Viewpoint

The Emergency Care Crisis in Rural Canada

by Ana Piric

Graphic design by Vicky Lin

No one expected emergency departments’ 24/7 availability to come to an end. Many rural towns across Canada are experiencing reduced emergency department hours, operating only during daylight and with planned evening and weekend closures.1 In Chesley, a small community in Bruce County, Ontario, the emergency room (ER) has been open only on weekdays from 7a.m. to 5p.m. since 2022.2,3 In addition, countless unplanned closures have left patients stranded with no option besides travelling to the closest town with an open emergency department.1 Even according to Natalie Mehra, the Executive Director of the Ontario Health Coalition, ER closures have become so severe that “it’s at the point that if a hospital ER is closed in one place, there’s no guarantee the one at the next-closest hospital is open.”2 Similarly, The Globe and Mail reports that 34% of Canadian ERs have experienced a closure since 2019, collectively totalling 1.14 million hours or 47,500 days.1 

While the pandemic deepened discrepancies in rural emergency care, unequal access to care is nothing new. In 2015, just 11.8% of Canadian nurses served rural or remote communities, despite these areas representing approximately 17.8% of the population.4 Even recent data from 2024 demonstrated only 7% of physicians in Canada practiced in rural areas.5 Recruitment and retention of healthcare workers has long been imbalanced in rural compared to urban communities across Canada due to challenges with attracting healthcare workers.6,7 Contributing factors include limited hospital financial resources and infrastructure, the geographic isolation of communities resulting in reduced access to transit and schools, and increased burnout in overworked hospitals.7,8 These recruitment challenges contribute to a snowball effect of reduced access to primary and emergency care, ER closures, and ultimately, poorer health outcomes for patients in rural areas.6 Furthermore, generations of residents are faced with the difficult choice of leaving their smaller hometowns due to limited healthcare access.1,2 With over 350 physician vacancies in Northern Ontario alone, 7 it’s clear that this already concerning issue will worsen if effective solutions are not implemented.

The cycle of instability in emergency care systems causes further problems, as unpredictable closures deter new healthcare workers from accepting positions at rural ERs.2 One solution is hiring locum physicians and nurses who temporarily step in and fill desperately-needed positions that would otherwise be offered as permanent roles.6,7 While this approach bridges the staffing gap, several other issues have emerged. Locum physicians and nurses are compensated by the provincial government, but hospitals often provide incentives by topping up their salary and paying for expenses such as accommodations, flights, and car rentals.7 These financial benefits hinder long-term solutions by de-incentivizing healthcare workers from accepting permanent positions.6 Top-up practices also lead to competition for emergency care between hospitals in neighbouring towns, further contributing to poor health care outcomes.7  

The Ontario and municipal governments have additionally proposed that some ERs be reclassified as urgent care centers to redistribute resources and healthcare staff based on the level of care patients require.1 In contrast to ERs, urgent care centers (UCCs) provide same-day care for pressing, yet non-life-threatening concerns; UCCs often operate later than walk-in clinics, but close nightly. It is possible that reclassifying ERs into UCCs could lead to shorter wait times and less crowding, ensuring more timely care and improved patient outcomes.1 Conversely, the issue with reclassifying ERs into UCCs lies in the fact that round-the-clock access is no longer the status quo. Without improvements in accessing emergency care in ERs, reclassification is not a long-term solution, and inequities in accessing emergency care will be deepened.6,9 

Systemic solutions aimed at achieving long-term impacts are being implemented. As of September 2024, there has been increased funding from the Ontario government to enhance physician compensation in ERs and standardise pay for physicians in rural areas.10 In August 2025, the Ontario government aimed to address nursing shortages by expanding the number of nursing training and education seats at Ontario colleges and universities.11 To alleviate physician shortages, the Northern Ontario School of Medicine has established a social accountability mandate to promote medical school enrollment from students in rural, Francophone, and Aboriginal communities in Northern Ontario and to encourage graduating physicians to practice in their home communities.12 This program has successfully retained 50% of physicians in independent practice within Northern communities; however, more physicians continue to settle in larger centres across Northern Ontario rather than rural communities.12 As a parallel effort, initiatives like the Ontario government’s Learn and Stay grant and the Canadian government’s Canada Student Loan Forgiveness program aim to encourage healthcare program graduates to provide care in underserved rural or remote communities.13,14 Ontario’s Learn and Stay grant covers educational costs for students enrolled in priority programs such as nursing, paramedic, and laboratory technologist programs in underserved communities as long as they work a term in the same community after graduation.13  Similarly, through the Canada Student Loan Forgiveness program, family medicine physicians and residents are eligible for $60,000 in loan forgiveness while nurses are eligible for $30,000 in loan forgiveness for five years of work in underserved or rural communities.14 It is only through continued targeted actions such as these, which address the underlying issues in attracting and retaining healthcare workers, that ERs can return to providing reliable 24/7 care.

