急诊室危机与家庭医学十字路口：安大略省医生为何深陷倦怠？

Jan Jagenovan: When you think you're having a health emergency, what do you do? You get yourself to the hospital as fast as you can. And then all too often, you wait and wait, sometimes a really, really long time. It can be stressful and exhausting. And not just for patients. It's taking a toll on ER doctors as well. One recent Canadian study found nearly half of the emergency doctors surveyed had cut back their hours. 10% had left the profession entirely. So, what's driving all of this and what would it take to keep these doctors? We talked to two physicians and hear their stories.

One reason so many people are turning up at the ER is because they can't go see their family doctor because they don't have one and the situation could get even worse. One study found just 42% of medical students were considering a career in family medicine. So, why don't more people want to become family doctors and what would it take to change that? I'm Jan Jagenovan. Welcome to the rundown.

Okay, let's go back to that ER doctor study from the Canadian Medical Association Journal for a minute. In that survey, researchers asked doctors to share their experiences, and some clear themes emerged. A health care system under pressure, difficult working conditions, and wanting to leave emergency medicine. Are we at a crisis point?

Dr. Rodrik Lim, Dr. Farzan Arsari, great to have you on the rundown. Hope you're doing well. Dr. Lim, you are a seasoned emergency physician who was part of a team conducting a nationwide study that surveyed physicians from April 2020 to January 2025. Lots have changed in between that time. A pretty a lot of important stuff and a lot of hard things happened during that time for doctors and patients. Help me understand what changes did you see in emergency departments that explain the burnout?

Dr. Rodrik Lim: Yeah, I mean we've been suffering from worries around burnout in emergency medicine prior to the COVID pandemic. We actually had done some studies prior showing quite a high rate of burnout, higher than most medical specialties in Canada. And this was of great concern to us, our colleagues and and our national organization. We were lucky enough to try to dig into that and form a a study that would follow the same physicians through the many years from 2020 to now and get a snapshot of how things are changing and it happened to fall right in the middle of the pandemic, the post pandemic and kind of where we are now.

And as anyone who has a family or or or thinks about their own lives, you know, it feels like we've had nine lives in the last five years, many many different situations. The constant through it, however, is that we're unfortunately extremely unhealthy work environment. We're in an environment that is hurting us. That is leading to burnout. It's affecting patient care. It's affecting our ability to staff departments. It's affecting our pipeline down the road. And it's it's a it's a great concern. So, you know, a lot of energy has gone to study this to try to understand it. And I'm really glad to be part of part of that.

Jan Jagenovan: Dr. Ansari, I see you nodding your head. You're an emergency medicine resident. Does what Dr. Lim is saying, does that resonate with what you're seeing on the ground?

Dr. Farzan Ansari: Yeah, absolutely. I think he hit the nail on the head in terms of explaining what we're going through. It is an ongoing crisis. And when I reflect on my training, prior to COVID, emergency doctors were heralded as some of the most resilient people within the healthcare system. And with COVID and other challenges that came up, you started seeing that peel away.

And that's why this study is so great and groundbreaking, because it doesn't just show one point in time, but it shows us that it's not a question of individual resilience anymore, but these physicians who are already quite resilient, highly motivated, are in this environment. And I think what this study shows is that it's now chipped away at self-efficacy, their sense of accomplishment. And what this tells me that this deserves to be looked at as a workforce and as a system issue ultimately.

Jan Jagenovan: Dr. Lim, um Dr. Ansari mentions emotional exhaustion. There's de dep personalization, sense of decreased personal accomplishment as well. Help me understand how does all of this affect not only an emergency physician's life on the clock but outside of the ER room as well.

Dr. Rodrik Lim: Yeah, that's a great question and I think one thing that's really important to clear up is that these are incredibly resilient, you know, amazingly dedicated physicians who love what they do. They love their patients. They wouldn't be doing it otherwise, to meet people at potentially the worst time in their lives.

However, you can only run so long when you're in an environment that is challenging, where patients are having to wait for 10, 12, 14 hours, they're in hallways, they're in conditions that you know are not the best for them. And to take that on, the guilt, the ethical and and moral burden of that day after day after day, for extended periods of time it's gonna you're going to take it home. And obviously none of us want that to happen.

