As a rural ER doctor, I feel guilty cutting back my hours. But it's the only way for me to keep working

This First Person article is written by Dr. Sarah Giles, who works in Kenora, Ont. For more information about CBC's First Person stories, please see the FAQ.

I'm a rural emergency room doctor — and I feel the need to publicly apologize. 

I'm sorry that many of you are often not receiving the health care you need, in the right place or at the right time. And I'm sorry that many of you don't have a primary care provider, that wait times are so long and that I sometimes see you in the hallway where you have little privacy. While this happening in our rural hospital in Kenora, Ont., I've seen similar experiences reflected in emergency rooms across the country.

So, I need you to believe me when I say that my colleagues and I cannot fix these problems ourselves. In fact, trying to fix the problem has pushed some of us to the point of leaving the profession — and the effort to look after ourselves may worsen services.

I no longer work as many ER shifts as I did in the past; I may never get back to that number. These days, I rarely eat or pee during my shift, which lasts, on average, 10 hours. I stay overtime for every single shift. 

The ER is full of people who continuously — and genuinely — need us to go the extra mile: people are sicker and their illnesses more complex than ever. I often have difficulty getting the OK to move critically ill patients from our small hospital to larger ones in Thunder Bay, Ont., or Winnipeg, due to staffing and bed shortages there, too. I can find myself begging — literally begging — for what patients need. 

And I often fail. 

In 2023, I made the ER schedule and naively put myself down for every long weekend between Easter and Thanksgiving. It was part of a team effort to keep the doors open that summer, but I finished burnt-out and angry. 

I learned that patients and their families often don't know that doctors are working themselves into the ground; they just expect the ER to be open. That's a reasonable expectation, but for me it comes with a high personal cost.

Burnout meant I dreaded going to work. I started to anticipate the feeling of impending doom that began days ahead of each shift. 

In a bid to lessen my anxiety, I started arriving at work earlier and staying later. But my job left me feeling impotent; I felt like a failure when I couldn't get my patients the help that they needed, regularly watching patients with broken hips wait days to get flown out for surgery.

I frequently found myself completely overwhelmed and reduced to tears. Consumed by the problems at work, I had trouble sleeping. In the past, I'd always been able to out-work problems in my life, but longer hours just made the problem worse.

Last October, I called my department head and said I needed to drastically reduce my shifts or I was going to end up quitting.

As a former humanitarian doctor in conflict zones, I have seen what happens when people don't have access to health care, and I was beyond stressed when I imagined being at home resting while a neighbour, a friend or any person died.