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Brian Goldman is an emergency physician in Toronto, and host of White Coat, Black Art on CBC Radio One. His latest book is The Casino Shift: Stories from an ER on the Edge.
Lighthouses have been around since the reign of Ptolemy II of Egypt. The earliest recorded of these, the Lighthouse of Alexandria, stood over a hundred metres tall and used a fire at the top to guide ships to safe passage. Today, they’ve been updated with powerful LED lights and foghorns that switch on automatically based on light sensors.
Emergency departments are like lighthouses. They serve as a safe harbour for critically ill patients. They’re a safety net for the close to six million Canadians who lack primary care as well as people who are unhoused or who have substance use disorders. They are meant to be open every hour of every day, no matter what.
These days, the light in the lighthouse is like a flickering bulb. The signs can be seen at ERs across Canada.
As a 40-year veteran of emergency medicine, I can remember when closing the ER was never supposed to happen. Last year, a Globe and Mail investigation found that since 2019, at least 34 per cent of Canadian ERs either closed suddenly on a short-term basis or had a planned long-term reduction in hours. Those closures added up to 1.14 million hours in which the light in the lighthouse was off.
In 2026, ER closures are being reported in every province across the country.
Emergency department closures since 2019, according to a Globe investigation, added up to 1.14 million hours of lost treatment.Fred Lum/The Globe and Mail
Emergency departments that manage to remain open despite the challenges have begun to lose their safe harbour status. Increasingly, it feels like I’m reading reports of sick patients suffering cardiac arrest while spending hours in the waiting room.
It’s the knock-on effect of a lack of acute care hospital beds. Stretchers in the emergency department are occupied by admitted patients who can’t be brought to the wards because their beds are full.
I know many ER colleagues who start the day shift with just one or two open stretchers available to see and treat every critically ill patient who arrives by ambulance, by car or on foot.
The reasons behind these increasingly daily occurrences are well known. There aren’t enough hospital beds and long-term care homes for older patients and especially those with complex needs. There aren’t enough primary-care providers, forcing unattached patients to visit the ER instead. These patients seldom need critical care, but they do take time and contribute to the crush of waiting room patients.
There are proven ways to keep the light on in the lighthouse. We need more hospitals, more long-term care homes, and more front-line health care providers.
Canada needs to learn from other countries. Denmark provides primary care to nearly all its population through a mandatory enrolment program. It means everyone eligible for health care in Denmark is assigned to a GP without having to look for one. In fact, the name of your GP is printed right at the top of your Central Person Register card, which is like a Canadian social insurance number card.
Mandatory enrolment means far fewer patients need emergency care.
The Netherlands goes one step further, with superb after-hours care. Patients who call their GP when the office is closed are automatically routed to an urgent medical call centre staffed by GPs and other providers. They assess patients and either treat them, send them back to their regular GP, or call an ambulance to transport them to the hospital.
Unlike Canada, patients in the Netherlands can’t just show up in the ER. If they’re having a life-threatening emergency, they arrive by ambulance. For anything else, they need to be referred by their GP or after-hours provider.
These structural changes will take time to implement. In the meantime, we need to be open to trying new approaches like virtual emergency medicine. British Columbia has a program called Virtual Emergency Room Rural assistance, or VERRa.
It gives family doctors who work in small, rural ERs a precious night off by replacing them with experienced, albeit remote, ER specialists. It also ensures access for patients. When they register at these small ERs, an in-person nurse assesses them, then connects the patient with a virtual ER physician by phone or tablet.
The program is still in its infancy. So far, VERRa has been successful at giving hard-working family doctors a night off while maintaining patient safety.
To help keep the ER lighthouse from flickering out, ERs need innovative thinking like that. They also need the provinces to understand that a health care system cannot function without a lighthouse.