication non-adherent. Of course, non-adherence varies on the provincial level and within populations. British Columbia has the highest rate of non-adherence within the provinces, between 17-26% depending on the estimate. Nova Scotia has the lowest at around 14%. A meta-review estimated non-adherence to account for 4.4% of hospital admissions in developed countries. If (given that this specific figure could not be found) the rate of hospital admissions can approximate the rate of emergency admissions, then total non-compliance would account for 660,000 extra visits per year. It is tempting to stop here and say that implementing universal pharmacare would relieve about 5% of emergency room visits. However, this would not be an accurate view of the impact of universal pharmacare. Medication non-adherence results from cost-related and non-cost-related factors, and it stands to reason that only the cost-related portion would be affected by universal pharmacare. 

Non-cost-related medication non-adherence is dependent on demographics and the nature of the prescribed medications. Older patients are less likely to be adherent than younger patients. The patient’s relationship with the prescribing physician is relevant. People are more likely to follow their agreed plan if they are the same sex as their physician—an effect more pronounced for male patients. The complexity of the prescription will alter adherence. Patients with more drugs or who have to take drugs at shorter intervals are less likely to take their prescriptions. 

If the side effects of medications are adverse, patients may stop taking the prescriptions they filled. Primary adherence is highest for cardiovascular drugs. People fill their initial prescriptions, but they do not take the medications for long. Many cardiovascular drugs are statins, a class of medications with unpleasant side effects like aches and nausea. Because of the side effects, patients often forgo their statins during treatment, and so the rate of secondary non-adherence is very high. The result is that long-term adherence to cardiovascular drugs is among the lowest for all classes of medication. While non-adherence may account for roughly 4% of admissions, universal pharmacare would solve none of the above non-cost-related factors. The elderly would still skip their medications. Patients would still ignore their physicians, discontinue uncomfortable drugs, and neglect complex regimens. Therefore, the number of emergency cases prevented through universal pharmacare is likely marginal. 

When patients do not fill prescriptions or ration medication because they cannot afford the price, that is cost-related non-adherence. The strongest predictors of non-adherence are all cost-related. The out-of-pocket cost faced because of co-payments, deductibles, or being uninsured is the most accurate single predictor of non-adherence. People are less likely to buy drugs that cost them more money. In Québec, the introduction of co-payments caused an increase in non-adherence and emergency visits. Nation-wide, a study on the effects of drug pricing schemes in Canada estimated that there are 93,000 preventable emergency room visits each year because of cost-related non-compliance, or about 0.6% of the total 15 million emergency visits. 

Close-up of Pills and Cash. Free to use under the Pexels License.

With expected gains at a modest 0.6%, universal pharmacare could increase, not decrease wait times in the healthcare system. Patients with drug insurance are more likely to assess clinical care than those without. Those who can afford to fill prescriptions will seek prescriptions for their ailments. Canada’s 20% previously uninsured population would exacerbate backlogs in clinical care and create further spillover onto emergency care. Universal pharmacare would not be a panacea for healthcare clinics in Canada. In the best-case scenario, less than 5% of hospital patients would be relieved, and there would be no increased burden. The best-case scenario will not happen. Does that matter, though? 

Delays of care are a problem because they represent a deficit in the system. Other systemic deficits are worth fixing even if they are not a fix-all solution. Recently, the government has made progress through the passage of the Pharmacare Act, which provides coverage for contraceptive and diabetes medications. The Pharmacare Act is a decent first step, but the law aims to deliver drugs at the provincial level, as is the case with clinical care. More than clinical care, pharmacare benefits from single-payer systems because the government gains negotiating power against drug companies. A unified negotiator lowers the price of drugs beyond what can occur through an open market. To ensure an efficient and universal system in the future, the federal government must work to unify the provinces into a single negotiating bloc to provide comprehensive pharmaceutical coverage to its citizens. Millions of Canadians skip meals, leave their homes unheated, and cut other essential services every year to afford their medications. 20% of Canadians lack drug insurance. Yearly out-of-pocket costs for drugs sum to 6.5 billion dollars. In Ontario alone, hundreds of people die from complications from diabetes each year. People go blind, lose limbs, suffer mental anguish, and die because the government does not cover the cost of their medications. Even if universal pharmacare exacerbates clinical wait times, it is still worth implementing for the millions of Canadians who need care.

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   This article discusses the issue of over-crowding and long wait times in the Canadian healthcare system. A statistic I found…

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For over a decade, Canada has experienced a slow but sure decrease of healthcare professionals in the public sector, a crisis of Canada’s own making. As it can be attributed to multiple issues within the educational system as well the shortcomings of the licensing process. Lack of opportunities, barriers to practice, discrimination, and biases are some of the evils that poison every level of the public sector of the Canadian Healthcare system.

 This lack of personnel ultimately ends up affecting hospitals the most; lots of people attend hospitals due to lack of alternatives, creating an overload of work for already overworked professionals—something that would not happen if there was a better healthcare system. The professional healthcare personnel crisis is more concerning than people might think, and if we do nothing to stop it, we will be out of more than 78,000 physicians by 2031.

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Unfortunately, these numbers suggest more than an imminent shortage of doctors. Across the country, this crisis has affected professionals related to all levels of care, ultimately leading to the overwork of hospital staff all around Canada. Prevention, diagnosis, treatment, and rehabilitation programs have all dwindled in numbers in the public sector, with professionals deciding to work in the private sector instead, which accounts for almost 70 specialized professions in need of personnel.

The province that has been affected the most by the migration of its professionals to the private sector is without a doubt British Columbia (BC). In 2019, only 33% of healthcare professionals worked in the public sector, compared to New Brunswick, the second lowest at 42%. Although this crisis is revertible, it has deeply affected clinics and hospitals across the province. For example, one respiratory therapy department in an acute hospital in BC can only manage its demands by using up to two thousand hours of overtime each month.

