Finding a solution to Interlake-Eastern Region Health Authority's emergency room challenges is easier said than done. That's according to CEO Ron Van Denakker, as physicians begin to raise concerns over the practice of nurse managed care. The practice aims to keep emergency rooms open even without a doctor at the facility, by having nurses look after the ER's patients, and contacting doctors at a complimentary location if necessary.

Van Denakker says the practice was intended to be a short-term solution to a shortage of doctors, and while he feels they've been providing quality care to patients, admits there are challenges associated with the measure. While the temporary solution was backed by the doctors and the College of Physicians and Surgeons, Van Denakker says they now want to cease the practice.

IERHA CEO Ron Van Denakker

"We're in conversation with the doctors right now. They've indicated they want to sit down and need an understanding of where we're going by such-and-such a time, or they will pull away entirely. There have been conversations with them, and meetings are planned to establish an exit strategy."

Under the nurse managed care ERs, ambulances are at times diverted to other hospitals that have doctors in place to care for critical patients, while the nurses in place triage those who come to the hospital with less life-threatening issues. Van Denakker knows it's not a permanent solution, but says ceasing nurse managed care could create a new set of challenges.

"The nurse managed care process that we use, so to speak, is really only employed in our region. There are other situations in other regions, where if there are no physicians available there are service interruptions in those locations."

He says the only solution would be to have more doctors in place, but that's something they've been challenged with for quite some time. Van Denakker says while they took on an initiative to hire international physicians, they're typically not permanent.

"It's clearly not working. Even though we have four year return of service agreements with them, once they pass their Canadian board exams they typically leave to go back to where their families are, and I understand that. What has worked effectively in other regions is growing your own physicians from within your own region."

Van Denakker says every other health region in the province has a clinical teaching unit, which sees practitioners trained by local doctors. However, Van Denakker says the IERHA has a lack of resources preventing that from moving forward in the near future.

"We don't have a group of physicians that's large enough to deliver that program. However, there's a significant amount of interest. We also would need to create the infrastructure, which is essentially a clinic large enough for a larger group of docs to practice together, so we can start this process in our region."

While significant investment would be needed, the IERHA has some partners will to assist if the program moves forward. Van Denakker says the University of Manitoba, Manitoba Health, Physicians and the RHA are all taking part in discussions to try and implement a clinical teaching unit.