"People Should be Panicking About This": One Former Chief of Anesthesia's Perspective

 As the former chief of anesthesia at Bluewater Health, Dr. Barbara Bertram faced an aging population, a hospital-wide cyberattack and a global pandemic. But her most frustrating challenge faced as chief: “Recruitment.”

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In the summer of 2019, Sarnia was at risk of losing its pain clinic. The anesthesiologist who had been running it for the past few years was retiring and initially, no one stepped forward to replace him. Had it closed, almost 1,000 patients would have lost specialized support for chronic pain.

Dr. Barbara Bertram, then a staff anesthesiologist at Sarnia’s lone hospital, Bluewater Health, knew she couldn’t let that happen. While she’d had an interest in pain management while a resident, she ultimately decided not to pursue that focus. However, “This need was in the community, and I didn’t want our community to go without a pain doctor,” she recalls. 

Dr. barbara Bertram

Her strong belief in preventing health care from falling through the cracks would lead her to take on an even bigger role in the fall of 2019: Chief of Anesthesia at Bluewater Health, which covers a regional population of around 150,000 in Lambton County. (Bluewater Health also oversees Charlotte Eleanor Englehart Hospital in Petrolia, but this facility does not offer anesthesia services.)

Over the next five-and-a-half years, Dr. Bertram would guide Bluewater’s anesthesia department through challenge after challenge: Massive technological upgrades, including to the hospital’s electronic records management system; treating a population that is increasingly older and more complex; and dealing with the COVID-19 pandemic and an extensive ransomware cyberattack, both of which caused thousands of Bluewater appointments and procedures to be delayed. The last few years also saw an increase in equipment backorders and even the occasional shortage of essential medications.

But despite all that, “Recruitment was probably one of the most, if not THE most, frustrating part of being chief,” recalls Dr. Bertram, who stepped away from the chief’s role in March 2025. That recruitment sticks out from the other challenges Dr. Bertram faced highlights just how dire anesthesia staffing has become in some parts of Ontario. 

 “I hate to use the word ‘panic’ but people should be panicking about this,” she says. “We are the gatekeepers; without anesthesia you don’t get your surgical services,” a situation that Dr. Bertram unfortunately encountered several times as chief. These shortages threaten not just access to surgical care but also core principles of patient safety, particularly in aging, medically complex populations. 

She explains that while Bluewater’s anesthesiologists are excellent, dedicated doctors who often work extra shifts to ensure patients get the care they need, “We just don’t always have the people to provide all the services that we could be providing.” Dr. Bertram’s experience highlights the pressing need for sustainable, long-term solutions, such as expanded training capacity, improved exposure to community practice during residency, and stronger recruitment incentives, to ensure anesthesiology services remain safe, timely, accessible, and resilient across Ontario.

While Dr. Bertram describes Bluewater as a community hospital, she’s quick to add that it routinely does major surgeries, from joint replacements to bowel resections to stabilizing trauma victims before transferring them to nearby London, ON. It has eight operating rooms, a dedicated caesarian section room, and three endoscopy suites.

As chief of anesthesia at Bluewater, Dr. Bertram was responsible for ensuring the hospital had appropriate anesthesia coverage and what it needed to safely and efficiently deliver care. She also addressed and resolved complaints, and dealt with various day-to-day tasks, from creating schedules to checking in with staff on how they were doing. She did all this while still practicing anesthesia full-time.

Dr. Bertram explains that ideally, Bluewater’s anesthesia department would have the equivalent of eight full-time anesthesiologists, though she adds, “Nine would be even better.” However, since the retirement of her predecessor and another physician in 2019, the department has often had fewer than eight full-time members. 

She points to a recruitment ad that features an eye-catching photo at the top: Caribbean blue water lapping up against golden sand that gives way to a bright, modern hospital lobby. “That ad has run for the past six years straight,” Dr. Bertram says with a sigh. But despite it painting Sarnia and Bluewater in a flattering light, there hasn’t been enough interest in recruitment to keep up with staffing needs.

While chief, Dr. Bertram was able to hire a few new faces. However, during the same time period, the department also lost some members who relocated to other hospitals for various personal reasons, resulting in Bluewater regularly not having a full complement of anesthesia staff. Thankfully, in 2024, a recent anesthesiology resident graduate who is also a Lambton County local accepted a position at Bluewater, easing some of the human resource issues. 

