Why Suburban ERs Are More Overcrowded Than Montreal's
In 2025-2026, Laval (32 %), Laurentides (31.4 %) and Outaouais (30.7 %) record higher emergency room overcrowding rates than Montreal (25.9 %). A paradox explained by two decades of population growth without proportional hospital investment.
ER overcrowding rate by region (2025-2026)
The ranking that defies conventional wisdom
Most people assume large cities bear the brunt of hospital overcrowding. Quebec's 2025-2026 MSSS data tells a different story. Laval, Laurentides and Outaouais top the provincial ranking - ahead of Montreal, which lands in sixth place.
Laval's trajectory is particularly striking. In 2021-2022, its overcrowding rate stood at 17.8 %. By 2025-2026, it reached 32 % - a 14-point jump in four years, while Montreal edged down slightly from 26.4 % to 25.9 %. Laval is the only region whose overcrowding has risen so consistently and continuously over the period.
Laval: 463,000 residents, one hospital designed to serve 280,000
The answer comes down to a few numbers. Laval has only 106 short-term hospital beds per 100,000 residents, compared to a provincial average of 190 beds[1]. The Cité-de-la-Santé - the only hospital in Quebec's second most populous city - was designed for a population of 280,000. Laval now has 463,000 residents, a 32 % growth over two decades[1].
The hospital operates with the equivalent of 540 to 550 beds per day against a licensed capacity of 489, with 40 stretchers permanently placed in corridors. And yet, in the provincial 2025-2035 infrastructure plan, Laval ranks last among 17 regions at $9,298 invested per capita - compared to $20,337 for Montreal[1]. A $350-million expansion project (108 additional beds) has been waiting for approval since May 2024.
Outaouais faces the same structural pressure. In January 2025, Hull Hospital reached 220 % occupancy - the worst rate in Quebec that day - with an average wait of 34 hours on a stretcher[4]. In March 2025, a mental health patient waited more than 230 hours (nearly ten days) on a stretcher at Gatineau Hospital before a bed became available[5].
Medical deserts pushing patients to ERs
ER overcrowding is not only a bed shortage problem - it is also the result of insufficient primary care. When there is no family doctor available, the emergency room becomes the only option.
In Laurentides, 115,000 residents have no access to family medicine services[2] - equivalent to the entire population of Drummondville. The region has only 148 doctors per 100,000 residents, versus 247 for Quebec as a whole[6]. The direct result: 30 % of care episodes for Laurentians are delivered outside the region, forcing tens of thousands of patients toward Montreal or Laval[6].
In Montérégie, the waiting list for a family doctor in the Pierre-Boucher network jumped from 33,699 to 63,599 patients between 2020 and 2024 - a 89 % increase in four years[8]. Across Quebec, more than one in four residents had no family doctor in 2024, up from one in five in 2019[7].
The pattern is not new, but it is intensifying. In December 2023, Laurentides already recorded 148 % ER occupancy versus 118 % for Montreal[3]. The 2025-2026 data confirms this is not a seasonal anomaly.
What the data does not capture
The MSSS overcrowding rate measures the share of stretcher patients waiting more than 24 hours. It does not directly reflect waiting room times or patients who leave without being seen. Regional comparisons may also be influenced by differences in how individual facilities report their data.
Downstream congestion - patients occupying stretchers while awaiting transfer to a long-term care facility - is also a significant driver that these figures do not separate from overcrowding caused by new patient arrivals. Understanding the suburban ER crisis fully requires looking at long-term care capacity alongside acute care.