The Agenda with Steve Paikin (Audio) - Why Are Ontario's ER Doctors Burning Out?

Episode Date: October 6, 2026

Ontario's health-care system is under growing strain, from emergency rooms to family medicine. ER doctors describe difficult working conditions, distress, and thoughts of leaving the field, while more than 2.5 million Ontarians lack access to a family physician. Dr. Rodrick Lim and Dr. Farzan Ansari examine what's driving the pressure in emergency medicine. Then, family physicians Dr. Jennifer Wilson and Dr. Carlye Jensen discuss the challenges facing GPs and what it could take to attract more medical students to family medicine.Donate Today : https://tvo.me/See omnystudio.com/listener for privacy information.

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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 the 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 talk 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 Jay and Jagan-Authan. 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. Roderick Lim, Dr. Farzan Aransari, 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 lot of important stuff, a lot of hard stuff, 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.

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, shown quite a high rate of burnout, higher than most medical specialties in Canada. And this was a great concern to us, our colleagues, and our national organization. We were lucky enough to try to dig into that and form a study that would fall 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-pendemic and kind of where we are now. And as anyone who has a family 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. And 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 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 that. Dr. Ansari, I see you nodding your head. You're an emergency medicine resident.

What Dr. Lim is saying, does that resonate with what you're seeing on the grounds? Yeah, I think absolutely. I think burnout is something that's discussed in emergency medicine, both among staff as well as learners such as myself. And I think it's very important that we're having these discussions and being open about how we're feeling. What I can say is definitely that this study is very recognizable. And you see people working in very demanding environments. We're dealing with access flock. We're dealing with competing demands while trying to provide the best care that we can for the patient in front of us. And I think ultimately what this study adds is that it puts the numbers behind. kind of conversation that has been happening in emergency medicine for quite some time now. And we're seeing a substantial proportion of physicians reporting emotional exhaustion or depersonalization. And I think we're seeing physicians ultimately change the way they practice. And for me, this tells me that this deserves to be looked at as a workforce and as a system issue ultimately. Dr. Lim, Dr. Ansari mentions emotional exhaustion. There's depersonalization, sense of

decrease 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. 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 individuals that have spent years and years and years to train to do the work that they do. But the work environment itself is leading to these sims that we see people who are put under the stress, you know, 50 to 80, percent of doctors showing signs of just not feeling like they're making a difference every day, to feel exhausted, to feel like that the person in front of them isn't another human being, that is just an object.

These are all very well-studied effects of occupational stress of the work environment. And of course, we take that home. We can have amazing home lives, but when you work in that environment for sustained periods of time, you're going to take it home. And obviously, none of us want that to happen. Dr. Ansari, with patients having to wait long hours in ERs, how does this affect the learning experience where someone like you? And, you know, as you navigate the system, understanding sort of the realities,

I don't want to say that you signed yourself up for, but, you know, we talk about hallway medicine a lot over the years, but as I understand, that's evolved in itself. So help me explain sort of what you're seeing there and sort of the challenges as being a resident. Yeah, I think definitely as a learner, one of the big, impacts is that you're trying to learn how to provide for patients in the best possible way that you can, while also trying to navigate these systemic pressures that are ultimately out of your control. And so as a learner, we're learning how to assess a patient to come up with the appropriate management plan

and ultimately determine the ultimate angle for them, whether that is if they need admission. But I think that if there isn't an inpatient bed available, then that patient remains in the emergency department for days at a time. And ultimately, I think it's very, very early in the process it saw me that the system ultimately is broken. And the resources aren't always necessarily available for us to be able to provide for our patients. And I think this is where a lot of that moral distress comes into play. And so I think it's very important to talk about this

and understand that if these are the same problems that are burning out today's doctors, we should necessarily be trying to fix those problems and not just teaching the learners today how to tolerate them moving forward. 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. 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're going towards chair medicine. And I think 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 see these patients who are overcrowded inside of our emergency department as well in the chairs. 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 visits by expanding access to primary care teams. Investing $3.4 billion through our primary care action plan to connect every person to primary care by 2029 and expanding scopes of practice for health care professionals, including pharmacists, improving access to care closer to home. Dr. Lim, what's your reaction to that? You know, I think this is a great example of two important problems. I don't think anyone with the family out there would say that access to a primary care provider,

preventative medicine, all the important roles that are done desperately need help, and it's great to see investment in that. But we know that that has nothing to do with the crisis that's occurring with, in emergency medicine, that is more of a function of the system, having the wrong patient in the, unable to flow through, either to long-term care, acute beds taken up by patients that need to go to long-term care, emergency patients that have made the decision to be admitted, cannot get into the hospital, and therefore we're working in a reduced capacity, providing less than ideal care in the spaces that we have left.