This all stems from the shortcomings of the recruitment and retention strategies of the province, as BC’s salary for multiple positions varies from 11% up to 24% less economic compensation compared to Alberta, a middle-of-the-pack province in terms of payment. Increasing the salaries is a good short-term solution to even the private and public sectors in BC.

However, bad remuneration and the rise of the private sector are not the only reasons for the national staff shortage in hospitals and clinics, as these previously mentioned problems are BC-specific. The national crisis stems from the flaws of the education system, and in the lack of practice opportunities that Canadian doctors trained locally and abroad face, which affects the private and public sectors equally.

Unfortunately, these measures are not enough to solve the staff crisis, and it can even be considered counterproductive. Because no matter how many more spots or new medical training institutions the government creates, if the residency programs are not fixed, then this crisis will continue. Creating more med school spots but not targeting the lack of residency positions will only increase the number of capable medical professionals who are unemployed, further worsening the current state of hospitals all around Canada.

Census data reveals that, in Canada, there is no shortage of doctors, but what we have is a shortage of licensed doctors. Unfortunately, the latter is the only one that can get a healthcare job (in either the private or the public sector) due to Canada’s standards. The licensing process is a tedious process that vastly dwindles the number of healthcare professionals that are eligible to work. However, a great deal of these professionals do not even get to start this process due to their lack of a completed two-year residency position—a pre-requisite for licensing.

It is estimated that, to supply the demand for residencies for recently graduated medical students, a ratio of 110 to 120 positions for every 100 graduates is necessary. Unfortunately, in the last few years the ratio has fallen to just 101 positions per 100 graduates, and in some provinces, such as Ontario, a staggering 25 residency positions have been cut.  “In 2009, there were eleven unmatched graduates. Last year it was a hundred and sixty-nine.” Said Dr. Genevieve Moineau, the president of the Association of Faculties of Medicine of Canada, in 2018.

However, the number of spots available is not the only reason as to why the residency system is flawed, the specialties and locations available play a big part as well. For example, at the University of British Columbia, about 40% of the residency spots are reserved for family medicine and 60% are for other specialties. Experts on the matter, such as Dr. Shelley Ross, the cochair of doctors of BC’s general practice service committee, disapprove of this arrangement, claiming that the ratio should be the opposite, as the crisis of lack of medical doctors is in an arguably worse condition than that of the hospitals.

Furthermore, data suggests that family medicine is losing popularity among graduate students. In 2016, 38.5% of graduate students across the country labeled family medicine as their first option for postgraduate training, but in 2023 that number was 30.3%.

This year in Quebec, 91 family residency slots were left vacant after the first round of the matching process, almost seven times more than the vacancies for all other disciplines combined. This lack of interest in family medicine ultimately leads to the oversaturation of hospitals, as without enough family doctors, key aspects of care such as detection, and diagnosis are left unchecked, and it is now the hospital’s job to handle such responsibilities.

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One might look at the foreign-trained doctors to fill up these family medical vacancies, however, surprisingly (or not) we found that these types of doctors, who are as capable as the locally trained, face discrimination when they apply for residency positions. According to the Canadian Resident Matching Services (CaRMS) in 2022 1,661 international medical graduates applied for residency positions in Canada, and just 439 of them were matched with the necessary post-graduate training, a match rate of only 26%.

There is no academic reason for refusing that many residency spots to competent graduates. Furthermore, they are not foreigners, as you need to be a Canadian citizen or permanent resident to be able to apply for residency in Canada. These problems create a loop that affects every aspiring doctor in the country: Canadian students realize that there are not enough residency opportunities in their country, so they decide to move to other countries, such as Australia or Ireland to continue their education and training. However, once they are done with their studies and they want to return to their home, they come face to face with a harsh reality—Canada favors the locally trained and discriminates against those who studied internationally. This leaves them in the same spot that they were before leaving the country in the first place.

Jake Portnoff is among the approximately 1,000 Canadian med-students per year who decide to study internationally. After not being accepted into his Canadian Medical school of choice, the Toronto-born student decided to move to Australia and study medicine at the University of Queensland, where around another 100 Canadian students who were also rejected in their local med-school study. Portnoff explained that most of the Canadian students there want to return home, but that the residency process discourages them. “There are so many qualified and educated medical students who I believe really should be given a chance. The amount of residency seats available right now is just such a barrier. It’s certainly hard to hear that many qualified Canadians are being turned aside in the face of what we’re experiencing,” he told CBC News.

International students have noticed this trend, as the number of applicants has steadily fallen. In 2013, 2,219 international students applied for a residence in Canada, a number 25% higher than that of the 1,661 international students that applied for one in 2022. This is particularly worrisome as, according to the Canadian Institute for Health Information, 25% of all doctors in the country are foreign-trained physicians, and in family medicine, nearly a third of doctors have international medical degrees.

Unfortunately, the deeply flawed Canadian system of producing new doctors is not the only reason for the shortages of them. The barriers that limit existing doctors from applying for a position freely within the country also play a part in this problem. Technically speaking, Canadian licensed doctors are free to apply anywhere in the country, however, to practice in different provinces they need to obtain a new license—an expensive and tedious process. For example, according to an assessment tool by the College of Physicians and Surgeons of Alberta, the licensing cost even for a physician who is licensed in another province who wants to work in Alberta would be more than $3,500, a price that only goes higher for international graduates. In total, this process could take months to finalize, months that a person applying for a new job in a different area from where they live might not have to spare.

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Early retirement (before 65 years old) and its increasing popularity among registered nurses and healthcare professionals in the public system is another factor that leads to the national shortage of staff in hospitals. Without enough new doctors coming toward the workforce, and with the existing ones having mobility limitations, this trend is not likely to decrease. Early retirement is not something wrong or problematic by itself, as the most determining factor for this trend in public healthcare professionals is the increase in household income, which shows that (except for BC) these professionals are well remunerated.

