“Working together, we can achieve that goal by supporting the students here in Neepawa that are starting their journey towards fulfilling careers as future nursing professionals,” said Premier Wab Kinew in a news release on Jan. 22.

The Neepawa Training Centre will partner with Assiniboine Community College (ACC) to run a two-year, licensed practical nurse program. Licensed practical nurses (LPNs) provide health care, usually under the direction of medical practitioners like registered nurses (RNs), according to a job description on the Government of Canada’s website.

In February of 2023, the previous Progressive Conservative government announced it was giving ACC $2.1 million in operating and capital funding to offer a one-time LPN course. In March of that year, ACC said in a news release it would prioritize applications from people living within 100 kilometres of Neepawa or within the Prairie Mountain Health region.

That program could accept up to 25 students. Twenty students began studies at the centre in January, the Winnipeg Free Press reported.

A new hospital is also in the works for the community. In an Oct. 17, 2022 news release, the province announced it would build the facility with an expanded emergency department, 63 acute care inpatient beds, up from 38 at the current site, and increased space for other programs like surgery and palliative care.

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Thirty-three students from the University of Manitoba’s faculty of medicine were placed in 13 communities, including Brandon, Dauphin, Glenboro, Grandview, Hamiota, Neepawa, Rivers, Russell, Souris, Ste. Rose, Swan River, Treherne and Virden.

“I would be shocked if this experience dissuaded anyone from rural medicine. I think most, if not all, students will come away from this with a better appreciation for rural doctors and the need for physicians in these areas,” said participating student Ryan Best.

Best participated in Rural Week in Rivers, along with fellow medical student, Justin Kozak. Both Best and Kozak are from Winnipeg and had had little previous exposure to small-town Manitoba.

“I think these early exposures to rural medicine make students way more likely to take up a longer rural exposure down the road,” said Kozak. “I have been blown away by the hospitality we have received here this week. There have been so many individuals who have gone above and beyond to make sure that we feel welcome and you can tell that it is so genuine.”

The event was co-ordinated by Manitoba’s Office of Rural and Northern Health (ORNH), the University of Manitoba and regional health authorities to give students the opportunity to gain first-hand experiences of how rural medical practices work.

“Rural Manitoba offers tremendous opportunity for a rewarding career and a great lifestyle, but it is only through direct experiences like Rural Week that students become aware of the possibilities,” said Wayne Heide, administrative director with ORNH. “For urban-origin students this may be their first real experience with rural life. For those from rural areas it is a chance to reinforce the positive aspects of rural life and to connect them to medical professionals who have chosen to practise rurally.”

Manitoba first held Rural Week in 2003 as an optional experience for medical students. Rural Week was approved as a mandatory component of the Medical-One curriculum in 2004 as part of the strategy to address chronic medical doctor shortages in rural communities.

Throughout the week students work with area physicians in the office, hospital, clinic, during on-call and emergency room coverage, to gain a basic understanding of the role of the rural family physician.

“There is no doubt that rural doctors are required to be more generalist. You might have to be the first person to see a trauma case come in and at the same time you are dealing with pediatric cases, where in the city a pediatric physician would handle,” said Best.

Outside of the medical clinic, hosting towns are encouraged to offer lifestyle itineraries, where students can take part in everything from fishing expeditions to recreational activities in order to learn about the community and experience the rural lifestyle.

“We took the students all around town. To the golf course, around the lake and to the nearby Hutterite colony and they have been able to talk to all different kinds of people, in the hospital and out,” said Donna Morken, chair of Healthy Rivers Area committee and key community member behind Rural Week activities. “We wanted them to get an appreciation for the rural area and what life would be like living in a community like this.”

The student week in Rivers was concluded with the second annual, Walk with your Doc event. The initiative that comes from a doctor in B.C. that began six years ago, is aimed to encourage doctors to prescribe exercise.

“We always want to keep the community healthy and I saw something about Dr. Jim Wilson from B.C. and how he was a family physician who was prescribing exercise for his patients,” said Morken. “Last year, we were excited to be the first community in Manitoba to hold a Walk with your Doc event. We were also able to co-ordinate it with Rural Week, so the two students could walk with the community on their final day here.”

Nearly 300 individuals came out for a stroll around Rivers for the second annual Walk with your Doc event. Morken and the Healthy Rivers Area committee have now issued a challenge to other hospitals and communities throughout the province, to hold their own Walk with your Doc event.

“The people who we have been spending time with in Rivers are really committed to the community. From setting up grants and building the new recreation complex, to organizing this kind of walk. The sense of community is really quite impressive,” said Best.

In terms of attracting doctors into Manitoba’s rural areas, Kozak believes that there isn’t one simple solution to combating the ongoing shortages.