Rural ERs are in crisis. Patients requiring immediate care are considered lucky if their local ERs are open and often have to travel to neighbouring ERs, which may or may not be open.2 Consequently, healthcare staff are discouraged from working in rural ERs, perpetuating a cycle of instability.2 Addressing discrepancies in emergency care in rural communities requires urgent, intentional decision-making that reflects the underlying issues in rural health care to ensure long-term impacts. While progress has been made in the right direction, continued efforts are needed to eliminate emergency care inequities in rural areas across Canada.

References

  1. Drawing more doctors and nurses to rural and remote communities through Canada Student Loan forgiveness. Government of Canada [Internet]. 2025. [cited 2025 Oct 25]. Available from: https://www.canada.ca/en/employment-social-development/news/2025/03/drawing-more-doctors-and-nurses-to-rural-and-remote-communities-through-canada-student-loan-forgiveness.html
  2. Raman-Wilims M, Thanh Ha T, Grant K. Canada’s emergency room crisis is worse than we thought. The Decibel: A Daily News podcast from the Globe and Mail [Internet podcast]. 2025 [cited 2025 Oct 25]. Available from: https://www.theglobeandmail.com/podcasts/the-decibel/ 
  3. Kerr P. Ontario Health Coalition warns that Chesley Hospital most at risk of closure in the province. Ontario Health Coalition [Internet]. 2023 [cited 2025 Oct 25]. Available from: https://www.ontariohealthcoalition.ca/index.php/ontario-health-coalition-warns-that-chesley-hospital-most-at-risk-of-closure-in-the-province-2/ 
  4. Bhargava I. Rural Ontario residents offer solutions amid emergency room closures at local hospitals. CBC News [Internet]. 2024 [cited 2025 Oct 25]. Available from: https://www.cbc.ca/news/canada/london/rural-ontario-residents-offer-solutions-amid-emergency-room-closures-at-local-hospitals-1.7383545 
  5. Macleod MLP, Stewart NJ, Kulig JC, et al. Nurses who work in rural and remote communities in Canada: a national survey. Human Resources for Health [Internet] 2017;15(1). Available from: https://dx.doi.org/10.1186/s12960-017-0209-0
  6. A profile of physicians in Canada. Canada Institute for Health Sciences [Internet]. 2025 [cited 2025 November 5]. Available from: https://www.cihi.ca/en/a-profile-of-physicians-in-canada 
  7. Ireton J, Ouellet V. 2024 Worst Year for Ontario ER closures, CBC analysis finds. CBC News [Internet]. 2024 [cited 2025 Oct 25]. Available from: https://www.cbc.ca/news/canada/ottawa/data-analysis-er-closures-three-years-2024-worst-year-for-scheduled-closures-1.7396789 
  8. Hassan S. Rural Ontario hospitals offering hefty incentives for traveling doctors amid shortage. Global News [Internet]. 2025 [cited 2025 Oct 25]. Available from: https://globalnews.ca/news/11312973/rural-ontario-hospitals-offering-hefty-incentives-for-traveling-doctors-amid-shortage/ 
  9. Challenges and Opportunities in Recruiting Rural Healthcare Workers. Supplemental Health Centre [Internet]. 2024 [cited 2025 Nov 10]. Available from: https://shccares.com/blog/workforce-solutions/rural-healthcare-recruiting-challenges/ 
  10. Ireton J. Should some rural ERs close permanently if better supports are in place? CBC News [Internet]. 2024 [cited 2025 Oct 25]. Available from: https://www.cbc.ca/news/canada/ottawa/rural-er-issues-should-some-close-permanently-1.7402517
  11. Ontario Government and Ontario Medical Association Confirm Funding Increase That Will Protect Provincial Health Care. Ontario Newsroom [Internet]. 2025 [cited 2025 Oct 25]. Available from: https://news.ontario.ca/en/release/1005805/ontario-government-and-ontario-medical-association-confirm-funding-increase-that-will-protect-provincial-health-care 
  12. Ontario Government and Ontario Medical Association Confirm Funding Increase That Will Protect Provincial Health Care. Ontario Newsroom [Internet]. 2025 [cited 2025 Oct 25]. Available from: https://news.ontario.ca/en/release/1006278/ontario-investing-568-million-to-expand-nursing-enrollment 
  13. Ross B, Newbery S, Cameron E, et al. Rurally focussed undergraduate medical education at the Northern Ontario School of Medicine University. Canadian Journal of Rural Medicine. [Internet] 2025;30(2):101-102. Available from: https://journals.lww.com/cjrm/fulltext/2025/04000/rurally_focussed_undergraduate_medical_education.10.aspx 
  14. Ontario Expanding Learn and Stay Grant to Train More Health Care Workers. Ontario Newsroom [Internet]. 2023. [cited 2025 Oct 25]. Available from: https://news.ontario.ca/en/release/1002652/ontario-expanding-learn-and-stay-grant-to-train-more-health-care-workers