However, when 85% of your registered nurses and 77% of healthcare professionals retire early and your system is actively disrupting the licensing process for new people to fill those positions, then it becomes an issue. According to the Canadian Longitudinal Study of Aging (CLSA), registered nurses and healthcare professionals in the public sector in 2020 retired at 58.1 and 59.4 years old respectively, compared to 64.3 years among Canadian retirees in all sectors during the same year. These are worrisome numbers considering that according to the Organization for Economic Co-operation and Development, there are only 2.8 doctors for every 1,000 Canadians—a number well below Countries like Australia, France, and Germany, with 3.9, 3.4, and 4.5 respectively.

Solving the personnel crisis that hospitals across the country suffer requires targeting the multiple shortcomings of the system previously discussed. Solving them will take time, but fortunately, it is doable. According to Rosemary Pawliuk, the president of the Society for Canadian Studying Medicine Abroad, the first and easiest step Canada can take is to eliminate the jurisdictional segregation toward foreign-trained doctors. “You should be entitled to apply for the job regardless of your place of education if you’ve met the Canadian standards,” she said. In the short term, this would revert the downward trend of interest regarding family medicine due to the previously discussed statistics about internationally trained students in this field.

Furthermore, there should be an effort to nationally standardize the licensing process. There is no benefit greater than the harm it causes to require licensed doctors to obtain a new license just to be employed in a different province. One can argue that it is necessary due to the structural differences between provinces, however, the purpose of licensing should be to assess the qualifications of the doctor, something that is not going to change due to these differences. Overall, there are actions that the government can implement today that are going to show short- and mid-term solutions, but in the long run, the only way to combat the lack of professionals in hospitals is to expand the number of residency positions.

This, however, is not as simple as the short-term solutions. Only increasing the number of residencies available could lead to other problems, such as a decrease in the quality of these positions. However, it is important to understand that residencies and their inaccessibility are the main reasons for the lack of doctors and healthcare professionals in hospitals and the public sector in general.

It would help if licensed doctors could apply freely across provinces so understaffed hospitals can hire qualified and experienced doctors with ease. It would also help if the licensing offices would stop showing bias against international graduates and let these Canadian nationals and permanent residents return to the country so that we have an alternative streamline of qualified professionals to train.

However, these proposals alone will not solve the crisis. 54 Canadian medical graduates were not matched to a residency position in 2023, and 108 positions in Ontario only for family medicine were left vacant, if trends like these continue, hospital staff and the rest of the public healthcare system will continue to suffer the understaffed crisis. There is no straightforward answer as to how to solve the residency system’s shortcomings, as experts have different takes on this matter, however, it is important to understand the severity of the situation, analyze different points of view on the matter, and create a coherent solution before it is too late, as identifying a problem and understanding the severity of it is the first step to solving it.

A Canadian citizen’s right to receive healthcare is constituted under section 7 of the Canadian Charter of Rights and Freedoms, stating “Everyone has the right to life, liberty and security of the person”. Meaning access to healthcare in Canada is a fundamental right ensured by the state. However, this guarantee of access to healthcare isn’t always actualized in the reality of emergency care in Canada. Across Canada emergency rooms are operating far beyond their capacity, according to the Canadian Medical Association, some ERs are operating at up to 360 percent capacity, delaying the efficiency and reducing the quality of care patients receive. Though there are many factors prevalent in wait time issues in Canadian ERs, one of the biggest blockages to adequate and timely care is bed shortages.

Even with additional wings being built onto hospitals and care unit expansions, the number of emergency admittance and inpatient capacity remains misaligned. While adding additional beds in emergency departments and other hospital units is a necessity, this implementation cannot act on its own to reduce wait times and overall improvement to the functioning of ERs. To effectively ensure improvement in emergency patient care and reduce wait times, the root causes must be addressed. There is no one problem that has caused overcrowding in emergency rooms and hospitals overall in Canada, rather multiple factors leading to the oversaturation of patients directed to emergency and acute care for various reasons, such as better access to diagnostic technologies, admittance of patients with no foreseeable discharge, or long-term elderly care patients residing hospitals while they await placement in specialty long-care facilities. 

Many emergency patients wait long hours in waiting rooms, hallways, and corridors before being assessed by a nurse, resident, or emergency doctor. In Ontario,  only 23 percent of emergency patients were granted admittance within 8 hours during November 2023. Long wait times in emergency rooms aren’t tied to Ontario, all across Canada patients are awaiting emergency care for long periods of time, often exceeding the provincial target time. Many emergency patients admittance fall under acute care; however, bed shortages are very common within acute care units at hospitals due to the unpredictable nature of acute illness and injuries. In addition to the unpredictability of patient numbers, both emergency and surgical patients are in line for the same beds, causing more capacity problems. 

Once patients have received diagnostic care and are discharged from the hospital they become what is considered an outpatient. Outpatients with chronic or recurring illness/injury require regular care provided by family physicians, specialists, or specialized clinics. The lack of outpatient care for chronic or acute illness or injury outside of hospitals also plays a role in the overcrowding in acute care and consequently in emergency rooms. Many patients with an established illness make repeat visits to the ER after they have been discharged due to the inability to locate or access alternative services. A report in the Canadian Medical Association Journal also pointed to specialized care within hospitals, commenting on the need for specialists to better manage outpatient care for those with chronic illnesses to avoid unnecessary repeat ER visits and prevent the need for long-term hospital stays. Additionally, specialized clinical units or programs in many provinces have been condensed within fewer hospitals and less specialized clinics or community health services outside of hospitals.  

