Across Canada, under a number of provincial health systems, a spate of closures of emergency departments (EDs)—whether for hours at a time, a day, several days, or indefinitely—raises serious questions about how the health care system is coping with an existential crisis and what can be done about it. Largely, but not exclusively, in hospitals serving small towns and remote rural communities, these closures sometimes get announced with a handwritten sign taped to the hospital’s door, leaving patients and families who show up with emergencies to drive to the closest alternative facility.

Canadian EDs face many of the same overcrowding issues seen in the U.S. and other countries: long wait times and treatment delays; patients in need of emergency care piling up in waiting rooms; others boarding for days in ER bays—or hallways—often because there’s no bed available upstairs; ambulances “ramping” in the parking lot, unable to unload patients or respond to other emergencies in their communities. But closing the ED entirely, even just for a day, as has happened thousands of times in Canada in recent years, reflects a serious breakdown of the system.

Canadian emergency medicine advocates say the problem has been brewing for a long time, with warning signs that went largely unheeded by the provincial health authorities responsible for planning and budgeting health services in Canada. Then the COVID-19 pandemic hit, making everything worse.

“It’s a long-standing human resource problem that is now manifesting in what we could consider the most extreme form, which is ED closures in rural and remote areas of Canada, but also now in more suburban regions,” said Catherine Varner, MD, an emergency physician in Toronto and deputy editor of the Canadian Medical Association Journal.¹

Dr. Varner sees a confluence of issues coming to a head, presenting big challenges going forward. “We in emergency medicine on the ground are seeing the increasing complexity of our patient populations as they age,” she said. Canada also has a large and growing number of patients who lack a primary care physician and thus look to the ED for their primary care.

“What’s been surprising, both to people who work in health care, but also to the public, is that we’re seeing these closures more frequently, in higher numbers, in all regions across Canada,” she said. “Rural hospitals are saying, ‘We don’t have anybody to work tomorrow. We don’t have the professionals to provide the emergency care.’”