One hospital is forced to close its emergency ward some evenings. Another is staffing its ER after hours with doctors working extra shifts. And a third is grappling with a shortage of emergency doctors by luring new recruits with generous incentive pay.

The Glace Bay Hospital in Cape Breton, N.S., shut its emergency department from 4 p.m. until 7 a.m. the next morning for three days this month. The Pasqua Hospital in Regina avoided a similar fate this week after doctors agreed to work additional shifts – its emergency doors were slated to shut between 7:30 p.m. and 8 a.m. And, in Thunder Bay, home to Canada's second-busiest emergency department, the hospital has been hit with an exodus of doctors. Six of the 27 emergency doctors resigned from Thunder Bay Regional Health Sciences Centre this summer. Another three retired over the past 16 months.

The shortage of doctors is chronic in some regions. It highlights major discrepancies in the level of patient care in the country's emergency departments, especially between major urban centres and remote regions, say health-care experts. The number of doctors in Canada is at a historic high, but there is no comprehensive planning to determine how many are needed and where demand is greatest.

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The Canadian Association of Emergency Physicians has called on the federal and provincial governments to set standards for treatment, including a patient's maximum travel time to an emergency department.

"It is a national problem 10 years in the making," said Dr. Alan Drummond, a spokesman for the association. "But how do you solve a national staffing problem working out of all these provincial silos?"

Ontario is dealing with the problem in many hospitals by keeping emergency departments open with the help of the provincial government's roster of temporary doctors, or locums. HealthForceOntario emergency doctors worked a total of 26,000 hours in 21 hospitals in fiscal 2013, said Health Ministry spokeswoman Joanne Woodward Fraser. That same year, the government spent $15.3-million on the program, according to the public accounts.

Other provinces have started staffing their emergency departments overnight with nurses and paramedics in hospitals that have difficulty maintaining 24/7 service. Nova Scotia, the first province to adopt the model, has expanded it to eight rural hospitals since 2011. Emergency department closings in Nova Scotia declined by one-fifth over the past four years, to 15,083 hours in fiscal 2013.

Saskatchewan and Prince Edward Island have followed Nova Scotia's lead. This month, the PEI government restored overnight emergency services at the Western Hospital in Alberton. The tiny community hospital's emergency department was open only 14 hours a day over the previous five months.

As the only major health-care centre in Northern Ontario between Sault Ste. Marie and Winnipeg, the hospital in Thunder Bay has no choice but to remain open around the clock. The hospital is seeking $400,000 in one-time funding from the Ontario government to pay bonuses to temporary recruits.

The ministry's Ms. Woodward Fraser said the funding is under consideration. Gordon Porter, the hospital's chief of staff, said he expects the ministry to view it "favourably."

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Bonuses, or isolation pay, are the norm in Northern Ontario. But the bonuses paid by the ministry to HealthForceOntario doctors are much more generous than what hospitals pay, according to an internal presentation prepared by Thunder Bay Regional.

The presentation, titled Overview of Emergency Department Staffing Crisis, says HealthForceOntario emergency doctors are paid $190 an hour over and above the standard pay for working a shift.

By comparison, the Thunder Bay hospital pays locums a bonus of $67 an hour. The hospital plans to fully staff its emergency department until next summer with the help of 20 locums, or temporary doctors.

Ms. Woodward Fraser said the ministry's payments to doctors vary widely, depending on travel time and shift lengths. Doctors say the more generous pay is controversial, because it creates a two-tier compensation system between staff and temporary doctors.

The Regina Qu'Appelle Health Region also plans to recruit doctors to work in the Pasqua Hospital. But it won't be offering bonuses, said vice-president David McCutcheon, leaving it at a competitive disadvantage.

"We obviously don't have great big mountains and oceans that attract people," said Dr. McCutcheon. "We don't have the highest salaries in the country either."

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In Thunder Bay, the hospital's decision to hire Chris Mazza, the former chief executive officer of air-ambulance operator Ornge, as a locum has generated considerable controversy.

"We said this is likely going to create some stir," Dr. Porter acknowledged. But the hospital hired him based on his background as a well-trained emergency doctor. Dr. Mazza worked at the hospital last weekend in a mentorship role. "He was a great teacher," Dr. Porter said.