Head North Young Doctors … Far Away From Fort Erie

By William Hogg  ,MD reporting from Kirkland Lake, Ontario
If you were a toolmaker, would you remain in a space without a factory to work in? Not likely. Trends to outsourcing aside, you’d head to a space with a place for you to do your work. The question is this: to stay or to go? No real dilemma. Go!

Ontario NDP leader Andrea Horwath joins south Niagara residentsat one of many protests last year over the closing of the Fort Erie hospital's emergency room. File photo by Doug Draper.

Doctors (and nurses) in many outlying areas of southern Ontario, where their workplaces, the hospitals,  are being dismantled apace, are faced with that very dilemma. To stay or to go. But no – ethics prevail.

Almost a year ago,  I visited the chairman of the Premier’s Panel on outlying hospitals. (His report, due over a year ago, was recently circulated.  To say the least, it was platitudinous nonsense.)  Coincidentally, and of much interest, that same chairman is also the well-paid CEO of the Kirkland Lake hospital.  That small gold mining town of about 8,000 people has a beautiful big hospital. Look at its picture below.  It has an emergency.  That lovely hospital has many beds, too, and few doctors.  It beckons.

At almost the same time that I was visiting several similar places up north, the far away Fort Erie hospital in the far southern tier of Niagara was already thoroughly dismantled. Almost totally inoperative.  No emergency.  No active beds. The local doctors had no place to do their tough work. And patients, young and old alike, were already dying en route – to elsewhere.  I must repeat: the isolated snow-town of Fort Erie, really a real city of thirty thousand people, has no really functioning hospital. Is there any doctor’s dilemma here? To stay or to go? Yes, there is. 
No proper doctor will abandon her hometown patients for greener fields afar.  Ethics prevail.

But the Premier’s Panel perhaps may think otherwise. Young graduates will avoid the spaces that have no places. To work, as the Panel says, “up to their capability,” they will go to where a good hospital is.  Any young doctor worth any salt will go to where s/he can deliver babies. And look after children. And be on emergency call.  And treat heart attacks. And care for their elderly.  And do all the things a really good doctor can.

Well, points north are beckoning. The old or frightened ‘health care providers’ will stay in the south. The ethical and well-established will stay too. But the new, young and adventurous nurses and doctors may just never arrive in the south at all. Straight from school – they’ll go north.
The Ministry of Health will soon, methinks, be advertising thus: We’ll provide you a workplace. If you are a well-rounded family MD who wants to ‘be all you can be,’ go north where the hospitals (still) are.

At Large.Dr. William Hogg is a retired medical doctor living in Fort Erie, Ontario and frequent contributor to Niagara At Large.

(Click on Niagara At Large at www.niagaraatlarge.com for more news and commentary on matters of interest and concern to residents in our greater binational Niagara region.)

18 responses to “Head North Young Doctors … Far Away From Fort Erie

  1. Thank you for providing an interesting “take” on hospital restructuring in Ontario — it’s vital that ordinary Ontario residents hear from doctors and other health professionals.
    The logic behind the restructuring of hospital services in our own little corner of the world — the Niagara region — continues to elude me. While staying with me and my family here in Welland as she does every Christmas holiday, my elderly aunt developed symptoms of what seems to be congestive heart failure. Thinking she was suffering from bronchitis, we took her to the Port Colborne UCC, where she was quickly triaged. As soon as word came that the Welland General had a bed for her, my aunt was sent there by ambulance, and admitted immediately. The bed, however, is in the WGH Emergency Room, where she has been since Friday night. It is now Monday, and there are no indications that there will be a bed available on a ward anytime soon.
    Visiting twice a day, for a minimum of an hour each time, it is impossible to miss the fact that the hallways of the ER are usually crowded with paramedics and patients on gurneys waiting for an ER cubicle to become available. Hospital and EMS staff are doing a remarkable job of caring for patients under these circumstances, and I am filled with admiration at their professionalism and consideration for those under their care.
    I have one question: how can the NHS continue to close beds at the Welland General in the name of “patient-centred care”, while the ER is clogged with patients needing beds? What is the argument for turning an emergency department into a virtual ward, one lacking any of the amenities, such as washrooms and bathing facilities, that contribute to the kind of comfort and well-being that help speed recovery?
    What is the WGH going to look like in 2013, when the HIP has been completely implemented? Can admitted patients expect to spend days in the ER, or does the NHS see this situation as a temporary “glitch”? Perhaps the Public Health Committee of the Niagara Regional Council can tease some answers to these questions out of the NHS. It’s high time residents were adequately informed.