Diagnostic tools, such as MRIs and CT scans are primarily available in Canada though hospitals and outpatient orders for tests often have long waiting periods. Many patients may feel they can’t manage symptoms or pain for the length of the waitlist and may seek emergency admittance to receive diagnostic care. British Columbia claims to have the second shortest wait times in Canada for outpatients to receive medical imaging, with the majority waiting less than 159 days. The province was able to improve accessibility to MRIs and CTs from 2023-2024 through increasing staff, the number of machines, and additional hours of operation. However, for patients living in provinces that have higher wait times or in cases where diagnostic care is more emergent, emergency admittance is essential to receive timely care and results. 

Along with diagnostic technologies and care, long-term care for elderly patients, specifically for patients with dementia, often falls back on hospitals and emergency admittance. The inaccessibility to private home care or long-term care facilities leads families and caretakers to seek hospital admittance for their loved ones due to safety concerns and continuous vigilance they may be unable to provide at home. Hospital admittance for long-term care patients is highly unpredictable and greatly impacts capacity demand, particularly in acute care, which as mentioned previously, trickles down and creates more overcrowding in the ER. 

A CBC News article links patients who should be in long-term care facilities but have ended up in hospitals to both budget deficits and bed shortages in New Brunswick. Horizon Health board member, Susan Harley spoke to CBC, claiming 35 percent of some hospitals’ capacity is occupied by elderly care patients who don’t require hospital services, but specialized home care. The article directly connects this growing population of alternative level of care (ALC) patients to limitations to emergency admittances. In order to lower the percentage of beds occupied by ALC patients, Greg Doion, Horizon vice-president of clinical operations in New Brunswick, claims there needs to be an expansion in long-term care homes. Unfortunately, the current number of patients requiring placement in long-term care is not being met with additional capacity, instead wait lists for home placements are only getting longer, leading to longer hospital stays. 

Inaccessibility to long-term care is a problem from coast-to-coast in Canada. According to Island Health, the majority of care homes on Vancouver Island, British Columbia have wait times up to or over 1 year, some being predicted up to 2 years. Considering the population size on Vancouver Island compared to more densely populated areas of Canada, such as Greater Vancouver or Toronto, the wait time is generally low. In Ontario, approximately 45,000 people are currently on waiting lists to receive placement in a long-term care facility. Ontario’s average time spent on a waiting list for placement is 126 days, but some may wait up to 2.5 years. In many cases across Canada, wait-listed patients often are placed in hospitals for vigilant care which most hospitals aren’t equipped for nor have the available capacity to accommodate without disrupting bed availability for acute and emergency patients. 

A study published in the Canadian Journal of Emergency Medicine establishes how these shortfalls of capacity are dangerous for patients and raise many safety concerns regarding appropriate supervision and space for necessary medical practices on the patient. This same study evaluates the relationship between emergency care access and inpatient capacity blocks. Patients who have been admitted, but are waiting for an available bed in the corresponding hospital unit, are kept in the ER until one opens up. This causes a significant portion of increased wait times for other emergency patients who have yet to be admitted. Rather than capacity overflow being placed on individual units based on care needs, these admitted patients are kept in overcrowded ERs, often stuck on stretchers in noisy and chaotic hallways. In more extreme cases of emergency room and hospital overcrowding, the study states that health officials reported more than 30 hours for emergency department length of stay. 

Overcrowded emergency rooms have led to the practice of “hallway healthcare”, in which patients are placed within busy hallways or other common areas to receive care due to shortages of emergency beds. Patients confined to stretchers in hallways of the emergency department may experience deficits in their quality of care due to the chaotic environment, preventing adequate rest, privacy, and dignity. Discharge delays in individualized hospital units put further pressure on emergency rooms and staff. When inpatient discharge is delayed between the times of 9 am until 4 pm, another ER patient will be confined to a stretcher for a full day. Mismanagement within specialized hospital units blocks access to emergency care and increases wait times for emergency admittance. 

In January 2024, a reported average of 2,000 hospital patients per day in Ontario were placed in unconventional locations for care, such as hallways. Despite Premier Doug Ford promising to address the rapidly growing problem of hallway healthcare when he was elected, the rates of hallway admitted patients have increased. Ontario hospitals have faced such a high rate of hallway healthcare patients due to the large and growing population of the province. However, the crisis of insufficient hospital infrastructure resulting in hallway healthcare can’t only be attributed to a rise in population or even provincial underfunding of healthcare. 

A CBC News article points to Alberta experiencing the same problem despite having a significantly smaller population than Ontario. Alberta’s emergency rooms are consistently overcrowded and many hospitals have resorted to partake in hallway healthcare, as well as using plastic sheets secured with duct tape to create more spaces to place patients. These so-called “over-capacity beds” are not equipped to handle many different treatments and types of care. United Nurses of Alberta vice president Danielle Larivee notes that putting more people in a room than it is designed for or in hallways causes many safety concerns to arise. These make-shift beds aren’t equipped with essential tools such as oxygen or call bells for patients to signal need for assistance. Hospital board members and officials deny differences in the care delivered to overcapacity patients in comparison to those staying in regular capacity beds. However, it appears those working within these conditions, such as the United Nurses of Alberta, disagree with this assertion feeling as though these improvised care spaces only amplify the issue of understaffed units and overworked nurses. 

The American Journal of Emergency Medicine addresses how emergency room overcrowding and hallway healthcare could potentially be resolved to a point where emergency rooms are more operational and have reduced waiting times. This study suggests Full Capacity Protocols (FCPs) be put in place to redirect overcapacity patients to units within the hospital rather than be kept in emergency hallways while awaiting a bed. FCPs, as suggested in this study, wouldn’t move patients to rooms within units as the capacity issues as a whole hospital problem wouldn’t be resolved within this model. Rather than admitted patients being kept in the ER hallways or secondary waiting areas, they would likely be relocated to hallways within specific units. Though this still falls under the definition of hallway healthcare, common spaces within units are significantly less trafficked areas compared to ER hallways. Additionally, unit hallways are much quieter and most units’ lights will go out at night, allowing for hallway boarded patients to get some rest. This study does recognize that FCPs, such as the one suggested above, isn’t a solution to overcrowded hospitals or ERs, rather it could help alleviate some pressure on busy ERs. Additionally, there is limited information and reports available that have evaluated how these procedures may lack or cause other problems. 

