The GNWT just bumped up pay for locum physicians. Here’s why.

NWT doctors say Stanton Territorial Hospital has so few physicians that its emergency room is in danger of closing. Healthcare bosses insist that will not happen and are increasing pay to address part of the problem.

Either way, the conversation of recent days – which came mostly in briefings with MLAs – suggests the territory’s main hospital is being pushed closer to the edge of what it can manage.

“There’s a weekend in May where we’ve only got one physician currently scheduled for most of the days. We have no idea how we’re going to keep the doors of the emergency department open,” said Courtney Howard, an emergency room physician and president of the NWT Medical Association, last week.

“There will be no closure of emergency departments,” territorial health authority administrator Dan Florizone told Cabin Radio in response.

“An emergency department would be the last thing we’d want to close … We’re going to do everything we have to do, and can do, to avoid that.”

On Wednesday evening, the health authority said it was increasing locum rates and taking other steps to try to bring in more staff from June onward.

So how bad is the situation, what might happen next, and what’s being done to address that? Here’s what we know so far.

Why is there a problem in May?

The picture painted by the NWT Medical Association (which represents the territory’s physicians) is of staffing issues gradually getting worse, to the point where there are simply too few people to do the job.

Howard says around half of the physician shifts in Stanton’s emergency room – there are four shifts per day – are staffed for the next four or five months.

According to her, the May long weekend is a particular concern and, for the first time, physicians are wrestling with what it would mean to close the Stanton emergency room, which is based in Yellowknife and serves the entire territory.

“We’ve never before had to choose between leaving the emerge uncovered and making someone work for 24 hours, and we’re going to end up in that position,” Howard told the CBC. “We don’t really have a backup plan.”

Health authority administrator Florizone insists no closure will take place. He represents healthcare leadership. Howard leads the association that speaks for doctors and represents them in bargaining with the GNWT.

Both Florizone and Howard emphasize how important Stanton is as a hub for territorial emergency care. Unlike in the south, you cannot simply drive to the next nearby ER.

“The minimum staffing to be able to run emergency services will continue,” Florizone said.

“We’ll look at alternate providers. We’ll look at alternate locums. We’ll look at southern connections, the whole network of physicians that we have to be able to secure those services.”

Florizone said if none of those options work out and there is a disruption in service at Stanton, “we’ll be clear and transparent with the public on that – we’ll let you know what we know, when we know it.”

What happens if the Stanton ER closes?

“We would probably have to call in military medics to cover the gap. I genuinely don’t see that we could close with any degree of safety,” Howard said last week.

The health authority has said it will not consider closing Stanton’s emergency room and will find some way – any way – to keep the doors open.

The alternatives, like sending every NWT patient by medevac to Alberta, would involve mind-bogglingly complicated logistics and great expense.

What is the new announcement on locum rates?

The NWT’s health authority says it is increasing rates for locums – physicians who come here from elsewhere to work temporarily – effective June 1.

If you’re a locum who comes here for more than 75 working days in any given financial year, you’ll get a new bonus. (The amount wasn’t specified.) There are also increased standard daily rates “designed to target hard-to-recruit physician work, particularly in small communities.”

The health authority is committing to paying locums a travel stipend and offering new premium rates for night shifts at Stanton.

Why did the health authority need to do this?

The NWT healthcare system’s struggle to find staff has been an issue for years. One of the big problems appears to be that the territory’s pay is no longer as competitive as it once was.

“This is a market problem. People will simply go to where they’re paid more,” Howard told the CBC. “When I moved up here 15 years ago, we were paid a little bit more. Now we’re hearing from locums that when they’re coming, they’re usually taking a pay cut to come to the North.”

She gave the example of Vancouver Island, where she said some locums are being paid “almost double” what you can earn for a night shift in the NWT.

Florizone only started in his job a few months ago, replacing a leadership council that was controversially scrapped. He agrees on the pay issue.

“The key consideration when you’re competing for practitioners across the country and even internationally is that we have to have rates of remuneration that are high enough to attract them,” he said.

Howard (who is herself a locum right now) says any increase in locum pay must take place alongside a concerted effort to improve terms for contract doctors who actually live in the territory.

The NWTMA wants a new approach to collective bargaining for physicians, known as interest-based bargaining, which tries to take the position that both sides have something to gain rather than falling into an adversarial stance. Florizone said the health authority “acknowledges and supports” that idea.

It sounds like Florizone and the physicians agree a lot.

Florizone has gone out of his way – in interviews and briefings with MLAs – to praise the physicians’ association and its leadership.

