Canadians are waiting too long in the emergency room
Economic Note looking at the levels and evolution of wait times in Canadian emergency rooms
Annexes
Detailed provincial data on emergency room wait times (A to H).
Data on the evolution of lengths of stay in Canadian provinces (Annex 2).
Related Content
This Economic Note was prepared by Emmanuelle B. Faubert, Economist at the MEI, in collaboration with Yassine Benabid, Research Intern at the MEI, Krystle Wittevrongel, Director of Research at the MEI, and Samantha Dagres, Manager, Communications at the MEI. The MEI’s Health Policy Series aims to examine the extent to which freedom of choice and entrepreneurship lead to improvements in the quality and efficiency of health care services for all patients.
Canada’s healthcare system is notorious for having long wait times. The lack of access to primary care and problems with retaining personnel are well-known issues that affect the efficiency of the healthcare system.(1) With tens of thousands of patients going to the emergency room (ER) daily and waiting hours for treatment, ERs are one of the many bottlenecks that must be addressed to ensure that Canadians can get timely access to the care they need.
In order to have a clearer picture of the levels and evolution of wait times in Canadian emergency rooms, we looked at the data both across provinces and across time.
Two main indicators
One of the best ways to measure how long Canadians need to wait in the ER is by evaluating the total length of stay. This is how much time patients spend in the emergency department, from the moment they enter and register to the moment they leave the department, whether discharged or admitted to the hospital.
Another important indicator is the time to physician initial assessment, which represents the amount of time that elapses between initial registration and/or triage and receiving an initial assessment by a physician or nurse practitioner. This indicator illustrates how long patients wait before being taken care of by a medical professional.
Data show that the shortest length of stay was in Newfoundland and Labrador at 2 hours and 45 minutes, almost half that of Quebec, where it came in at 5 hours and 23 minutes, quite a significant difference.
The median, the chosen statistical measure, represents the middle point, meaning that 50 per cent of patients will wait for less time, while the other 50 per cent will wait longer. This measure is less affected by extreme cases than a simple average and is therefore more likely to represent what most Canadians experience after entering the emergency room.
Wait Times in Canadian Provinces
We examined the data concerning both indicators across several Canadian provinces. Data was available for the fiscal year 2024-2025 in the following provinces: Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland and Labrador, Ontario, Prince Edward Island, and Quebec.
Length of stay
For the median length of stay, some provinces fare better than others. Data show that the shortest length of stay was in Newfoundland and Labrador at 2 hours and 45 minutes, almost half that of Quebec, where it came in at 5 hours and 23 minutes (see Table 1), quite a significant difference.
Time to Physician Initial Assessment
As for the time to physician initial assessment, Ontario and Alberta both achieved the fastest time with 50 per cent of patients getting their first assessment by a physician in 1 hour and 30 minutes. British Columbia, Quebec and Newfoundland and Labrador are middle of the pack. At the other end, Prince Edward Island had the longest time, with a median of 2 hours and 58 minutes, almost double the times seen in Alberta and Ontario.
The performance of each individual hospital also varies considerably across the country. For example, the median length of stay in Newfoundland and Labrador’s Bay d’Espoir Medical Clinic is of very short duration at only 29 minutes. In comparison, 50 per cent of patients in the emergency room of Pavillon Albert-Prévost in Quebec stay for more than 13 hours and 5 minutes (see Annexes A to H). This is a difference of over 12 hours.
The Evolution of Wait Times since 2020
When it comes to the evolution of wait times over the last five years, all the provinces (for which the data is available and has been provided) have seen both their median length of stay and their median time to physician initial assessment increase.(2)
The highest jump was seen in Prince Edward Island, where both median length of stay and time to physician initial assessment increased by 1 hour 35 minutes over those five years, representing a 51.8 per cent increase in the former and a 114.5 per cent increase in the latter (see Figure 1).
Over the last year of the five, however, the changes do not all go in the same direction. Most provinces, including British Columbia, Quebec, Prince Edward Island, Ontario, and New Brunswick (Réseau Vitalité) saw their median length of stay get worse, with the largest deterioration being seen in British Columbia, where it increased by 14 minutes. Newfoundland and Labrador and Alberta, however, achieved the same median length of stay as the previous year.
The trend for the median time to physician initial assessment is less uniform. Only Alberta has improved over the last year, pulling off a modest six-minute reduction. Some provinces, such as British Columbia, Prince Edward Island, Newfoundland and Labrador, and Quebec, have shown increases over the last year. Prince Edward Island increased the most, adding an extra 14 minutes when compared with the previous year. Ontario, meanwhile, has stagnated, showing neither improvement nor deterioration.
Canadians are waiting longer and longer to receive care in the emergency department.