That is nothing to do with primary care. That's a problem on it's all right, and we're glad for that investment, but that investment will not help emergency departments. Now, I should mention that the province did say that, you know, they have shovels in the ground for over 60 hospital development projects. Those can include expansions as well. And they say that it will add an additional 3,000 beds to support the workforce. There is money as well allocated to training, including nurses,

but also in the emergency department as well. Does that help? You know, I think everybody realizes that we're dealing with a massive, you know, huge problem that does not have a single solution. And any kind of investment tort capacity where we're increasing the number of beds available is going to help. Making sure that we're all accountable at every level,

whether that's the government, the hospitals, the departments, we're all accountable to share that load and to make sure that your mom and my mom can traverse through the system in an ethical, expert, and humane way should be everyone's goal. 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 long-term sort of look at this project and plan here. We're talking about health care. but how does that reflect what you are seeing on the grounds? Not only what the government is touting,

but when we talk about the investments there, you've got fresh eyes into this. And so here you are walking into this problem of burnout. Is there an obvious solution to some of this? Yeah, I think it's definitely a very nuanced answer. And I think as a resident, I have a unique perspective. Because not only do I get to rotate to the emergency department, but through my training, I rotate to various other specialties as well in the inpatient unit as well.

And I think it ultimately is a outflow problem that is trickling down and affecting emergency departments across the country. And I think a big portion of that is we don't have the necessary facilities to be able to discharge patients. For example, when you look at the numbers from the Canadian Institute for Health Information, We see that amongst inpatient, in patients who are in the altered level of care units, the median hospital stay for these patients were about 44 days. It's very difficult to get these patients to the right place when there's not these systemic places available for them to be able to go. And from my perspective, being in the inpatient units, I see this.

It's very difficult to be able to find the space to be able to discharge these patients and ultimately free up the bed. 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? Yeah, that's a wonderful question.

On the other side of this, like the issue is definitely important to us. and we're not going to sugarcoat the horrible effects that it's having on emergency physicians across Canada. Despite this, you know, there are many, many patients that need our care, they need the best version of ourselves. And so even though it's not the solution, you know, making sure that we're good mentors showing the impact that we do have in these difficult situations, you know, providing that positive skills and advice to the upcoming generation is so, important because as the study has shown, these aren't threats of people leaving, people have left.

And we know that the solution for these problems are not going to happen tomorrow. They're not going to happen next year. They're probably not even going to happen in the next five to 10 years. We need sustained, consistent effort to tackle this massive problem. And the people that are getting crushed in it, we need things like mentorship. We need things like supports and anything that can be done in order for us to be the best version of ourselves to help, not only the new generation physicians, but the patients in front of us. Dr. Limb 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 there was, you know, if we had the Minister of Health across the table, what message would you have for them? Yeah. I mean, I think, you know, you don't have to, you don't have to, it doesn't take much for people to understand that there's a problem. As you said, these are people that want. to do a great job and help people and are doing their best to help people, but have to put one foot out or two feet out in order to survive for their own personal health. So the message I would

give to them is that I'm glad you think that there's a problem and I'm glad that you're dedicating resources and you've got to keep trying to fix the system. You've got to be accountable to fix the system. And you've got to support the people that have to work in the system while it's broken. And if you continue to do those things to your greatest effort, we can get out of this because we need, you know, all our residents, our future generations, to have many years in this profession. We don't want them to be out of emergency medicine in 10 years. That would be an absolute tragedy because they just want to do the best,

take care of the patient in front of them, and give them, you know, excellent care that they've been trained to provide. 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. Thank you. Thank you, Robert. Okay. We've heard that part of the ER crisis is being caused by another big issue in health care. 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?

Great. Great. So happy to be here. Well, congratulations on Family Roeastern. 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?