Other solutions for bed shortages proposed include: increased outpatient support for those suffering from chronic illnesses, improved communication between primary care physicians and specialists for condition management, more funding for hospitals to expand their capacity and capabilities, and more accessibility to long-term care. Many researchers have come to the same conclusion that expanding bed capacity can’t alone solve overcapacity or overcrowding problems seen within emergency healthcare. Overcrowding needs to be approached as a whole hospital problem, not just in the ER, as capacity limitations in hospital units restrict the capacity for emergency admittance. None of these solutions on their own will eliminate emergency rooms wait times or reduce bed shortages, rather there must be changes in multiple sectors both within hospitals and out, in order for effective improvements to be seen. 

Emergency room wait times and their relationship to bed shortages is a nationwide problem in Canada. Though there are many contributing factors that play a role in the ongoing problem of high wait times for emergency care, the infrastructure of hospitals and the limited bed/patient capacity is a significant cause and can’t be overlooked when seeking solutions. Bed shortages, particularly in acute care units, directly correspond to overcrowding and increased wait times in the ER. Specialty care and diagnostic technologies, such as MRIs and CTs are primarily accessible through hospitals, which outpatient use of such technologies or other forms of specialized care have their own wait lists. In many cases, patients need to be admitted through the emergency room in order to receive this kind of care and potentially to acquire a diagnosis. Furthermore, access blockages to long-term care facilities often redirects ALC patients to hospitals, where they occupy a bed for an unforeseen period of time. 

With many admitted patients being placed in unconventional spaces, such as ER hallways while awaiting a bed opening, the issue of capacity needs immediate attention. Hallway healthcare not only makes the jobs of emergency nurses and doctors more difficult, but also results in high rates of patient discomfort and dissatisfaction with care. Emergency patients being confined to beds or stretchers for numerous hours deprives patients of privacy and necessary rest. To effectively improve emergency care in Canada a multifaceted approach is essential for success. A problem as complex as this requires changes made both within the confines of hospitals in the form of increasing capacity and in community outpatient services, such as better accessibility to medical technologies and long-term care.

In March of 2023, while skiing in Jasper, I crashed into a chairlift post at full speed, dead on. Needless to say, I do not ski anymore. I woke up with my friends hovering around me while the ski patrol prepared to take me down the mountain. I was put into an ambulance and driven to the local emergency room, where they told me I had broken my leg. I got a cast, crutches, and the instruction to leave it on for 8 weeks and then check in with a doctor back home. Instead, my parents took me to an orthopaedic specialist as soon as I got home; away from the rush and stress of the emergency room, the specialist found that I had partially torn the ACL in my other leg (and should have been in a wheelchair rather than using crutches), a bone chip floating around in my knee, and a severe hematoma in my arm that had lacerated the fat protecting the muscle there – an injury which could have forever impacted the functionality of my arm if not treated. In addition to that, they did an x-ray of my broken leg and found that the cast hadn’t been set properly – the break in my bone had gotten worse and required surgery. Two out of three injuries I accrued went completely ignored, with one being improperly dealt with, as a result of overstimulation in Canadian emergency rooms. Incidents like this happen more often than we would like to think in emergency medicine. Moreover, the average wait times in ERs all across Canada is astounding: fifteen-plus hours, with only 23% of patients being admitted before hitting the eight-hour mark in 2023. To many Canadians, this seems completely unacceptable – it is understandably frustrating to be told one needs to wait for urgent care. However, the sobering reality of the mental strain ER physicians face must be taken into consideration when discussing how to improve emergent care in Canada. 

 Burnout is defined as the exhaustion of physical or emotional strength or motivation usually as a result of prolonged stress or frustration. A doctor’s job is stressful, this is a universal truth. Holding the health of another person in one’s hands is a big responsibility. However, the severity of stress faced by Canadian emergency physicians is often forgotten, and they go unsupported because of it. Emergency physicians do not get the luxury of time. The state of emergency rooms is always high-paced, high-stakes, and stressful. ER physicians must identify issues and create treatment plans in a matter of minutes for an unbelievably wide variety of patients. Furthermore, ER physicians must be emotionally tough enough to effectively deal with the injuries they witness on a regular basis or to make snap judgements that severely impact a patient’s health – positively or negatively. Additionally, an essential part of being a doctor is interactions with patients and their loved ones. Due to stress and anxiety in ERs, physicians are often forced to deal with aggressive, hostile, and at times violent, individuals all while treating injuries that require the utmost focus, and maintaining a professional composure. The mental toll that this would take is massive – unimaginable for the average person. Considering these factors – and more – it is no surprise that long wait times and insufficient amounts of doctors to preform quality work is afflicting Canadian emergency rooms – factors which only worsened after the Covid-19 pandemic. All this to say: there is an epidemic among ER doctors that they are not supported to treat: burnout.  