  2. Excuse if this is repeated. The last posting didn’t seem to go through.
    I can tell you how they can close beds Fiona. They don’t give a shit. Medicine is now a business, not to the health care professionals but to the government and administrators. Wait until the Canada Health Act comes up for review in 2014. Welcome to US health care. If you can’t afford it, you don’t get it.


  3. The forces of privatisation secretly love this chaos. They want the public to accept the toxic myth that public health care doesn’t work, so the private system should be embraced. In fact public health care is far more efficient and cost-effective than private care. More importantly, well-funded universal public health care saves many more lives than the private model.


    • True Mark. This is like planned obsolescence. Keep doing things that have degraded the system in the past, like closing beds, so the government can claim the system is no longer sustainable. I worked in the system for many years and any idiot can see this was planned very carefully. If our system is so terrible, why is the US, “the best health care in the world” according to their politicians, rated by the World Health Organization at 37th just below Costa Rica and just above Slovenia. Now there’s something to aim for.
      I had a cousin who had surgery in Welland. (Cost to OHIP including hospitalization – $14,000). Her brother had identical surgery in South Carolina a week later. (Cost $62,000). This is called profit for the insurance companies. How thrilled they will be to get another market of 33 million plus!


  4. It frustrates me to continually read of how bad our health care system is with the recent changes.

    We, as Canadians, and especially Ontarians, are infact “spoiled” with our superior health care system.

    Having a baby, no problem, won’t cost you a penny. Had a heart attack, no problem, any followup surgery won’t cost you a penny. Smoked all your life, got cancer, no problem, your kimo treatment won’t cost you a penny.

    Johnny’s got a temperature, take him to emergency, won’t cost you a penny. And THAT is where the problem lies. If Johnny has a temperature, you give him a suitable childs aspirin, tuck him in bed and take care of him as a parent should. But no …… you rush him down to emergency.

    Our health system has been abused for years, by the very people who are complaining about it now.

    Fiona made a very valid point.

    Why, if she lives in Welland, did she take her aunt to Port Colborne?

    I suspect that the reason is because she knew that her aunt would be attended to quicker at Port Colborne. And she was. Was she directed to take her aunt to Welland, no. Did her aunt receive prompt, efficient care, yes.

    Frankly, I feel sorry for the residents in towns that have the emergency departments in their hospitals. A person requiring the same type of attention that Fiona’s aunt required would have to wait 6 to 8 hours.

    Our hospitals, even those that have lost certain services are capable of responding to everyones needs. Those without emergency responsibilities are able to respond quicker than those with.

    Think about it.

    I would like to add that publishing an article promoting that doctors leave our area is the type of thing that hurts our health care sysytem, quite contrary to the implied concerns of the writer.


  5. A breath of fresh air from a retired nurse.


  6. Costa Rican health care also took a nose dive because of privatization.


  7. Our “universal” health care is being dismantled by private interests. This is a very legitimate area of concern, especially since people are dying due to inadequate or non-existent Emergency Rooms. The private model of health care is far less efficient than the public model. Dr. Hogg and retired nurse Ms. McKellar are eminently qualified to criticize what was once a beloved, distinctive health care system in this country.