Jan Jagenovan: Dr. Ansari with patients having to wait long hours in ERs. How does this affect the learning experience for someone like you? Um, and you know, as a resident sort of what comes through your mind?

Dr. Farzan Ansari: It has a profound impact. On a learning level, when you're seeing patients who have waited 8 to 12 hours, the interaction starts differently. You're dealing with a lot of frustration, a lot of anger, understandably, from patients and their families. So a lot of your cognitive load and emotional energy is spent trying to de-escalate and build rapport under compromised circumstances.

Beyond that, the educational experience is compromised because the attending physicians, our preceptors, are under immense pressure to move patients through and manage the sheer volume. That leaves less time for dedicated teaching, debriefing, and the kind of mentorship that builds confidence.

And as a resident, looking ahead, you wonder: is this sustainable? Is this what the next 20, 30 years of my career is going to look like? We need to focus on fixing these problems, and not just teaching learners today how to tolerate them moving forward.

Jan Jagenovan: Dr. Ansari, help me understand a little bit of sort of call it a reality check for you when you're in the hospital in an ER and you're dealing with a patient in a chair, not even in a bed. Tell me sort of the challenges there. I guess we call that chair medicine is the term that's been sort of coined for that, but tell me the little realities that you're dealing with that.

Dr. Farzan Ansari: It's it's definitely tough. I think starting in my medical career, we ultimately had hallway medicine and then now we've gotten to a point where we are so filled up in our hospitals and now we we're going towards chair medicine. And I think it it it's very difficult to be able to see a patient in a chair and then be able to provide them with the dignity that they deserve in some of the toughest moments of their lives and be able to get the full history, ask very sensitive questions. And I think that's been a tough aspect of having to to see these patients who are who are overcrowded in our inside of our emergency department as well in in the chairs.

Jan Jagenovan: Now we did reach out to the Ministry of Health and they emphasized investments in staffing, training and hospital capacity. I want to read part of what that statement reads. It starts as "as part of our plan to provide the right care in the right place, we are helping to reduce emergency department crowding and improve patient flow. We are adding hospital bed capacity, expanding interprofessional primary care teams, and investing across the province to train and recruit more health professionals, including nurses, but also in the emergency department as well." Does that help?

Dr. Rodrik Lim: You know, I think everybody realizes that we're dealing with a massive, huge problem that does not have a single solution. And any investments are welcome, obviously, and needed. But emergency departments don't operate in a silo. We are the barometer of the entire healthcare system and society.

If the downstream beds aren't available, if long-term care isn't available, patients get stuck in the hospital. If primary care isn't available, patients come to the ER. So ensuring that patients can traverse through the system in an ethical, expert, and humane way should be everyone's goal.

Jan Jagenovan: Now, Dr. Ansari. The province did also say that they hit a 10-year low in bed blocking by moving recovered patients into the right care facilities, freeing up space. What they say is equivalent to two large community hospitals. Now, I understand this is a as we mentioned a structural problem. This isn't something that a government inherited. This is a a long-term plan look at the space to be able to discharge these patients and ultimately free up the bed.

Dr. Farzan Ansari: Well, to be honest, when you're on shift in the middle of the night, those aggregate statistics don't always translate into a tangible difference on the front lines. Even if certain metrics show improvements on paper, the day-to-day reality in the emergency department remains defined by long waits, overcrowded waiting rooms, and admitted patients who are boarded in the emergency department because there are simply no inpatient beds upstairs.

Until the moment arrives where an admitted patient doesn't have to wait 24 hours in the hallway or on a stretcher in the ER, the front line will continue to feel that pressure. That's why we need to see that downstream continuum of care truly materialize on the ground.

Jan Jagenovan: Dr. Lim, what role does mentorship play in helping you know residents like Dr. Ansari manage the pressures of emergency medicine? I imagine there are conversations where you know there are limitations to what you're able to do because of the structures. How do you help navigate all of those?

Dr. Rodrik Lim: Yeah, that's a that's a wonderful question. You know, on the other side of this, the issue is definitely important to us and we're not going to give up. We know that this next generation of physicians is the future of our health care system.

Mentorship isn't just about clinical knowledge or procedural skills; it's about navigating the emotional and moral landscape of medicine. We have to create safe spaces to talk about moral injury, about burnout, about boundaries. We have to remind them that systemic failure is not personal failure. You cannot carry the entire weight of a broken system on your shoulders alone. We have to care for each other so that we can bring the best version of ourselves to help not only the new generation physicians, but the patients in front of us.