“I think that it is a matter of several different factors. I don’t think that there is one specific thing that will attract doctors to rural Manitoba. Exposure is a huge part of it and experiences like this one, especially early on in medical school, can really make a difference,” said Kozak. “It is a matter of finding the right balance between financial incentives, ongoing exposure in the classroom and attracting people who are from the rural area to pursue medicine as they are more likely to return to this kind of lifestyle.”

Both Best and Kozak say that it is far too early to pinpoint where they hope to end up following medical school, but note that Rural Week has certainly given them a better perspective on the benefits of a rural practice.

“Rivers has left a really good impression on me. One of the really nice things about a community like this is that you can really make a difference and you can see the difference you’re making,” said Kozak. “Sometimes when you are in a big city it feels like everything you do is just a drop in the bucket.”

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The Brandon Medical Education Study in 2011 began studying options for training more doctors for rural and northern practice.

The 246-page report concludes a separate medical school in the Wheat City isn’t needed because the small regional rural population doesn’t require the volume of new medical graduates such a school would produce.

It is recommending what it calls a modest increase in “homegrown supply” of doctors trained in Manitoba.

The provincial need is for no more than 30 more primary-care physicians per year, not 50 doctors, which is what is the minimum feasible class size for a free-standing school, the study said.

But a Brandon physician practising for more than 30 years in Westman and a vocal proponent for facilities that train doctors who want to practise in rural and northern areas said the proposal won’t address the problem.

“It will have little or no effect on the problem we have out here,” said Dr. Derry Decter. “It’s an illusion to think that this is going to solve anything.”

Illusion

A half-dozen new residencies per year while continuing to focus undergraduate studies in Winnipeg will neither raise the numbers of doctors up to what’s needed, nor address why doctors don’t often opt to practise outside the city, said Decter.

“This is going to generate five or six doctors a year,” he said, adding that as many as 300 doctors are what’s needed to fill all the vacancies across the North and rural areas, particularly to fill ongoing gaps each time recruited foreign-trained doctors move on after just short periods of service.

More residencies won’t have the desired influence of getting doctors to practise outside Winnipeg either, Decter said. Studies show it’s where students do their undergraduate studies — or first years of their training — that is the strongest influence on where they end up practising.

“The first four years of school… that’s the major influence on where you go,” he said. “So if we continue to train them in Winnipeg we’re going to continue to have the same problem that we have now.”

The Brandon Medical Education Study (BMES) also concluded that lack of access to doctors in Manitoba is a problem felt across both urban and rural areas, but says needs can be met by redirecting current physician resources and what it terms “a modest increase in homegrown supply.”

Among its other recommendations, it calls for the eventual development of a satellite medical school in Brandon to work in partnership with the University of Manitoba’s faculty of medicine.

The province said it has accepted all 10 recommendations of the report. Health Minister Theresa Oswald said six new family medicine residencies in Brandon, Steinbach and Morden/Winkler had already been added.

Other recommendations include creating community campuses with clinical teaching units for third- and fourth-year medical students interested in rural practice and ongoing assessment of whether additional spaces for medical students are needed. If more are needed there is potential for the formation of a satellite medical campus in Brandon and possibly other rural communities in the future, the study said.

A working group with representatives from the faculty of medicine at the University of Manitoba and Brandon University will begin to implement recommendations from the study.

Deborah Poff, Brandon University president and chair of the steering committee that oversaw the study said in a news release the BMES recommendations “are a step toward training more doctors in Brandon and rural Manitoba.”

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Both those shortcomings could be addressed if governments encouraged more rural students into careers in medicine and health, he said in an interview. He was in Ottawa as part of a lobby by the Canadian Federation of Medical Students to raise awareness of the barriers to delivering medical services in rural and remote areas.

A native of Miramichi, New Brunswick, Stymiest is enrolled in the Dalhousie University Medical School in Halifax, but doing much of his training in his home province. His goal is to work in a rural practice after he graduates.

“Currently, 22 per cent of Canadians live in rural areas, but only 17 per cent of the doctors are there,” he says. That gap will widen in the coming years unless changes are made. “That makes it harder to access family doctors or get referrals to specialists. Also, doctors need to understand the issues farmers face dealing with pesticides and hazardous materials.”

Farmers and other rural dwellers also find it harder to make the time to visit a doctor’s office “because of the time pressures of their employment,” he adds.

One significant barrier for rural students interested in a medical career is the cost of a university education, he said. The government has addressed this in part with its announcement last March that it will forgive a portion of Canada Student Loans for new family physicians working in rural and remote communities.

“The government could make this program a lot more effective,” he says. It needs to realize that students with a rural background are more likely to return there when they’re ready to begin practising.

The federation says graduates must begin to pay off their loans during medical residency training, before they are eligible for the loan forgiveness. “We are requesting that the government defer repayment of these loans until the completion of medical residency training. This would more effectively attract new medical graduates to rural and remote communities and better serve the needs of Canadians.”

The CFMS is also calling upon the federal government to allocate funds for the establishment of mentorship programs that attract rural students to medical school. Mentorship programs in the United States and Australia have been highly successful in recruiting rural students to careers in medicine.