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When looking at any problem that needs fixing, such as burnout among ER doctors and the subsequent challenges it poses to emergency care, it is imperative to find the source of the problem. While band-aid solutions work at times for smaller scale issues, problems in the health-care system require more focused attention in order to truly improve the quality of care for Canadians. In medical fields, the most common place where issues begin is residency. While being an exciting endeavour full of knowledge, new people, and experiences, residency is an incredibly stressful and taxing part of the path to becoming a doctor. It poses negative impacts on residents’ health, whether that be mental or physical. The transition from medical school to residency is a big one and residents often face high levels of burnout as they do not feel supported to seek wellness resources. Canadian residents have reported wellness concerns from cardiovascular disease to suicidal ideation – overall decreased qualities of life – because of the stress residency causes.  To boot, even though there are wellness resources available to Canadian residents, the rate of individuals who access said resources is very low. That is to say, given the stressful or, at times, toxic, nature of residency and the relationship between residents and doctors, Canadian emergency medicine residents do not feel supported to access these resources, do not feel supported in learning how to properly manage their mental health in order to build good habits at the start of their career. This demonstrates how the epidemic of ER doctors facing burnout begins from the get-go, how problems in the culture of medicine are ignored from the moment physicians begin training in Canadian ERs, and how physicians do thus not learn how to properly manage their mental health. Ignorance of one’s own wellness from the beginning of one’s career, especially in emergency physicians, only serves to encourage burnout; residents should be more involved in their training and encouraged to point out problems to remedy the continuous mental health epidemic ER physicians face. 

The general discourse around burnout among emergency physicians is usually centered around the effects of Covid-19 and the strain it put on emergency rooms; however, it is crucial to remember that physician burnout was not caused by Covid-19 but merely exacerbated by it. Even though the impact that the global pandemic posed to emergency rooms and their physicians cannot be ignored, burnout was still a prominent issue pre-Covid-19. Emergency medicine, in general, is a high-risk specialty for physician burnout. In a national study done pre-Covid-19, 86% of Canadian ER physicians reported being privy to feelings of burnout. Likewise, 42% reported having some feelings of depression, and 14.3% had contemplated suicide before – 4.3% of those being in the last year. Even though percentiles such as 14 and 4 do not seem like large numbers, any deficit in motivation or zest for life among doctors hugely impacts their performance – there is no room for depression or burnout in an emergency room. Considering this, there is a higher turnover in physicians resulting in longer wait times and periods where emergency rooms have deficits in doctors. This gives rise to lower productivity and lower patient satisfaction. Furthermore, emergency physicians with underlying mental health conditions (such as depression) have very high associations with burnout, indicating that emergency physicians who face mental health struggles are not effectively supported to manage them, to preform to the best of their abilities. Coupling such high rates of burnout and the correlation between underlying depression and burnout it becomes clear that Canadian emergency physicians are not supported to manage the toll that practicing emergency medicine poses. Without proper access to wellness-management information such as meditation and exercise, the standard of care in Canadian emergency rooms obviously suffers. 

Burnout and its effects were already prominent in Canadian emergency rooms before Covid-19 – then came the effects of the pandemic: the masses of patients, the long hours that had to be worked, the incredibly high death rates among patients, and the practice of emergency medicine for maintenance rather than the beginning of long-term solutions. Physicians faced moral injury (which is characterized by the shame and guilt experienced after violating a personal, moral code) leading to feelings of disappointment with their care and thus job dissatisfaction.  The effects of the Covid-19 pandemic were seen immediately: ten weeks in, 16% of participants in a survey conducted on emergency physicians from British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, and Quebec reported experiencing high levels of emotional exhaustion. Additionally, due to the high-stress environment of emergency rooms and moral injury that emergency physicians faced from not being able to provide a quality standard of care (also taking into account the general feelings of dread and worry that were widespread for all individuals during the pandemic), Canadian ER doctors who worked during the pandemic faced effects more complex than burnout. Workplace safety, childrearing woes for physicians with children, and stress from constant exposure to illness were all particularly taxing to emergency physicians. Moreover, if exposed to Covid-19, emergency physicians were burdened with losing their income, (Canadian ER physicians get paid on an hourly basis) adding an extra level of stress. Remember: these effects were all seen in the first 10 weeks of the pandemic – conditions only worsened as the pandemic carried on. In a survey done on emergency physicians in all provinces and territories in Canada (with the exception of Yukon) in 2020 (during Covid) and then again in 2022 (as Covid began to calm down) burnout levels were significantly higher in the 2022 survey. This survey discusses how the effects of the pandemic were seen more severely in younger generations. This proves how broken emergency healthcare is in Canada. Older generations were less affected, they were already used to the harsh conditions and burnout. Newer physicians were not yet broken in, and were not cognizant of resources to manage wellness. 

As mentioned, Canadian emergency physicians, during the pandemic, were faced with more than just burnout. They had to deal with “the brunt of [the government’s] failures,” the “meter of what is excellent care wavering,” and “seldom moments of levity,” as said by two Canadian ER physicians who were asked to discuss their experiences working in emergency rooms during the pandemic. Emergency physicians faced burnout that affected their spirits and challenged their passion for their profession – severe moral injury. Being invested in one’s work is crucial to adept performance; burnout among emergency physicians breeds a debt of efficiency and an inconsistent supply of doctors, negatively impacting the effectiveness of Canadian emergency rooms and leading to their overstimulation. The burden of the pandemic was obviously put on emergency physicians. Not only did they face unmanageable workloads but also criticism from the public: “no recognition” of the harsh conditions they were working under, and “no room to perform as human beings”. Doctors were feeling dissatisfied with their care, and thus unsure if they would be able to continue in their profession after the pandemic. Burnout rates before versus after the pandemic were hugely different: 74% of people who responded to this survey on Canadian burnout before versus after the pandemic saw higher emotional exhaustion and depersonalization scores after the pandemic than before the pandemic. The effects that the pandemic brought about forever altered how emergency physicians view their jobs; lack of resources from the government, brutal criticism from the public, and the creation of toxic working environments led many Canadian ER physicians to quitting the profession, massively contributing to the overstimulation in emergency rooms we see today. 