Jan Jagenovan: Dr. Lim, very quickly, you know, I don't think anyone would blame you if you decide to pack your bags. You've been in this industry for quite a while. You have seen a lot and a lot change. Is there a message or if you we had the minister of health across the table, what message would you have for them?

Dr. Rodrik Lim: Yeah, I mean I think you don't have to look far—listen to the front-line healthcare workers and trust their insights. Emergency physicians, nurses, allied health professionals—we are not asking for luxuries; we are asking for an environment where we can deliver safe, dignified, compassionate care. Value your workforce as your greatest asset, not as an infinite resource that can simply absorb an ever-increasing strain without breaking.

Jan Jagenovan: Dr. Lim, Dr. Ansari, thank you so much for what you do. Thank you so much for taking the time with us on the rundown.

Dr. Farzan Ansari / Dr. Rodrik Lim: Thank you. Thank you. [music]

Jan Jagenovan: Okay, we've heard that part of the ER crisis is being caused by another big issue in healthcare. Too many Ontarians don't have GPs. As of last year, we're talking millions of people. That's the patient side. But what's it like right now to be one of those precious GPs? What kind of pressures are they facing? And what could we do to get more medical students interested in family medicine?

Dr. Jennifer Wilson, Dr. Carly Jensen. Great to have you on the rundown. How are you both doing?

Dr. Jennifer Wilson: Great.

Dr. Carly Jensen: Great. So happy to be here.

Jan Jagenovan: Well, congratulations on Family Rooms. You both served as doctors in the rural community of Uxbridge for over 20 years. You have found yourselves in places not only clinics, ER rooms, talking patients homes, sometimes grocery stores, where you are treating people, but help me understand what pushed you both to sort of share these real-time stories in this book.

Dr. Jennifer Wilson: Well, Canadian family medicine's at a bit of a crossroads right now. I prefer to say crossroads than crisis, but there's 6.7 million Canadians without access to family medicine and primary care. Millions in Ontario are in the same situation.

So, while there's a lot of efforts underway to increase family physicians in the future, Carly and I felt there was something really important missing from the conversation and that is the joy of what family medicine actually is and the importance of family medicine to a population to a society. And so, we thought how what can we do? What can we do to help create a positive narrative around family medicine so students will choose it so that our colleagues will remain in it and we thought perhaps we could use the power of storytelling to change the narrative from what's primarily a negative one right now to something positive which is profession we love and we value. So this book is a collection of true stories of the work that we do with our patients.

Jan Jagenovan: Well Carly maybe you can share a story or two of sort of some of the patients that kind help explain sort of not only the the crossroads as Dr. Wilson has sort of laid out here, but that really takes us home.

Dr. Carly Jensen: Sure. Well, you know, family medicine above all is really about relationships. And so, this book is full of those relationships. And those relationships, they give a great deal of purpose and meaning to what we do. And like that's really the fuel. And it's I think it's the balm or the sort of the tincture for burnout, right? So, if if you look around, you know, why are people not practicing much? I think they've lost that connection to the people.

And so, you know, I've got a lovely couple that I looked after for many years who are big players in one of the chapters. And, you know, you can probably even see in my face when I think about them. I smile. And so, to be able to show up at the bedside of a patient encounter and smile because I'm not just treating the disease, I'm treating that person. It makes for a beautiful practice.

Jan Jagenovan: Jennifer, let's pick up on a little bit of the what's driving some physicians away from the practice of family medicine or at least making them think twice about it.

Dr. Jennifer Wilson: Well, there's very real challenges and and we face them every day. Um there are issues around physician burnout. You know, Carly and I are also emergency room physicians. There's a high level of burnout amongst our emergency room colleagues as well as family physicians. Uh we hear a lot about the administrative burden. We're we're stuck doing paperwork when we want to be serving with patients. There's access issues. There's not enough of us. So our patients can't get in to see us because we're full.

Dr. Jennifer Wilson: Um compensation issues are something I'd rather not talk about, but it's it's a reality. These are all factors that are contributing to physicians moving out of family medicine or perhaps choosing to focus their practice on something more narrow or more specific rather than staying comprehensive and broad. They're very real challenges and and and we face them every day and they have to be acknowledged and they have to be dealt with.

