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Rural Doctors Should Come From Rural Communities

“Once you have people in the community, how are you going to keep them there? You really want to keep them there.”

– DR. PETER WELLS

Delivering medical care in rural areas is full of special challenges, says Dr. John Wootton, president-elect for the Society of Rural Physicians of Canada.

“Canadians in rural Canada are older than the average, they’re engaged in riskier activities, they’re more isolated, more sparsely distributed and therefore more difficult to serve,” he told the Commons health committee. Studies show “they’re in poorer health to begin with.”

Part of the problem is lower incomes on average.

“Some indicators of well-known risk factors such as smoking and obesity are very present in rural Canada and in some, particularly First Nations communities, have devastating health consequences,” he added. The scattered population complicates service delivery.

There have been efforts in the past to improve rural health care “but I would characterize them as being somewhat disconnected, certainly not part of a national rural health strategy,” he noted. It’s important to “identify the critical elements of a national rural health strategy that would allow us to move forward.”

Rural Canada suffers from a shortage of doctors, nurses and other health-care professionals, he said.

“Communities are struggling to outbid each other in the incentives and the attractiveness that they present their communities. It’s a lose-lose proposition for many rural communities who start off with few resources and are forced to use them as incentives.”

From his experience working in west Quebec, Dr. Wootton says a workforce trained for working in rural communities is essential.

“We need to understand the kind of health worker that we need. We need to understand the kind of teams that we need, and we need to understand how those teams can be trained. I think if we are to seriously address the issues that are facing the distribution of this workforce, we need to mandate some organizations to actually have some authority to get the training done at the appropriate level for the long-term solution.

“If we continue to depend on individual interest and the size of the incentives, we will be continually faced with putting out fires, band-aid solutions, and we won’t have a durable infrastructure that can solve the problem in the long term,” he stated.

Dr. Peter Wells, executive director of the Rural Ontario Medical Program, said the main ingredients in attracting rural health-care providers are finding people with a rural background and then training them to deal with rural problems.

The rural program began in 1988 in Collingwood and now covers a large area of south-central Ontario, he said. “We’re a training organization for community practice, so our intent is to try and create generalists that come out into community practice.”

The program delivers its message to high school students “to encourage students from more rural settings to consider a health career,” he said. It tries to keep the focus on rural care with students in university and college.

It’s also vital to retain the health professionals already working in rural communities, he added. “Once you have people in the community, how are you going to keep them there? You really want to keep them there. If you start losing the folks that you planted there, then you’re defeating your own purpose. Education and providing continuing medical education are all factors in keeping physicians in the community.” So far the program has succeeded in keeping about half of its candidates in rural communities.

He agreed that incentives aren’t the answer to attracting medical personnel to rural communities. “The physicians who are already there are going to start asking, well, if you’re having them in, bringing them in and providing all the incentives, I’ve been here for 25 years: what have you done for me? So it can be a very divisive tool. We would like to not look at that kind of suggestion in health human resource planning.”

He suggested the committee consider a national conference on interprovincial collaboration of organizations working in rural health care. “It would also allow us to share best practices so that we’re not trying to reinvent the wheel.”

There should also be support for a website for rural health care called practicaldoc.ca,he said. It’s just getting started but could be a real boon to medical practitioners.

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