Well, Canadian family medicine is 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 to family medicine in 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, what can we do? What can we do to help create a problem? 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 a profession we love

and we value. So this book is a collection of true stories of the work that we do with our patients. Well, Carly, maybe you can share a story or two of sort of some of the patients that kind of help explain sort of not only the crossroads, as Dr. Wilson has sort of laid out here, but that really takes us home. 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 bomb or the tincture for burnout, right? So if you look around, you know, why are people not practicing as 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. person, it makes for a beautiful practice. 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. Well, there's very real challenges, and we face them every day. 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. We hear a lot about the administrative burden where 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. Compensation issues are something I'd rather not talk about, but 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 we face them every day and they have to be acknowledged and they have to be dealt with. I'm scared to ask this, but how many hours a day are you putting into your practice from administrative to seeing patients to maybe even like after calls or, you know, just checking on a patient that you're worried about? Yeah, it's a fair question. I mean, Carly and I are both full-time family physicians. So 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. Let's add another layer in that. So we're teaching. We're teaching regularly 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, you know, family members and other commitments outside of medicine.

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 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, so it opened in 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? Well, I think it's very positive. Okay.

It's very positive. And the Queens Lake Ridge 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 wonderful initiatives. And Jane Philpott's work to attach every Ontario

to a primary care team. It's hopeful. It's wonderful. But we still have to convince these medical students to choose family medicine. What are they choosing instead? What is something that is like something you're competing against? Oh, well, do you want to answer that? All the specialties. All the ologies. All the ologies. Yeah, like you've got cardiology, respirology. You have to remember, like until these new programs came 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. Your book arrives at a time where Ontarians are facing a primary care shortage, crosswords as you mentioned. How is 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?

Oh, well, I mean, there are lessons we learn 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. seeing each other, you need to be examined by your physician. So, you know, we saw what happened during the pandemic when we couldn't see people. We couldn't examine them, the challenges that resulted from that. So, yeah, more than ever, we recognize the importance

of physically being together. And a supportive community, I think, as well. Like, different communities had different levels of success 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 had trust.

We 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. I am curious. Uxbridge is kind of in this middle area. Yes, it's rural, but you are not too far,

you know, from Ajax, Oshoa, Markham, and so forth. What is it like recruiting for a team? Are you guys on, 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. Talk to Dr. Sarah Newberry, who is in the north, has tried and tried and has pleaded the case to get doctors up in the north. But is that the case in Xbridge?

Well, we are really privileged to be in Xbridge 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 there. Yet we are 30 minutes away from the calf lab. If you are having a heart attack, our colleagues at South Lake,

we're 30 minutes down the road from our intensive care unit at Oak Valley Health. Markham Stoville, our specially colleagues are right there. So 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.

And I think being a training site, Carly, maybe I was gonna 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 gonna 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, like, that's just the best feeling in the world. And for our students get to see that and they get to experience it, which then makes them want to join a community like ours. Now, Jennifer, you had mentioned what the province is doing.

The Ministry of Health announced it's $3.4 billion primary action plan. We connect everyone to the province with the family doctor by 20209. The province is doing well. 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 school? 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. It is not necessarily as simple as getting a referral, you know, through the province. Help us understand sort of where are you getting people and how people are coming and getting to you. Okay. So, 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's full. I'm not actually taking patients on unless someone needs a favor. Like my oncologist's friend calls me up. So for example, in our clinic, we are rostering new patients to physicians 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 will receive outside referrals for someone in our community. But mostly it's a rostering system.

And births. Yes. Right. Like if you're born into the practice, you have that spot. But it's not like where sometimes they'll say to me, a patient will say, well, when my father dies, will you. you take me on. Got it. So 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. If you take on too much, then you'll be stretched too thin. Carly, you read in your book, as we approach our collective 45 years on the practice, the duty, the privilege of teaching the next generation has never felt more essential. Talked a little bit about your role as teaching that next generation. What about this practice? It makes you sort of responsible for this.

next generation of doctors. Well, 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 any time 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. Carly, Jennifer, I want to thank you so much for taking the time, and really lovely read. Thank you so much.

Thank you. 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 tbO.org. Until then, I will see you tomorrow. Starting this year, grade 10 students must complete

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