  8. Kudos to Justin Carn! It is refreshing to read a comment that ‘disagrees’ with a published article. But Justin’s arguments seem to come from a vacuum of misconceived perception. Perhaps he is one of those fortunate ones who doesn’t have to make much personal use of our deteriorating Health Care System. Let’s hope so for his sake. Otherwise he’s got his head in the sand or is an apologist for the government bureaucrats who now run our ‘privatizing’ Medicare. As far as recommending that doctors head north, I don’t actually. I merely, tongue in cheek, point out what could happen. And, ethics aside, if it does happen, there will be a long overdue equalization of medical service in the long deprived cold places up there beyond North Bay.


    • Dr. Hogg, we realize your article was partly tongue in cheek. It is true however, as you said, that doctors must go where they have adequate access to services they need. Nobody would want to be an internal medicine specialist on call 24/7 without others as backup and facilities for investigative procedures nor would a cardiac surgeon go where he has no facilities to perform his craft. Dedicated family MDs will remain in small towns but will work with tremendous pressure and difficulty re. such things as specialist consultations and advanced testing procedures.
      What Justin said is partly true. There is a lot of abuse and the public is spoiled in expecting instant service and can be very demanding as illustrated be a man who drove his car into an Emergency department because he was told his wait would be 45 minutes. Seems he was well enough to walk to his car! I have seen people go to their family MD, a walk-in clinic and an ER all in one day to get antibiotics for a cold (which as we all know is ridiculous). As I wheeled past a woman with the body of a 40 year old man who had just died of a heart attack, she said “I suppose THAT is what I was waiting for”! She had been sreaming at the staff because she had to wait @ 1/2 hour for a trivial complaint! How selfish and uncaring can you be!!!! Society today with computerization and everything predigested for them except food, expects instant gratification in every aspect of life. Good luck on that one!
      How can you run an ER for those who are true emergencies when you don’t even have a bed to put them in. Often ICU calibre patients are held in the ER because no ICU beds are available. This means an ER nurse often cares for the “nomadic” ER population who are coming and going, whatever emergencies come through the door PLUS one or more critical ICU patients who should have a 1:1 nurse. How is that good care? I personally have had to get sick people out of an ER bed to wait in the hall or back to the waiting room because I received someone in triage having a heart attack. How is that good care? I had a lady with a broken hip – VERY PAINFUL – sitting in a wheelchair for hours because I had no bed. How is that good care? THIS is what we complain about when we say that cutting beds is destroying the system, not the trivial stuff. Jason is lucky that he likely hasn’t had such an awful experience.
      The reason this ER backlog is happening is due to bed closures on the floors to meet budget constraints and the cenralization of services causing increased attendance at the remaining sites, also for budget reasons.
      The only thing that keeps the hospitals functioning as well as they do is the staff who do their absolute best with what little they have. Even many of them are so fed up and burned out that they are demoralized to the point that the public may justifiably find them impatient or even rude. How much pressure can they take while the so called administrators (who really don’t administrate but hire consultants out their ying-yang) draw fat pay checks? I would like to see them on the front lines for a day in their crisp suits and high heels. (Oops, I’m getting on a rant here -sorry, but it upsets me). We do still have very good health care but that sure isn’t due to the powers that be.
      Maybe I’m paranoid, but the system is being destroyed and, I believe intentionally so, in order to facilitate the takeover by private interests so the government abrogate its responsibilities and waste our tax dollars on more G20’s and the like.
      As I’ve said before, the system has reduced my proud profession to crowd control. I fear for the future because very few will go into nursing in the future (with the attitude and devotion it requires). Sad.


  9. Well said. And once the private system becomes entrenched , it will be hard or impossible to get rid of it. NAFTA treaties etc. will protect them.


  10. Dr. Hogg and Linda McKellar,

    You are BOTH right. Having just celebrated by 61st bithday and I am fortunate that throughout my life have only been required to stay in the hospital over night on one occassion. The day I was born.