While these comparisons of waiting times depend on myriad factors affecting both the establishments themselves and the quality of the data collected, they offer a snapshot of patient experience in emergency departments across the country. The overall conclusion to derive from this initial data analysis is that Canadians are waiting longer and longer to receive care in the emergency department. This is partly due to a crucial lack of access to primary care,(3) but another cause is the lack of options in the case of minor emergencies.
It is essential to look into potential solutions that provinces could consider for alleviating the increasing pressure on ERs.
Finding the “Missing Middle” of Emergency Care: the French Example
Though far from perfect, there are resources in place to help patients who need access to primary care. When they are in a life-or-death situation, hospitals quickly take them in, providing the required care as quickly as possible. But when patients have a minor emergency, such as a closed non-displaced bone fracture, they are placed in an awkward position. Primary care doctors are not able to provide the emergency treatment these patients need, but if they go to emergency, they are likely to spend hours, if not the whole day, waiting for their relatively low priority case to be attended to. This type of issue could be classified as the “missing middle” of emergency care.
In France, there now exists a new type of clinic that aims to improve access to emergency care. These Immediate Medical Care Centres (“Centres médicaux de soins immédiats”), are independent clinics that specialize in handling lower priority cases, or minor non-life-threatening emergencies.(4) These types of emergencies could be bone fractures, wounds that need stitches, infections, flu and other “non-vital” emergencies. These clinics are not only equipped to provide care to the patients, but also include infrastructure that allows them to perform blood tests and imaging directly on site, making the whole treatment process quick and efficient.
The point of these clinics is to offer patients a point of access to care that differs from large hospital emergency rooms. And while most do have set business hours, even these selective schedules have an impact on the patients that use them.
This allows patients with comparatively minor emergencies to be treated rapidly, compared with the regular hospital system that prioritizes cases based on their urgency and severity.
The main benefit of this model is that it helps lighten the pressure on the regular hospital emergency rooms, which can redirect the more minor cases to the clinics. This allows the hospital ERs to focus on the serious and complex emergencies, and the cases that require hospitalization. This in turn allows patients with comparatively minor emergencies to be treated more rapidly than in the regular hospital system that must prioritize cases based on their urgency and severity, leaving minor cases to wait quite a long time before receiving treatment.(5)
These clinics are generally privately owned by the healthcare providers that operate them, and can either be affiliated with larger hospitals, or fully independent.(6) They may be staffed by private doctors, or by dual-practising doctors who also work in the public system.
Adapting these types of clinics to fit the Canadian provinces’ healthcare models could help fill the “missing middle” when it comes to urgent care.(7)
Conclusion
The data show that Canadians have been spending more and more time in the emergency room since 2020.
Patients in Quebec spend the longest overall time in the emergency room. The worst trend, however, was seen in Prince Edward Island, where patients now wait more than twice as long as they used to for a physician initial assessment and spend over 50 per cent longer in the emergency room compared with just five years ago.
These long wait times in Canada’s emergency rooms are just one of the symptoms of the many issues that plague its healthcare systems. Examples include the lack of access to primary care and delays in accessing specialist care, both of which can lead patients to the ER for lack of other options.
Introducing immediate care clinics following the French model would help reduce the burden on hospital ERs, thus reducing wait times. It would provide lower urgency patients with an alternative to the ER, ensuring that they do not have to wait even longer due to the lower priority of their cases. This, in turn, could reduce the number of people going to the emergency room, hopefully reversing the trend of patients waiting longer and longer for treatment that, right now, they cannot get anywhere else.
References
- Krystle Wittevrongel and Conrad Eder, International Health Perspectives: Comparing primary care in Canada, Germany and the Netherlands, Research Paper, MEI, October 31, 2024, p. 7; Emmanuelle B. Faubert, “Which provinces struggle the most to keep young nurses?” Economic Note, MEI, September 24, 2024, p. 3.
- See Annex 2 for the graphs for each province.
- Krystle Wittevrongel and Conrad Eder, op. cit., endnote 1, p. 5.
- CMSI France, Qui sommes-nous, consulted on May 13 2025.
- Jean-Luc Boujon, “Santé: qu’est-ce qu’un ’centre médical de soins immédiats,’ destiné à désengorger les urgences?” Europe 1, December 28, 2023.
- Marie Foult, “À mi-chemin entre la ville et les urgences, les centres de soins non programmés divisent,” Le quotidien du médecin, September 23, 2022.
- Some provinces, like Alberta, have limited public deployment of urgent care centres. The centralized nature of the deployment process for such public establishments, unlike in France, might be one of the reasons why its speed lags behind demand, as exhibited by the long wait times in the province. Nevertheless, additional research would be warranted to draw further conclusions.