Finally, aside from the stress of the job and the effects of the global pandemic, there are hospital policies that have emergency physicians facing burnout and a lack of motivation in their work: their salaries. For doctors who practise emergency medicine, experience and mastery of their work is crucial – it could mean the difference between life or death. However, for Canadian emergency physicians, their pay does not reflect this. Unlike other doctors in Canada whose salaries are based on their experience, an emergency physicians’ salary does not take this into account this at all. Not being paid for their experience can lead to dissatisfaction with compensation, and thus dissatisfaction with the job. Feeling dissatisfied and unfairly compensated in the long term results in burnout and switching to other specialties that implement a hierarchical scale, where experience is considered. Remedying the inequality between pay and experience through the implementation of a hierarchal scale for Canadian emergency physicians could improve morale with the effect of more career longevity and less turnover of emergency physicians, less burnout, and overall, more encouraged doctors. It is important to feel fairly compensated and supported for the work that physicians are doing, especially in fields that are mentally taxing and have extremely high rates of burnout such as emergency medicine. Changing the methods of compensation for Canadian emergency doctors could change the landscape of the entire field, and improve the oversaturation of Canadian emergency rooms on a grand scale. 

Overall, the Canadian healthcare system is extremely flawed, but one of the biggest issues seen today is the oversaturation of emergency rooms. When looking to tackle this problem and improve urgent care for all Canadians, it is important to look at the source of the issue: degradation of doctors. Withal, when looking at the core of the problem, people often blame Canadian emergency physicians without considering the extremely high levels of burnout they face, nor do they consider the enormity of the effect that the Covid-19 pandemic had on Canada’s emergency physicians. To solve the problem fully it is vital to go past the statistics that illustrate long wait times and imperfect medicine and to instead discuss ways in which Canadian healthcare workers can be better supported to perform their jobs, by including Canadian emergency physicians in the conversation. Hearing from physicians first-hand about the issues emergency medicine faces is imperative to improving the system overall. 

Last summer, I contracted a particularly virulent strain of COVID-19. I had a mild fever and my chest would crackle faintly when I exhaled. My symptoms lingered after I recovered. One afternoon, I suddenly felt out of breath and dizzy. Worse, my lips and fingernails were tinted blue. As anyone with hypochondriacal tendencies would do, I turned to the Internet. Dr. Google called it “cyanosis” and insisted I head to the ER. After spending an hour in the waiting room anxiously picking at my hands, I was triaged by a nurse, given a wristband, and sent forth through the promising double doors…to another waiting room. The TV screen read: WAIT TIME: 9h47. And every seat was full. I sat against a concrete brick wall and tried unsuccessfully to distract myself. My heartbeat was echoing in my eyeballs. A nurse called out a name and the woman across from me scrambled out of her seat and, with a minor limp, made her way to the front desk. Meanwhile, a little boy clutching his dad with one hand and gauze against his crown with the other came through the double doors. The little boy with an open head wound took the woman’s seat, blood beading along his hairline. His father took out an iPad to distract the boy, and we all commenced the dreaded countdown.

Family physicians are the backbone of the medical industry and care for everything from infant colic to osteoporosis in the elderly. Canada’s shortage of family physicians is one of the root causes of our oversaturated hospitals and exorbitant wait times. For the millions of Canadians living without a family physician, hospitals and walk-in clinics are their only options for healthcare. However, the lack of staff and overwhelming number of admittances decreases the time that emergency room (ER) doctors can allocate to each patient. The time pressure combined with the ER doctor’s lack of comprehensive knowledge of their patient’s medical history can lead to life-threatening errors. On the other hand, family physicians offer more comprehensive care as they are aware of their patient’s life circumstances, past afflictions, and genetic history. They often chronicle each visit with each patient to form an essential reference point for diagnosing complex illnesses whose symptoms develop gradually. Canada must mediate the growing physician shortage and consequent hospital strain by addressing issues of medical disinterest, administrative responsibilities, and the isolated medical model. 

Our lack of family physicians endangers the population by delaying emergency care to those with life-threatening injuries. As of 2022, approximately one in ten Canadians—totaling nearly 4 million individuals—do not have access to a primary healthcare provider; of the residents who do have a regular provider, over 40% visited the hospital because their physician was unavailable. This percentage is likely due to the ratio of practicing family physicians to registered patients, which averaged approximately one physician per 700 patients. This high ratio underlies patients’ difficulty booking appointments with their family physician and consequent reliance on emergency services. People of low socioeconomic standing and Canadian immigrants are less likely than other cohorts to have regular access to a primary care physician. This means that those with poor average living conditions and nutrition are less likely to receive medical care when their compromised immune systems become overwhelmed. This issue is compounded by the reality that these demographics are less likely to have the financial stability necessary to take a day off work for a hospital visit. 

Last year, over 60% of those admitted to the hospital for COVID-19 were subsequently discharged. Those patients who were sent home likely experienced anxiety-provoking but not life-endangering symptoms. These patients would have benefitted from a brief conversation with their physician rather than a multiple-hour-long hospital visit, which is strenuous for the patient and our overburdened emergency care facilities. As of 2023, patients hospitalized for COVID-related illnesses remained at the hospital for over one month on average. ER doctors who extend their patients’ visits to monitor their symptomatology would likely be more confident discharging them if they trusted that their patient could readily and regularly contact their family doctor. Additionally, unnecessary hospital visits contribute to the spread of disease in hospitals amongst limited staff and immunocompromised inpatients. These brief intakes for non-emergency cases also necessitate a rapid turnover in medical files and place an administrative burden on staff. Many staff, including nurses, spend time managing repeated inquiries from patients as to how accurate the wait times are rather than diverting their energy to more essential services. 

