Focus on family physicians in rural areas

Although there is a shortage of health professionals across Canada, rural areas are particularly affected by this phenomenon. Aware of this imbalance, the provinces and territories have for several years established a number of programs intended to promote physicians locating in outlying regions. What are they? What are their limits?

A FEW FIGURES ON RURAL AREAS

According to the Society of Rural Physicians of Canada, rural areas represent 98.8% of Canadian territory (estimated to be 10 million square kilometres). A little more than 31% of the Canadian population, 9 million people, live in areas that are essentially rural. While villages with less than 10,000 inhabitants represent 15.9% of the population, only 11.9% of doctors work there. In 2016, there were 82,198 doctors in Canada – less than 6,500 of them were practicing in rural areas (8%).

A MORE DIVERSIFIED PRACTICE

Family doctors practicing in rural areas are required to offer a more diversified range of treatments to compensate for the lack of specialists (barely 2% in these regions). They can, in a single day, facilitate an awareness workshop on infections diseases, conduct a delivery, administer an anaesthetic, go to the emergency room, etc…  Their role is therefore critical since they make certain medical care more accessible to which the population would not have access without them.

… WHICH CAN HAVE LIMITS

Given the variety of care provided by rural doctors, there is generally a lower number of interventions than for specialist colleagues in practices in urban centres. So some professional orders have wanted to establish thresholds below which the doctor is not considered to have the required skills. For example, the Society of Obstetricians and Gynaecologists of Canada (SOGC) has required doctors to have conducted 25 deliveries to maintain their skills. Saskatchewan, which applied this recommendation to the letter, has seen the number of deliveries conducted by rural doctors drop from 80% to 20%. Noting the damage, the SOGC has reconsidered, but the damage was done – Saskatchewan has never returned to the old levels.

SOLUTIONS TO COUNTER THIS UNEVEN DISTRIBUTION

  • Programs and incentives

While the College of Family Physicians of Canada wants a national policy in favour of care in rural/remote areas, the federal government, in 2013, did not pay anything for recruitment and retention of doctors in rural areas. Initiatives therefore now fall to the provinces, which explains some of the disparity. Communities, meanwhile, offer assistance which can take various forms (free housing, providing an official car, assistance with work for the spouse, assistance for children’s education, etc.).

  • Foreign windfall… for the short term

One solution to mitigate not the shortage of doctors but their poor distribution over the territory, is to call on internationally educated doctors. About 26% of Canada’s practitioners were educated abroad. This solution for rural areas may appear as a decoy, because foreign doctors accept being forced to work in rural areas, and once they have their licence to practice in Canada they are very likely to move to the cities (76%). This solution therefore creates a very high churn rate in remote areas.

  • Investing in the region’s youth

It has been definitively established that it is difficult to bring out a doctor who has grown up, followed his studies and started his career in the city. Actions currently undertaken revolve more around retention. On the one hand, it’s a question of educating young people from rural areas about the medical profession. On the other hand, it is important to encourage natives of these regions who are studying medicine in the city to be exposed as much as possible to their region of origin through internships, special training sessions, etc., so they face the peculiarities of practice in rural areas.

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