Why Ontario’s emergency physician workforce needs coordinated planning, stronger retention and sustainable practice environments.
The Ontario Physician Recruitment Alliance (OPRA) has been actively working towards a more coordinated approach to physician recruitment and workforce planning. Ontario’s Auditor General reinforced the importance of this work and advocacy in 2025, highlighting a fragmented and competitive environment where communities are developing their own solutions while competing for the same limited supply of physicians.
Emergency departments (ED) are the front door of our health-care system and, increasingly, its safety net. When people can’t access primary care, mental-health or addictions services, they turn to the ED. When home care, long-term care or community supports are unavailable, patients remain in hospital. When inpatient beds are full, admitted patients remain in the ED. When specialist services aren’t available locally, emergency physicians spend hours coordinating consultations and transfers.
These problems don’t begin in the ED, but many eventually arrive there and ED’s don’t close when demand exceeds capacity. The people working inside them absorb the risk, pressure and increasingly impossible tasks that follow.
Today’s emergency physicians have worked through an opioid and toxic-drug crisis, a global pandemic, rising volumes, increasingly complex patients and widening gaps across our health and social systems. They work nights, weekends and holidays, making high-stakes decisions with incomplete information, often while caring for emergency patients alongside admitted patients waiting for beds.
At the same time, health-care workers are increasingly confronted with aggression, harassment and violence at work. Add workplace culture, leadership, administrative burden and organizational politics, and it becomes easier to understand why some physicians are reducing their ED work or leaving altogether.
Compensation matters. Emergency physicians and health-care professionals should be appropriately paid for the responsibility, intensity and complexity of their work. However, recruiters are hearing something that money alone cannot fix. We speak with physicians who genuinely love emergency medicine. The diversity of the work, the teamwork, the challenge and the privilege of caring for someone on what may be the worst day of their life. Some of those same physicians are asking how much longer they can continue.
That concern is shared by physicians who have dedicated decades of their careers to Emergency Medicine.
“I’ve spent over three decades working in emergency departments and family medicine. I’ve seen firsthand how dedicated physicians will go to extraordinary lengths to keep the system functioning. But goodwill and professional commitment are not limitless resources. As both a Physician, a former ED Chief, and the Medical Advisor to OPRA, I believe our greatest challenge isn’t simply recruiting the next generation of emergency doctors. It’s creating a health-care system in which they—and those already practicing like me —actually want to stay.” – Dr. Jeffrey Remington, MD, CCFP(EM)
That is not just a recruitment problem. It is a workforce sustainability problem.
The Auditor General’s 2025 review of access to primary care identified an issue that extends far beyond family medicine: Ontario lacks a sufficiently coordinated provincial approach to physician recruitment.
When one Ontario community recruits a physician from another, one vacancy may be filled, but Ontario hasn’t gained a physician. When communities increase incentives to compete with their neighbours, we still haven’t created more doctors. When supply is insufficient, competition disproportionately impacts communities with fewer financial and organizational resources.
A hospital with uncovered emergency shifts can’t wait years for workforce planning to catch up. It needs coverage tonight. Locum programs and emergency recruitment initiatives are essential to keeping our ED’s open, but they are a bridge, not a workforce strategy. Ontario needs to stabilize today’s ED’s while building the workforce that will staff tomorrows.
The cost of an emergency department closure extends well beyond the community affected. Patients still need care, but may face longer travel times, delayed treatment or transfers to hospitals already struggling with capacity.
In rural and Northern Ontario, where hospitals are often hours apart, these disruptions can have consequences across the province. Longer ambulance transports tie up paramedics and vehicles, reducing availability in their home communities. Additional demands on land and air ambulance services can strain an already stretched provincial network, while receiving hospitals absorb more patients, adding to overcrowding and pressure on staff.
For patients experiencing a stroke, heart attack, severe trauma or another time-sensitive emergency, these delays can mean the difference between recovery, permanent disability and loss of life.
Keeping EDs open comes at a cost, but so does closing them. Locum coverage, last-minute staffing arrangements and recruitment incentives require significant resources, yet the broader financial and human costs of a closure are too often overlooked.
Many Canadians study medicine abroad, in part because there aren’t enough Canadian medical-school seats for the number of qualified applicants. Their route home can be difficult. Internationally trained physicians may arrive with years of specialty training and experience but face limited opportunities to demonstrate their competency and enter practice.
Reducing unnecessary barriers while maintaining high professional standards and patient safety is something Ontario should be capable of doing. Ontario has taken important steps to expand medical education and ease some pathway restrictions, and we have welcomed the province’s more inclusive approach to Ontario-connected medical learners seeking residency opportunities. Increasing medical-school seats isn’t enough though, a student entering medical school today is still years away from independent practice.