Jan Jagenovan: I'm scared to ask this, but how many hours a day are you putting into your practice? Uh from administrative to seeing patients to maybe even like after calls or you know just checking on a patient that you're you know you're you're worried about.

Dr. Jennifer Wilson: Yeah, it's a fair question. I mean Carly and I are both full-time family physicians. So um we're full-time our full-time work includes our office shifts, our emergency room shifts, our hospital work, and our home visits. We're also faculty members at the department of family medicine. So we're teaching we're teaching regularly and and full-time.

But the key for us is we're part of a team. We're part of an amazing team of family physicians in our clinic, in our hospital. And so we have to be very strategic about how we do life. We have had we have children that we've raised and um you know, family members and other commitments outside of medicine.

Jan Jagenovan: All right, I want to take a shift and look at what we're seeing here in the province in terms of a bit of a focus on on family medicine here. Toronto Metropolitan University's med school opened its doors just last year and soon we'll be seeing a brand new med school at York University set to open 2028. They've got a core mandate to train more family doctors and I am curious, is this reassuring for you or is there still a lack of emphasis on the practice of family doctors?

Dr. Jennifer Wilson: Well, I think it's very positive. Okay. It's very positive and and the Queens-Lakeridge program is the first in Canada that is actually you're entering medical school with a commitment to go on to family medicine full six years and I've been one of the teachers in that program too. These are these are wonderful initiatives and Jane Philpott's work to attach every every Ontarian to a primary care team. It's hopeful. It's wonderful. But we still have to convince these medical students to choose family medicine.

Jan Jagenovan: What are they choosing instead? What is something that is like something you're competing against?

Dr. Jennifer Wilson: Oh, well, do you want to answer that? All the specialties.

Dr. Carly Jensen: Physiologies.

Dr. Jennifer Wilson: Yeah. Like you've got cardiology, respirology. You have to remember like until these new programs come out, certainly in my training and your training, all my professors were specialists. And so, you see that you're being taught cardiology by the cardiologist as opposed to the family doctor, even though the family doctor probably does the vast majority of cardiac care here in Ontario.

So that's going to be the key: actually having mentors who are family practitioners themselves is going to be key to sort of picking that as your specialty and seeing your role in it that you can do that job and do it well and be happy and have a life balance and all the things that we hope for.

Jan Jagenovan: Your book arrives at a time where Ontarians are facing a primary care shortage crossroads as you mentioned. How has the practice changed? I'm going to feel like we don't want to talk about it so much, but the pandemic and sometimes we like to think that it's over, but how much has that changed the practice and sort of the need to connect people with a doctor in their communities?

Dr. Jennifer Wilson: Oh, well, I mean, there there are lessons we learned from the pandemic that we've applied, you know, for the better. We're doing more virtual care where appropriate. But I think more than ever we recognize the importance of in-person care where a patient is known by their family physician or their team and that team knows you how important that is to your overall health because we're also talking about preventative health, health promotion, early identification of diseases. And you can't do that over the phone. You can't do that over a video camera. You need to be together

Dr. Carly Jensen: seeing each other. You need to be examined by your physician. So, you know, we we saw what happened during the pandemic when we couldn't see people and we couldn't examine them, the challenges that resulted from that. So,

Dr. Jennifer Wilson: yeah, more than ever, we we recognize the importance of physically being together

Dr. Carly Jensen: and and a supportive community, I think, as well. Like different communities had different levels of success or or lack thereof depending on how they came together during COVID. And I think we certainly saw our community support us and come together and that was key because we we had trust we had built that trust and so a lot of the negative and the moral distress that occurred in some other communities we thankfully didn't really see that to any great extent in Uxbridge.

Jan Jagenovan: I am curious. Uxbridge is kind of in this middle area. Yes, it's rural, but you are not too far from Ajax, Oshawa, Markham and and so forth. What is it like recruiting for a team? Do you have a full staff in your team or has it been a challenge because we've talked about doctors on this program before? Talked to Dr. Sarah Newberry who is in the north has tried and tried and tried and has has pleaded the case to get doctors up in the north. But is that the case in Uxbridge?