    I tend to get a little hot under the collar when I read articles promoting that people leave Fort Erie. As you pointed out Dr. Hogg, I misinterpreted your comments and for that I apologize.

    Ms. McKellar, your writings enlightened me on what is going on in the hospitals. I understand that the Welland Hospital is dealing with a lot of issues which result in extended waiting times. You and your co-workers are appreciated in these trying times.

    I best keep my nose in subjects that I am more familiar with, and leave the educated discussions to those more knowledgable.

    Keep up the fight, I’ll probably have to go to the hospital someday …..lol.



    • Certainly no need for apology Justin. Your point re. abuse was perfectly valid. Unless someone has personally been caught up in some of these horrible situations they have no way of knowing what goes on. That is why I feel many people are so complacent when they should be screaming bloody murder. The old “don’t know what you got ’til it’s gone” syndrome. If someone has never needed emergency services or hospitalization, (often stuck on an uncomfortable stretcher in a hallway in a noisy ER with no privacy due to lack of beds), they are unaware of the acuity of the situation. They don’t even think about it. It is only when they need the services that they suddenly realize just how important the services are to them.


  11. Capitalizing upon medical expertise and running hospitals for instant profit is not a sustainable business in the long run. Why? Medicare, now called ‘health’ care, like recreation, etc., is a service ‘industry,’ not a genuine goods-producing industry. The wealth and buying power of people living on a continent that outsources much of its goods production will eventually go down and they’ll be neither able to afford to go skiing when young nor get medical and health care when old. The private partners of our misguided government therefore will get a windfall profit from the huge monster hospitals they are putting up and then the whole false-enterprise will collapse or fizzle out. How long will it take? I guess between 20-30 years. Then everyone will clamour for socially-supported public health care (a la Tommy Douglas) all over again. But, public health care delivery doesn’t fit the big business supply and demand equation. Demand always exceeds supply. So, until our governments learn that reality, the noxious cycle of kind public service to crass private profit to public to private and back again will repeat ad nauseam.


  12. Private enterprises have strong protections with NAFTA. I’m not sure how much we can get back once it’s lost.

    Chapter 11 of NAFTA needs to be revoked.


  13. Having just come back from southern USA and remembering the often remarked statement by Americans who were on hand to commission a production line in a “Once” owned Canadian Steel Mill (There are now none) I quote “A donut shop on every corner” in Canada.
    “Well!! Along US 675 in Ohio It is not donut shops that are springing up but huge hospitals are rising at a rate that astonishes the mind and makes one realize profit comes before medical treatment. Even before these mausoleums to corporate (for profit) medical care are completed they are building additions knowing they will be profitable.

    It comes to mind how Regional Councilor Rigby often states that the “New” Hospital mausoleum being built in the big region of St Catharines was never meant as a “Regional” Hospital but a hospital built for the peoples of St Catharines.
    Hey Rigby, that’s fine but when you Goulbourne and Salci lobbied in Queens Park for that Hospital it seemed to be a Regional One?????
    Yes Rigby, that hospital you guys lobbied for is being built where you wanted it BUT it was built at the expense of the peoples of the Niagara Region South and whywe ask are we the southern peoples having to cough up a red cent to pay for “YOUR” Hospital??

    The NHS was and still is as secretive as the KGB and is now laughing at the peoples they screwed in the southern region of Niagara ..Shame Shame!!!


  14. By and large I agree with most of what was said. We seem to forget the rule that all politicians/business live by. Very simply – 1 know where you want to be. 2 create a problem for the people. 3 let them stew for a while. 4 when they get fed up with the situation ,suggest a solution (all ready and waiting). The sheepl will thank you for taking them (blindly) to the place they wanted to be that you are now ready, willing and eager to accept with; “Thank you oh people of great knowledge.” Wake up! Want a solution I have one all ready!


  15. The Health Resource Centre, a private hospital in Calgary, recently went bankrupt. And the tax payers will be picking up the tab. No surprise there.


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