Nearly one in five Canadians are unable to make a same-day appointment with a medical professional; of the countries polled, Canada has the lowest same-day medical accessibility. For Canadians without family physicians whose quality of life is deteriorating but whose symptoms are not yet life-threatening, the hospital is their primary and only option. People with chronic health conditions but without reliable access to a primary care provider are especially likely to rely on emergency services. Over four in ten adults suffer from a chronic physiological or mental illness. The elderly are more likely to develop chronic conditions, and Canada’s aging population will only increase the demand for reliable primary care. Moreover, cases of long-term COVID-19 and COVID-related cardiorespiratory complications will likely persist. Such cases commonly include alarming breathlessness and chest pain. These are well-known symptoms of a heart attack, and those who are unable to make a timely appointment with their primary care provider will seek hospitalization. Nearly six percent of the 1.7 million Canadians who were admitted to the hospital from 2023 to 2024 did so for chest pain and lung infections. 

To prospective medical students, family medicine is not an attractive field of study. Currently, physicians are compensated per visit regardless of the complexity of their patient’s needs. Physicians are habitually treating patients with comorbid disorders whose treatments are complicated by overlapping symptomatology. A salary would offer fair compensation for the intensive service they are providing. Likewise, family physicians have few employee benefits—notably a lack of maternity leave and childcare services—and struggle to maintain a balanced lifestyle due to work hours and stress. The majority of family physicians are women. These female practitioners form a vulnerable medical cohort as they tend to be younger, earlier in their careers, and primary caregivers for their children. Moreover, most family physicians, who are primarily female, work in the private sector and undertake the additional responsibility of business administration. The majority of family physicians are denied necessary accommodations and saddled with undesirable tasks. The lack of parental accommodations in the family practice sector will likely worsen public access to primary care as most of the workforce consists of women. Female practitioners may reduce their hours and female students may decide against family medicine entirely.

Merely encouraging students to pursue family medicine is an insufficient solution. Administrative tasks contribute to a decline in the average number of patients per physician regardless of how long they have practiced. Many medical professionals choose family medicine rather than research-based roles because of their passion for providing interactive and individualized care for their community. However, most family physicians manage their own businesses and spend nearly 80% of their average weekly work hours on paperwork, including insurance forms and sick notes. As business owners, family physicians are also responsible for hiring and training staff, managing finances, including expenses, payroll, and infrastructure costs, and filing medical forms. Nearly half of physicians—most of whom are female or in a family practice—report that their time spent on administrative tasks exceeds the satisfactory amount. It would be much more appropriate for an administrative assistant who is trained in clinical software and organization to manage these tasks. This would improve physicians’ efficiency by maximizing the number of patients with which they can consult in a day. 

Rather than attempting to raise the numbers and practicing hours of family physicians, Canada should concentrate on establishing an interdisciplinary healthcare system as in the United Kingdom, Norway, and Finland. Patients receiving care from a diverse medical team are more likely to receive proper care for their chronic conditions and less likely to rely on emergency services. Compared to the international average, 10% fewer family physicians in Canada rely on fellow medical professionals such as nurses to manage their patients with chronic illnesses who require habitual checkups. Contrarily, in the United Kingdom, over 90% of family physicians cooperate with other medical professionals. Globally, conditions that were once diagnosed on the spot are being unearthed as more complex and commonly misdiagnosed. As a result, diagnosing diseases is becoming an increasingly intensive process. Overburdened family physicians cannot have specialized knowledge across all areas of medicine. However, they can learn to approach their practice cooperatively for the benefit of themselves and their patients. 

In a study conducted by the Canadian Medical Association (CMA), nearly 40% of family physicians describe their workplace conditions as busier than desirable. Moreover, 60% of respondents claimed that such workplace stress prevented them from maintaining a healthy lifestyle. However, not all of these physicians’ stress is caused by the demands of practicing medicine. 80% claimed to have experienced regular social hostility in their professional environment and young females—the dominant physician demographic—are at a heightened risk. Moreover, nearly 40% of physicians report low levels of collegiality in their workplace. The medical field is competitive and pits prospective students against one another to vie for limited seats in university programs. This competition pushes students to become more efficient learners and more knowledgeable practitioners in medical school. However, outside of the classroom, the relationship between physicians fosters an atmosphere of toxicity. The physician who receives the coveted residency spot is one whose knowledge and techniques are not shared by their peers, just as the private physician who operates with the least number of staff retains the most assets. One can either best their competitors by surging ahead or by holding others down. If physicians are going to adopt a communal medical model, steps will need to be taken to improve cooperation at the educational level. Students who are taught medicine in a cooperative environment are likely to mature into physicians that feel comfortable relying on their colleagues for support when overwhelmed with patients or confronted with a difficult case. 

Family physicians should confer with local specialists in their treatment of patients with interrelated conditions to provide the most effective treatment. This communication would reduce the average wait time of 30 weeks from when a physician refers their patient to a specialist to when the patient receives specialized care. While they wait, patients are actively suffering and risk not only a decrease in their quality of life but possibly further injury or death. Canadian physicians who participated in the National Post survey claimed that this wait period exceeded the permitted amount by over one month. Moreover, family physicians are often more apt at articulating their patients’ symptomatology. Patients, on the other hand, are prone to disregard seemingly inconsequential symptoms or misattribute them to unrelated conditions. Such a miscommunication of critical information could result in a misdiagnosis or a false reassurance that the patient is in good health. 

Canadians should not be forced to wait in hospital rooms because they do not have or cannot access their primary care provider. Needless to say, a little boy with an open head wound should not have to wait nearly 10 hours for treatment, and he should certainly not be preceded by an adult with a minor peripheral injury. When I finally saw the ER doctor and he diagnosed me with anemia, I was fortunate enough to have the financial means of receiving intravenous therapy through a private institution. However, many women with my condition wait months for in-hospital treatment. All the while, they are suffering and their quality of life is deteriorating. The future of family practice relies on Canada to drastically change how it accommodates its physicians both personally and financially. If the responsibilities and resources of family physicians are not ameliorated, fewer students will replace senior physicians when they retire. As a result, hospital wait times will continue to rise and jeopardize the health of all Canadians. 

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