Dr. Jennifer Wilson: Well, we are really privileged to be in Uxbridge because we are a rural community. Our hospital is run by family physicians. So, we run the emergency room. We run the ward. So, it is rural medicine. The breadth is is there.

Yet, we are 30 minutes away from the cath lab if you are having a heart attack, our colleagues at Southlake; we're 30 minutes down the road from our intensive care unit at Oak Valley Health, Markham Stouffville, our our specialty colleagues are right there. So, it's it's really the best of all worlds and I think that has made a big difference with our recruitment. Our emergency room right now is fully staffed. Our hospitalists are fully staffed and we have the highest number of family doctors right now in our community that we've ever had.

Dr. Carly Jensen: And I think our train being a training site say like and positivity builds on positivity, right? Like just as the reverse happens as you start to have attrition and a community is struggling to keep doctors, those that are there are going to get more and more burdened.

But the reverse is true as well and we've had a lot of learners come through and when they see the type of practice they can do where you can work to the full scope of practice right where everything you learned in medical school you can actually impact the patient like that is—

Dr. Jennifer Wilson: like that's just the best feeling in the world and so our students get to see that and they get to experience it which then makes them want to join a community like ours. Yeah.

Jan Jagenovan: Now Jennifer you had mentioned what the province is doing. The ministry of health announced it's 3.4 billion primary action plan would connect everyone to the province with a family doctor by 2029. Province is doing well. Um it was I think we're at nearly 90% of people are connected to a primary care doctor or provider rather.

Jennifer, what do you make of this goal? Is it ambitious? Because in the book I'm reading sort of referrals. You're getting referrals from an oncologist. You're getting a referral from a dentist in some cases. It is not necessarily as simple as getting a referral you know through through the province. Help us understand sort of where you're getting people and how people are coming and getting to you.

Dr. Jennifer Wilson: Okay. So I mean most of us as family physicians we have a roster of patients. So patients sign up and they're rostered to us. So some of us like for example I've been 26 years now practicing my roster is full. I'm not actually taking patients on unless someone needs a favor like my oncologist friend calls me up.

So our for example in our clinic we are rostering new patients to physicians who who have openings right now. So most of that is just patients going on to our website or coming through sort of a provincial system sign up come for an interview and get signed up. For most of us, that's how it works. With some exceptions like end of life care and palliative care, we'll receive outside referrals for someone in our community. Um, but mostly it's it's a rostering system—

Dr. Carly Jensen: and births.

Dr. Jennifer Wilson: Yes.

Jan Jagenovan: Right. Like if you're born into the practice, you have that spot. [laughter]

Dr. Jennifer Wilson: But it's not like or sometimes say they'll say to me a patient will say, "Well, when my father dies, will you take me on?" Got it. So that it's not that kind of a spot really like it's more do you have capacity because you obviously want to service the patients that you have.

Jan Jagenovan: If you take on too much then you'll be stretched too thin.

Dr. Jennifer Wilson: Yeah.

Jan Jagenovan: Carly you write in your book "as we approach our collective 45 years in the practice the duty the privilege of teaching the next generation has never felt more essential." Talked a little bit about your roles both as teaching that next generation. What about this practice makes you sort of responsible for this next generation of doctors?

Dr. Carly Jensen: Well, I I really want to say it's two ways though. Like yes, I love having students and I love being able to demonstrate what we can do in family practice, but I learn a lot from them as well. And one of the things they bring, they bring back that real joy. Like all of us went through medical school because we wanted to be a doctor. We wanted to help people. And sometimes in the mundane practice of dealing with patient after patient after patient, you can sort of lose sight of that.

And anytime I have a new student come in and they see something that they haven't seen before, it like reignites my love of medicine as well. So I really see it's a beautiful way to sort of have this reciprocal relationship where I have things to teach them and they have things that they can bring to the table as well.

Jan Jagenovan: Carly Jennifer, I want to thank you so much for taking the time and really lovely read. Thank you so much.

Dr. Carly Jensen / Dr. Jennifer Wilson: Thank you. Thank you.

Jan Jagenovan: Have you had to go to the ER because you don't have a GP you can talk to? Or do you work in medicine and face pressures you think the public should know more about? We'd love to know more about your experiences. So leave us a comment or send us an email to rundown at tvbo.org. Until then, I will see you tomorrow.