The Toronto Star’s Rob Ferguson has a fascinating article in the paper on Monday, talking about a controversy in the Muskoka area, one of Toronto’s prime cottage-country locales. The province has committed a billion bucks to building medical facilities in the region; while this would expand overall capacity, there is now disagreement over how much capacity should be in each of the major population centres. Under the current plan, one local city would gain capacity, and the other would have somewhat less (again, the overall combined capacity would be increased). You can imagine how the folks living in the area slated for “somewhat less” are reacting.
I have no particular thoughts on the specifics of the debate, beyond a general sense that we probably shouldn’t be reducing capacity anywhere right now, given how limited capacity is everywhere. But, hey, maybe there really is a case for shifting the capacity to a different location. Consider me agnostic on the details.
What did jump out at me is the underlying issue that the new facilities seek to address. It’s an issue I personally find absolutely fascinating, partially because it does have a direct effect on my family, but also because it’s just a fascinating insight into how bizarrely dysfunctional health care in this province can be. The issue with the Muskokas, in common with the other areas where many cottages are located, is that the population undergoes huge seasonal change. Ferguson notes that the two cities disputing the share of beds, Bracebridge and Huntsville, plus the surrounding areas that, combined, constitute the District Municipality of Muskoka, have about 60,000 full-time residents. But during the summer months, that population roughly doubles.
You can see the problem in terms of health-care capacity, when needs are determined by full-time residents, not regional influx.
Indeed, if anything, I was surprised that Muskoka only experiences roughly a 100 per cent seasonal surge. My numbers are admittedly out of date; I last looked into this in any detail just before the pandemic, so consider the numbers I’m about to present more illustrative of the challenge than useful as precise stats. But in the Kawarthas area where my family spends a lot of time, the local population in our little corner has a full-time population of about 5,000 (or did, in 2019) but an estimated 55,000 in the summer. That wasn’t an official statistic; it was the best guess of the local commerce officials, who grapple with the staffing of services and amenities in the warmer months. But even in big-picture terms, you can see the issue. The Muskokas see a doubling of the local population. In my little area, it goes up by roughly an order of magnitude.
This has obvious and harmful effects on access to local health care. I’ve wrung more than a few columns’ worth of content out of the various headaches involved. There’s no need to rehash them today, but what is worth mentioning is that cottage country isn’t new. It’s been a thing for a while now. Summers, likewise, are not new. Neither is the need for health care, particularly among the generally somewhat older population that has the discretionary income (and the time and energy!) to maintain secondary residences.
And, yet, somehow this reality still punches us in the face every year.
It is a constant source of discussion among the locals (I read the local news, to the extent any remains, and even just the local Facebook community pages). It’s also a huge issue among local health-care leaders, some of whom, I’ve discovered, try to entice doctors up north from the urban areas for a few weeks of shifts in a rural ER by tossing in access to a lake house as an unofficial sweetener to the offer.
To which I say, well, hey, whatever works. These parts of Ontario are gorgeous and well worth visiting, and if urban doctors want to spend some time up north at a lake with their families while putting in some shifts in the local ER, cool. Enjoy.
But I suspect the reader will agree that this isn’t really the best way to go about this.
I understand that the solution can’t simply be overbuilding the capacity in rural areas so that the full-time capacity is equal to the annual peak of demand. We don’t have the money or the staff to do that. I get it. But it is fascinating to me how little serious attention this issue gets at an official level. Years ago, during the pandemic, I was chatting with a doctor in a rural community. His community wasn’t itself in cottage country, as traditionally defined, but it housed the largest regional medical centre for some lake communities that experience the summer population boom. I asked him about some general ideas for how to cope with the emergencies that present themselves in the summer at a rate greater than the local systems can handle — so, the higher number of childbirths, heart attacks, and strokes that the increase in the population would necessarily cause, plus some more seasonal issues, like people getting hurt doing outdoor summer recreational activities.
How best to cope, I wondered. I asked about air evacuations by air ambulance or even military helicopter (a semi-regular sight over the lakes in my area, as the air force pitches in with search and rescue from CFB Trenton, which isn’t too far away by air). I asked about running ambulance shuttles down into the GTA on a regular basis or even having some kind of seasonal system of field hospitals set up where critically ill patients could be handled while the hospitals handle the routine care. Or vice versa. I didn’t care. I was just asking what the plan was.
Readers will probably not be shocked to discover that, in general, there isn’t a plan. Individual hospitals or health networks themselves try to come up with plans to address the seasonal surge, and there might be some regional coordination in real time to manage patient load. But that’s about it. And my family has directly experienced the outcome of that: spending hours waiting (in vain) for care at one hospital before moving down the road about 45 minutes to the next one and receiving almost immediate care. As one hospital struggled, the next one wasn’t busy at all.
There was no effort to balance the load. I’m not sure it had occurred to anyone at the overwhelmed hospital to even say to the people in the lobby, “Hey, guys. Sorry, but if you can, the next one down the highway has a wait time of under an hour.” I’d have been out the door like a cartoon road runner, leaving a little puff of dust in the air. Meep meep.
But no. That’s beyond us. It’s not how we do things. So this summer, like every summer, a predictable thing will happen on a predictable schedule, causing predictable challenges at predictable times and places, and we’ll discover (also predictably, sadly) that nothing in particular has been done to prepare for it.
It’s great that we are getting new hospital facilities in the Muskokas. It really is. I’m happy for them. But I think we need new ideas or a new mindset, and I see no evidence that any are on the horizon.
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