Rural ERs Are Not “Glorified Walk-in Clinics”: SRPC Responds to Globe and Mail Column
On July 8, 2025, Globe and Mail health columnist André Picard published a piece titled “Should Every Small-Town Hospital Have its Own ER?”. While we generally respect Mr. Picard’s contributions to health journalism, this particular article struck a deeply concerning chord with many in the rural medical community.
In the column, Mr. Picard characterizes rural emergency rooms as “glorified walk-in clinics” and suggests they should be shuttered in favour of urgent care centres and more paramedics transporting patients to already overburdened tertiary care centres. This framing not only lacks supporting evidence, it also disregards the lived realities of rural patients and health care providers and raises significant equity concerns.
Members of the SRPC’s Health and Human Resources Committee submitted a response to the Globe and Mail, which unfortunately declined to publish it, although they accepted a much more brief letter to the editor today, July 15th.
We believe this conversation is too important to be silenced. You can read the full op-ed below, a reasoned, evidence-informed rebuttal that outlines why rural Canadians deserve timely, high-quality emergency care close to home.
Dear Editor,
As members of the Society of Rural Physicians of Canada’s Health and Human Resources Committee, we write to you in response to Andre Picard’s column on July 8th, 2025, “Should Every Small-Town Hospital Have its Own ER?”
First, we agree with Mr. Picard that the current health care situation in rural Canada is untenable and that Canadians deserve better.
We agree that every Canadian should be assured a primary care provider regardless of where they live.
We disagree with Mr. Picard’s inflammatory assertion that emergency rooms in small towns are little more than glorified “walk-in clinics”, that uniformly provide poor care, and should be replaced by urgent care centres and paramedics to transfer rural patients far from home to “real emergency care” in larger centres. He makes this assertion with no empirical data for quality. We are not aware of any data that exist to suggest that emergency care is of poorer quality in rural settings when compared with urban centres. In some locations, however, rural ER care has certainly has been made less reliable with the uncertainty and unpredictability of staffing-related closures.
Every Canadian, regardless of postal code, should be able to access lifesaving emergency services in a timely manner — sometimes that means a local ER department and, at other times, that means regionally accessible ERs supported by available advanced- and critical-care paramedics who can transport patients in a timely manner. The decision on the exact care available to rural Canadians should be decided through the best available evidence, with consideration of distance and time to next nearest available service, and then supported through appropriately resourced infrastructure.
Mr. Picard’s assertion that the scant resources available in rural Canadian ERs be shifted away because it is not possible to deliver tertiary-level care in a rural setting, is puzzling. We know that people living in rural Canada, especially those who are First Nations, Inuit, and Métis, have demonstrably worse health outcomes and live shorter lives — removing access to lifesaving care will only exacerbate this problem.
Rural Canadian ERs do not operate in a vacuum. In our rural ERs, we see patients with life-threatening cases every day who we are able to manage and admit locally. Certainly, specific patient presentations require transfer to higher levels of care because we lack some specialized services, but those specialized services are needed AFTER the resuscitation and emergency care is provided locally in a timely manner. It must also be noted that tertiary ERs are in crisis and simply cannot handle more patients. Indeed, tertiary care centres rely on rural hospitals to off-load less acute patients so that they can free-up beds for others.
Canada needs to build a robust system in which physicians and teams are supported to provide high quality care that is locally and regionally accessible. We need both a Canadian rural health strategy and a rural health workforce strategy that includes doctors, nurses, paramedics and others in order to provide the high quality care in a reliable system that all Canadians – including those who live in rural and remote settings – deserve. We at SRPC are engaged in just this work and look forward to the time when we can present our findings and help to lead the way in high quality care for all Canadians that is close to home and cost effective.
Yours truly,
Drs. Sarah Giles (president-elect, SRPC), Sarah Newbery, Nicholas Potvin, and Sarah Lespérance,
Rural Generalist Physicians
Society of Rural Physicians of Canada’s Health and Human Resources Committee
