A treatment room in the emergency department at Calgary's Peter Lougheed Hospital. 1 in 13 patents nationwide left ERs before they were treated because of long wait times.Jeff McIntosh/The Canadian Press
Iris Gorfinkel is a family physician and clinical researcher in Toronto.
Last year, more than 1.2 million Canadians walked into an emergency room desperate for help, and walked out without ever being treated. That’s one in 13 patients nationwide. These people didn’t leave because their problems weren’t serious, but because the wait was simply too long.
A new report from the Montreal Economic Institute, or MEI, provides the first national snapshot of this troubling trend. Researchers obtained data directly from provincial ministries of health to track how many patients left emergency departments without being seen in 2024. The results are sobering.
Across the country, the numbers vary – but none are reassuring. In Quebec, one in nine patients left untreated. In Alberta, it was one in 11. Manitoba saw one in eight, nearly double its pre‑pandemic rate. New Brunswick’s Horizon Health Network reported one in eight as well, the second‑worst in the country after Prince Edward Island, where a staggering one in seven patients walked away. Nova Scotia and Newfoundland and Labrador each saw one in 10. British Columbia fared somewhat better at one in 18, while Ontario had the lowest rate at one in 20. Saskatchewan and the territories did not provide data.
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Compared to pre‑pandemic levels in 2019, the number of patients leaving ERs without being seen rose 35 per cent nationwide by 2024. In Manitoba and Newfoundland and Labrador, the rate has nearly doubled over the same timeframe.
Who are the patients most likely to leave? Emergency rooms don’t operate on a first‑come, first‑served basis. Patients are triaged on a five‑level scale. Level 1 is resuscitation: the patient could have a pending cardiac arrest or uncontrolled bleeding. These patients don’t leave ERs. The scale decreases in severity to Level 5, which is non‑urgent – someone needing a prescription refill, for example. Those patients can safely wait.
The danger lies within the middle levels. Nearly half of Canadians who left ERs without being seen were Level 3. These are urgent cases with, for example, serious asthma attacks, abdominal pains, fractures, pneumonia, or psychiatric crises. Even more concerning is that over one in 10 were Level 2 true emergencies that include chest pain, stroke symptoms and sepsis. These are conditions where minutes matter.
Why do they leave?
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The psychology of waiting is powerful. As the hours drag on, uncertainty erodes trust. Patients begin to feel invisible, or suspect others are being prioritized unfairly. People are exposed to potentially contagious viruses causing diarrhea, flu or pneumonia. Frustration, fatigue, pain, and family obligations push them to rationalize: Maybe it’s not that serious. Maybe I can tough it out.
But the data show the risk is real. A 2024 Ontario study found that patients who left ERs without being seen were 14 per cent more likely to die or be hospitalized within seven days compared to those who stayed. Walking out is not a sign of wellness – it’s an unwanted gamble and, too often, a losing one.
So what can Canada do? Hiring more doctors alone won’t solve the problem. The country needs 23,000 more family physicians, yet we graduate only about 1,300 each year. And too much of our time is spent on tasks that could be delegated to nurses and pharmacists. What makes more sense is offloading tasks such as vaccinations and cancer screenings, to make the most of family doctors’ appointments. This in turn would lessen the burden on emergency rooms. Modernizing electronic health records is also critical. Imagine logging in to your own profile, seeing what health updates are needed, and booking an appointment with a few clicks. Yet health systems fail to harness the technology that most family doctors already have at their fingertips, which would better enable them to focus on complex care.
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But the most immediate solution is to expand urgent-care clinics. This is where Canada lags badly. The United States, with a similar per‑capita supply of doctors and ERs, has more than 14,000 urgent-care centres. These clinics handle broken bones, infections, and other urgent but non‑life‑threatening problems. As a result, only one in 50 U.S. patients leave ERs without being seen, compared to one in 13 in Canada.
Canada, by contrast, has only a few dozen urgent-care centres, mostly in Ontario and British Columbia. That leaves ERs carrying the full weight of the system. For patients in smaller communities, there is often no alternative but to wait – or to walk out.
The lesson is clear: Canada’s ER crisis is not just about overcrowding. It’s about the absence of alternatives. Until we make the most out of the family doctors we have, modernize our electronic health records, and build more urgent-care clinics, our emergency rooms will remain what they have tragically become for too many Canadians: the front door to nowhere.