To help bridge the ongoing staffing gaps, the hospital routinely brings in locums, who are essentially substitute doctors. However, this is an expensive solution that can’t always be depended on as the pool of locums is limited and many other Ontario communities, also dealing with anesthesia shortages, are also pulling from it.

 As a result, Bluewater periodically does not have enough anesthesiologists to staff its operating rooms, unfortunately causing them to close. Consequently, “Surgical wait times are getting longer.”

It’s also been around 12 years since the hospital has been able to provide routine anesthesia services for undergoing cataract surgeries or endoscopic procedures, “We used to man every endoscopy suite and be there every cataract day,” recalls Dr. Bertram, “But now we don’t have the bodies to do that.” Anesthesia’s presence in the endoscopy suites was further reduced starting around 2020 when the department saw three of its then-members retire over the following three years.  

Now, patients who require stronger sedation than what the gastroenterologist or cataract surgeon can provide are scheduled for their procedures on the same day, when an anesthesiologist is available. This leads to a delay in those patients receiving their procedure.

Dr. Bertram would like to see this change and have an anesthesiologist available for more of these procedures; however, she explains that would require hiring that ninth full-time person. Financially, the hospital could afford this “extra” anesthesiologist, but first Bluewater needs to find someone to fill that role.

Anesthesia isn’t the only department at Bluewater currently dealing with staffing shortages. While the system has a lower-than-provincial average rate of job vacancies, several of its medical specialties struggle to fill available positions. Twice over the past few months, a lack of general surgeons caused the hospital to pause emergency and urgent surgeries. It also needs additional pediatricians, like many community hospitals across Canada.

Dr. Bertram isn’t sure why these other departments are also struggling to attract physicians, but she suspects it’s probably for the same reasons facing anesthesia. One issue she’s noticed is a lack of awareness about Sarnia and what it has to offer.

She speaks at length about how wonderful her community is, “We’re a hidden little jewel.” She also highlights how at Bluewater, “Our work-life balance is awesome,” noting that while Bluewater Health’s anesthesiologists work more call hours than an urban anesthesiologist, those shifts are generally calmer (and, she points out, more call shifts mean a bigger paycheque).

Dr. Bertram, a self-described “small-town girl” who always wanted to work in a community setting, recognizes that many new anesthesiologists may feel “the lure of prestige” and believe that hospitals such as Bluewater may not offer the clinical challenges or variety found at large, academic centres. However, she quickly points out that’s not the case in Sarnia, “We do large cases, not just day surgeries on very healthy patients.”  She adds that patients in these smaller communities can be more medically complicated and frail, often leading to very challenging clinical scenarios.

She believes that one solution, at least for community hospitals like hers, is for anesthesia residency to include more opportunities to work outside of academic and urban hospitals. “To see that it’s not just teeny-tiny hospitals that are ‘community,’ which is what you often feel when you’re in residency,” she explains, noting that by including more community rotations, residents will get a better sense of what these hospitals can offer them with respect to lifestyle and remuneration as well as clinical practice.

But ultimately, Dr. Bertram says, what Ontario really needs is, “More anesthesiologists.”  

She recalls attending a luncheon for chiefs organized by Ontario’s Anesthesiologists in 2022 and asking the 40 to 50 people in attendance how many of them were actively hiring. “Every single person put up their hand except for maybe two institutions.”

While she supports making it easier for appropriately trained foreign physicians to come and practice in Ontario, she believes that the long-term key to addressing the province’s anesthesia shortage is to create more training spots. “There needs to be the money and the resources and the commitment from the academic centres to start training more people. And if they can’t take more people, then we need more centres.”  

Additional funding for recruitment would also go a long way, especially for smaller communities like Sarnia. “To entice someone to work here, we have to offer incentives,” says Dr. Bertram, who lists off perks such as a signing bonus, moving expenses, and even interest-free loans.

Though she wishes that steps towards addressing Ontario’s anesthesia human resources challenges had started years ago, she realizes that now is the next best thing. “As our population gets bigger and older, we are going to get more and more behind,” Dr. Bertram says, adding again that this is a situation worth panicking over, a sentiment backed up by the fact that even urban, academic centres now sometimes feel the pinch of anesthesia staffing shortages.

This past March, she officially handed the role of chief to her colleague, Dr. Michèle Jomphe, who is still looking to expand Bluewater’s anesthesia department. Dr. Bertram is still practicing anesthesia at Bluewater and overseeing its pain clinic.

“I’ve grown to really enjoy it,” she says, “It’s one of the things I love about anesthesia, it’s never the same thing every day.”