“These are simple, sensible strategies for improving health-care access to those for whom it is least available,” says Matthew Tenenbaum, vice-president of communications. “It is important to ensure that the principle of accessible health care is realized everywhere in this country.”

CFMS represents more than 7,500 medical students at 14 medical schools across Canada.

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“We’ve been decreasing the percentage of foreigntrained doctors in Canada, as a percentage overall, but at the same time making certification of a foreigntrained doctor contingent on working in a rural area. That means we have concentrated them in rural areas.”

– JOHN DAVID STANWAY, SENIOR ANALYST, CANADIAN INSTITUTE FOR HEALTH INFORMATION

Visit a doctor somewhere in rural Manitoba these days, and odds are he or she did not earn their medical degree in Canada.

Yet, Canada’s percentage of foreign-trained doctors has actually declined since the 1970s, according to a new report.

The Canadian Institute for Health Information (CIHI) this summer released findings showing the percentage of Canada’s foreign-trained physician workforce has actually dropped from 33 per cent to 22 per cent in 2007.

The decline is seen in all provinces and territories, with the major reason for the decline in the number of foreign-trained doctors relative to the overall physician workforce being that the huge wave of British-and

Irish-trained doctors who were coming here to practice in the 1970s is now retiring.

At the same time, slightly fewer numbers of international medical graduates are setting up practices in Canada, the report says.

Today, one in five doctors has earned their degree outside Canada; in the 1970s, the ratio was one in three.

Why we see foreign-trained doctors still concentrated in rural areas is the result of deliberate policies, said John David Stanway, a senior analyst with CIHI. Foreign-trained doctors must serve two or three years in an underserviced area as part of the provisional licensing.

“We’ve been decreasing the percentage of foreign-trained doctors in Canada, as a percentage overall, but at the same time making certification of a foreign-trained doctor contingent on working in a rural area,” Stanway said. “That means we have concentrated them in rural areas.”

Unfortunately, they’re not sticking around long, this report confirms. Foreign-trained doctors have a much greater tendency, than the previous wave of Brits and Irish doctors, to move elsewhere within a decade of arrival.

The report also notes the major shift in countries from where Canada now sources doctors. Whereas in 1972, a major portion came from Britain and Ireland, by 2007, South Africa and India were supplying this country with most of its international medical grads.

Dr. Derry Decter, a Brandonbased physician advocating that a medical school be created at Brandon University to graduate new doctors who would commit to serving in rural areas, said the CIHI findings underscore the need to rely less on foreigntrained docs.

“It doesn’t make sense to me to raid the Third World for scarce physicians,” he said. “The obvious solution is to train our own docs.”

That is, in fact, what Canada as a whole has begun to do.

Dr. Ian Bowmer, executive director of the Medical Council of Canada points out that this country is about to see an influx of Canadian-born and trained doctors, as larger classes in medical schools across Canada begin to graduate. More Canadian medical schools have opened and more spots for medical residents have been created, he noted.

Yet, the rural shortage won’t disappear if all these new doctors still don’t want to practice rurally.

“The policy levers that need to be pulled right now are to attract all these physicians to rural practice,” Bowmer said, adding that he sees governments actively engaged in efforts to both recruit and retrain both IMGs and Canadian medical graduates in rural service.

Another part of the solution is “to create an environment where the lifestyle for physicians and other health-care workers actually improves,” he stressed.

Dr. Dean J. Sandham, dean of the University of Manitoba’s faculty of medicine echoes that view.

This fall the university’s faculty of medicine welcomed a 110-member class, representing a 53 per cent increase in enrolment in undergraduate medicine over the last nine years here. Forty-nine of them are coming in with experience either of living, working or volunteering in rural areas.

“We’ve been working hard on our admissions process to create an index that allows us to put extra value to people who have a commitment to working in rural and remote areas,” Sandham said.

The faculty of medicine is also currently hiring an assistant dean to improve and enhance both the education and the lifestyle students experience when they’re placed outside the Winnipeg area during the course of their studies.

“What we need to do is try to make these rural careers appealing to people.”

Meanwhile, the provincial government this summer announced an allocation of $2.1 million for a multi-tiered approach to recruit and retain physicians across Manitoba, especially in rural areas.

The cash will be put toward recruitment of specialists, rural physician relief so that doctors can take temporary leaves, and to cover costs such as moving expenses for physicians setting up practice in rural areas and grants for 10 second-year students taking part in the Northern Remote Physician Practice Initiative.

In addition, $90,000 in funding will be used to co-ordinate the repatriation of Manitoban and Canadian medical students studying in other provinces or abroad.

The CIHI report notes that over a quarter (27 per cent) of Canada’s foreign-trained doctors actually grew up in Canada but have studied overseas.

The CIHI is a non-profit, independent organization collecting and analyzing information on health and health care in Canada.

lorraine@fbcpublishing.com

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