Beginning this fall, Manitobans will notice some significant changes to the province's health-care system as a series of major cuts imposed by the provincial government start to come into effect.

As part of broad belt-tightening measures to cut health spending, the Winnipeg Regional Health Authority has a mandate to cut spending by $83 million this budget year. The province's total health-care budget is $6.1 billion.

In order to reach that goal, Health Minister Kelvin Goertzen has said the government and health administrators have had to make some tough decisions.

From shutting down emergency rooms and clinics, to cutting lactation and audiology specialists, to privatizing adult outpatient physio and occupational therapy, the changes will have wide-ranging impacts on patients.

The province said many of the changes stem from recommendations in two recent reviews of the province's health system: a study by KPMG and a report authored by Dr. David Peachey.

The full effects of these cuts likely won't be felt until years down the road and there may be more cuts coming.

With so many cuts announce over the past few months, it can be difficult to keep track. Here is a roundup of all the changes planned so far.

ER, urgent care closures and conversions

One of the most significant changes to Manitoba's health system was announced in April when the province revealed that three of Winnipeg's six emergency rooms would be closing.

The ERs at Victoria Hospital and Seven Oaks Hospital will convert to 24/7 urgent care centres, while the Concordia Hospital ER will close entirely.

Winnipeg's only current urgent care centre at Misericordia Health Centre will also close.

The Victoria Hospital ER will shut down by Oct. 3. The hospital will add 50 beds for mental health services.

The Concordia and Seven Oaks closures will happen sometime in 2018. Concordia will take on more orthopedic surgeries, while Seven Oaks will focus on renal service and rehab for the elderly, and be the go-to centre for endoscopy.

Misericordia has already stopped taking patients overnight. In October, it will close entirely and become a community-based intravenous therapy clinic.

Health Minister Goertzen said the overall number of hours worked by ER doctors won't be affected. The province plans to expand the ERs at Health Sciences Centre, St. Boniface Hospital and, to a lesser extent, Grace Hospital.

The overhaul to hospital services, which includes the ER closures and conversions, is expected to save the WRHA $30.9 million.

Changes to services in community

The changes to Manitoba's health system will be apparent outside hospitals in clinics and communities across the province.

Four of five of Winnipeg's QuickCare Clinics will close by the end of January. The clinics, which are staffed primarily by nurse practitioners, were touted as a way to reduce pressure on crowded emergency rooms.

Services at the clinics will be shifted to Access centres, which offer a range of services from front-line health care from physicians or nurse practitioners, to assistance with mental health, home care, employment and income assistance programs.

Until now, the centres have not offered walk-in services, but going forward the WRHA has said that will change.

The WRHA is adjusting patient-to-staff ratios and changing staff rotations at various units across the region.

The changes are expected to save approximately $900,000.

The WRHA also announced a variety of fee increases for services for seniors. Fees for the adult day program, transportation fees for geriatric day hospital, and income-based monthly rates for the PRIME program are all expected to rise.

Changes to services for women

Some of the proposed changes directly impact services for women.

The Mature Women's Centre will shut down in October. The centre helps women with gynecological issues, menopause transition, and other issues for women between 20 and 40 with "unique, premature gynecological issues."

The closure is expected to save $163,000.

After the closure, patients may go back to the general practitioners with a treatment plan, while others may be referred to a community gynecologist.

Women needing specialized care will be referred to specialists at HSC.

The province also announced it will be cutting two lactation consultants at HSC. In their place, nurses working on maternity wards will be trained to provide the service.

Changes to therapists, specialists

The province is moving to take adult physiotherapy and occupational therapy out of hospitals and transfer those services to private practitioners.

Exceptions will be made for specialty rehabilitation services, such as services provided by the spine clinic, as well as specialized neuro services and amputee services.

Accommodations will be made for people who can't afford private insurance for physiotherapy and occupational therapy, the province has said.

The WRHA said the change is expected to save the region $1.5 million in 2017-18 and $3.5 million in 2018-19, but couldn't say how many jobs might be cut as a result of the changes.

Two recreational therapists who provide care for mental health patients at HSC will be cut, leaving one to provide recreational therapy services to patients on five mental health wards.

Two audiologists in the adult audio hearing loss program at HSC will also be cut. The union is still waiting to find out if 12 remaining members who work as audiologists will see their jobs cut as well.

Changes to rural health care

Much of the attention on the announced health care changes have focused on the Winnipeg health region, but the impacts will be felt beyond the perimeter as well.

All health regions across the province have been ordered to cut management positions by 15 per cent.

The province will close 18 low-volume EMS stations in rural areas throughout Manitoba. Five new stations will be built and staffed with full-time paramedics.

The new stations will be located in the communities of Miniota, Cowan, Alonsa, Manigotogan and Eriksdale, while stations in Virden and Glenboro will be expanded, the province said.

These new stations will be staffed full-time by paramedics, while some of the stations expected to close were only staffed on a part-time or on-call basis.

The province is also scrapping a $4.2-million program that offered incentives to medical students to set up practice in rural Manitoba communities.

The Medical Student/Resident Financial Assistance Program offered $12,000 to medical students for each of their years in medical school, plus additional grants if they established a practice in the province.

In return, students were required to work in an under-serviced part of the province for six months for each year they received the grant.

Full coverage of health cuts in Manitoba