How many emergency physicians will Ontario need in five or ten years? How many rural and community ED’s will continue to depend on family physicians with enhanced emergency skills? How many physicians currently practicing emergency medicine will reduce their clinical hours or leave the specialty?
This problem isn’t unique to Ontario, or even Canada.
The United States experienced a dramatic decline in Emergency Medicine residency recruitment earlier this decade, with hundreds of positions going unfilled in 2023. Interest has since rebounded significantly, but the experience showed how quickly perceptions of a specialty can change.
Medical learners notice what is happening to the physicians ahead of them. They notice burnout and workplace culture. They notice whether physicians feel supported. They notice people leaving and whether those who remain still seem to love their careers. If we want learners to choose emergency medicine, we need to give them a version of emergency medicine worth choosing.
The ED cannot be the shock absorber for the entire health-care system. The Canadian Association of Emergency Physicians (CAEP) has reinforced an important point: fixing emergency medicine requires action far beyond ED’s. Workforce planning and patient flow, appropriate training capacity, access to specialists and transfers, team-based models that make better use of NPs, PAs, pharmacists, paramedics and other professionals, stronger primary, community, mental-health and addictions care are all interconnected with the issues we are facing in our ED’s.
An emergency physician can’t solve hospital overcrowding by seeing patients faster. A nurse can’t create an inpatient bed. A hospital can’t create community mental-health capacity and a physician recruiter can’t manufacture another emergency physician. We cannot continue asking individual parts of the system to compensate for problems that require system-level solutions.
There may not be one solution, but there are clear places to start.
What needs to change?
- Plan provincially.
Ontario needs coordinated physician workforce planning that anticipates need by specialty, geography, population, demographics and workforce changes, rather than leaving communities to compete for a finite supply. - Train intentionally.
Medical school, residency and enhanced-skills capacity should reflect where Ontario will need physicians years from now, particularly in rural, northern and underserved communities. - Create reasonable pathways into practice.
Canadians studying medicine abroad and qualified internationally trained physicians need transparent, rigorous and efficient opportunities to demonstrate competency and enter practice. - Protect the workforce we already have.
Retention deserves the same attention as recruitment. Sustainable schedules, appropriate compensation, safe workplaces, supportive leadership, respectful cultures and meaningful action on workplace violence are all workforce strategies. - Fix what flows into the ED.
Primary care, inpatient capacity, long-term care, home care, mental-health and addictions services, supportive housing, specialist access and transportation all become emergency medicine issues when gaps elsewhere in the system land at the ED door. - Coordinate rather than compete.
Ontario’s physician recruiters already collaborate across communities. A coordinated provincial approach can share pipelines and workforce intelligence, reduce duplication and competition, support communities with fewer resources and help physicians find practice environments where they are more likely to stay.
These actions also reflect OPRA’s broader strategic direction: collaboration rather than competition, stronger workforce intelligence, recruitment and retention working together, and local expertise informing provincial solutions.
Physician recruiters have a unique view of the health-care workforce and we need to use what we’re hearing.
We talk to students choosing careers, residents beginning them, physicians considering relocation, internationally trained physicians navigating pathways into practice, locums seeing our hospitals with fresh eyes and established physicians wondering whether they can continue doing the work they love. Sometimes, we have difficult conversations with someone who has decided to leave. We hear why an opportunity was declined. Why a locum won’t return. Why someone is reducing their ED shifts or choosing another province and, just as importantly, we hear what made someone choose a community and stay. This is workforce intelligence that we should be using.
OPRA has advocated for structural solutions to Ontario’s physician workforce challenges. The Auditor General has reinforced the need for provincial coordination. CAEP has identified changes needed to make emergency care more sustainable. We don’t need to wait for another report to tell us there is a problem.
Recruitment matters. Locum programs are essential. Compensation matters. Incentives can help but none of them can substitute for a sustainable workforce.
When physicians who love emergency medicine begin stepping away from it, we need to understand why. When learners look at the physicians ahead of them and question whether they want that career, we need to listen. When qualified physicians want to practice here but can’t find a reasonable pathway, we need to examine the pathway and when communities across Ontario are all recruiting from the same limited pool, we need to acknowledge what the Auditor General has helped make clear competition is not workforce planning.
ED’s are telling us something. Physicians and health-care workers are living it. Recruiters are hearing it. Patients are experiencing it. The question isn’t whether we know there is a problem. It’s what we’re prepared to change.
Author:
Erika Ingebrightson, Physician Recruiter – All Nations Health Partners/Kenora, Co-Chair NorthWestern Ontario Physician Recruitment Alliance (NWOPRA)