In return, the physicians’ association has expressed slightly more guarded optimism about the relatively new relationship between the two.

“We see that he definitely feels he has a task ahead of him. We see some urgency with it, in his eyes and in his voice when he’s speaking with us,” said Howard.

She appeared to suggest the physicians’ association was struggling to get a request approved for monthly meetings with healthcare bosses. Florizone told Cabin Radio leaders had “agreed to meet more often.”

Is this just a pay issue?

It sounds like a large part of the problem could be solved by offering to pay more than anywhere else in Canada – but the rest of Canada unfortunately seems to have the same idea.

That means provinces and territories could end up in an ever-spiralling battle to pay the most and attract the few available staff.

There are at least two other factors at play. One is management and working environment, and the other is what’s happening to our population.

Let’s start with population.

The NWT’s population is getting older. There are more seniors and fewer people of working age. In the field of healthcare, this means fewer working-age doctors and more seniors who need treatment.

“The elderly population has increased dramatically,” Stanton orthopedic surgeon Danielle Stachiw told MLAs last week.

In the past two decades, Stachiw said, the population over 70 has more than doubled and “demand for healthcare in the NWT is skyrocketing.”

Stachiw said she would see at most one or two patients with hip fractures each month when she started her job – hip fractures being more common among older people.

Now, she can expect to treat several hip fractures a week.

“These patients require urgent surgery. They have prolonged admissions afterwards. However, operating room nursing levels and anesthesia staffing have not increased in 20 years,” Stachiw said.

This is playing out across Canada, which is an underlying cause of the shortage in healthcare staff and increasing demand on the system.

With no fresh baby boom having occurred in recent decades, it’s not clear how the country will be able to implement the kind of change needed to drastically increase staffing. (Technology, which we’ll come back to, might help.)

And what about the work environment?

Money isn’t the only thing that dictates where people choose to live and work. Some people can be enticed to the NWT for its people, its landscapes and its way of life.

But physicians also have frustrations with management that they have aired in front of MLAs – both at public briefings and in private.

“I’m not just hearing from doctors. I’m hearing from other kinds of healthcare practitioners within the system,” said Yellowknife North MLA Shauna Morgan. “There was frustration all around.”

Morgan was referring to changes in Yellowknife’s primary care system. Some physicians say those changes – like the move from 10 to four teams – happened without prior consultation and caused fresh problems, even as managers sought to solve old ones.

Concerns include a perceived lack of appropriate staffing on the new teams, a high administrative workload that keeps doctors from seeing the number of patients they would like, and a knock-on impact for care provided to smaller communities.

The message to MLAs has been that staff had meaningful input they could have provided, but changes occurred without that.

“That’s why people are leaving. They don’t feel heard, they don’t feel part of the process,” Stachiw said at a briefing last week. “And I, personally, have not seen much shift towards that.”

“Every physician in NWT would like to see care being moved toward integrative team-based care. However, just making a team doesn’t check the box. You have to actually staff that team.” added Cassie Mooney, a physician in Yellowknife.

“Everyone is just very gunshy to have a meeting in the same room with each other, because it always seems to be heated.”

Florizone says he wants to tackle this head-on.

“They want voice and engagement … I’m here to say, ‘Bring it on.’ We want to have you connected,” he told Cabin Radio.

“You’re essential to our delivery of care. Your ideas? Bring those on too, because we want to try some of them and test them. And you know what? If they work, let’s see if they work by Tuesday.

“Let’s try some things in the next few weeks and if they fail, they fail. But I think the vast majority of great people will come up with great ideas that we can test. Not all of them cost money.”

Is there anything else we can try?

Howard pointed out that the Trump administration is making the United States a fairly hostile working environment for some healthcare workers, and both Canada and the NWT could look to capitalize on that.

Technology, too, is an increasingly big deal. Improvements to virtual care, for example, could make it easier to deliver care to small communities, while AI is being used by doctors to handle some of the writing that otherwise eats up hours they could spend with patients.

Florizone says he’s on board with pursuing any technological improvements that will help.

He says his priorities are improving recruitment and retention, plus improving access to healthcare outside Yellowknife to cut down on patient trips to the territorial capital – or Alberta.

“We’re paying for it, and we’re paying in a big way,” he said of medical travel.

“If you were to offer [communities] the best of the best in virtual access, in itinerant services, in types of chronic disease support, it will prevent the crisis that leads to an emergency admission or potentially even a transfer south.

“We’ve got to disrupt what’s going on now, because we’ve been caught in episodic firefighting. We can get upstream of this and start asking: what could avoid the crisis in the first place?”