Northern Ontario badly needs doctors. But ‘forcing’ them to work there is no solution.


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10 comments

  1. Sherman Quan

    I am no expert with delivering care in rural areas but here is a potentially fresh idea. If we can’t get physicians to come to Northern Ontario, could we create a model where physicians from other regions/areas have a more consistent presence from a distance? Locally, citizens currently living in these rural communities could get trained to be physician assistants or some other similar role. Then enabled through technology, physicians could remotely supervise the work of these physician assistants who are physically living in the rural communities. Although physically in another region, a physician could be consistently delivering/overseeing care of patients in these rural communities. This will allow them to form that relationship with the patients a locum that constantly changes is unable to do. By training local citizens to be physician assistants, this also creates jobs and economic prosperity, which has other benefits. Locals are also known by others in the community so would be more trusted.

    • Sarah Newbery

      Thanks for your comment Sherman! The model that you are describing is used currently in small remote Northern communities where NP’s are the main health care provider and family physicians support the NP from a distance and visit the community, generally monthly. The US makes extensive use of PA’s for remote primary care delivery in models that work well. Technology can definitely be used to support “physician extenders” in caring for the people of rural and remote communities. The challenge I think is that for patients to be able to maximize the care that they receive in their communities, they need physicians. For managing the complex, multimorbity patients, providing inpatient care, running the ER, providing obstetrical care, anaesthesia, etc, there is a valuable role for physicians. I agree with you that we should be encouraging PA’s and NP’s (and in a “grow your own” model encouraging local citizens to take up these roles). Excellent team based care can absolutely be a support for rural family physicians and knowing that there are strong teams would likely make the opportunity of rural practice more attractive. Thanks again for sharing your thoughts!

      • Heather Barrett

        Using disparaging terms such as “physician extenders” is not helpful. I wonder if you were to further familiarize yourself with the role if your ourlook would change. We depend on our docs, no question they are invaluable. But NP/PA’s are a solution that is often not sufficiently considered.
        I’m a rural NP.

        • G. S.

          Money.

          If a doctor gets paid the same to work in isolated Northern Ontario as they do in Toronto, they’ll 99% of the time choose Toronto.

          I have seen the incentive packages offered to physicians for Northern work, and are not substantial, encompassing an extra week of pay per year. Most people would rather have the week off if they’re going to be isolated.

          Living in isolated communities is for a very particular type of person, and unfortunately, that type is rarely ever interested in practicing medicine at all.

          Doctors are square pegs and the rural communities are round holes. They don’t fit, and forcing them in breaks both. The only tenable solution is money, as hard as that is to accept.

  2. Karen S. Palmer

    Such an important issue, so thanks for writing about it Sarah. When I lived in the US, I worked for the Hawaii State Department of Health as the Primary Care and Rural Health Coordinator. One of my jobs involved working with designated “Health Professional Shortages Areas” and the US National Health Service Corps, which offers loan repayment to physicians and dentists in exchange for living and practicing in rural and remote communities. https://nhsc.hrsa.gov/loanrepayment/ In Hawaii, this often meant working with Native Hawaiian people on the neighbour islands. Physician friends participated in this program, and some stayed in these communities long after fulfilling their commitment because they found the work fulfilling, the patients appreciative, and the lifestyle enticing. I believe the Government of Canada has an FP and nurse loan forgiveness program too, but with relatively low rates of debt relief. Is loan forgiveness the right incentive to attract the right people? Is the debt relieve level sufficient to be attractive? Is this a good way to recruit physicians, or does it lead to churn and instability for patients when physicians leave?

  3. Claire

    Thank you for this article, I had just been speaking to my cousin about her application for a role in a Northern Community that would see her and partner (Social Worker) moving to the area as well, so this article was timely for me. While of course creating a scenario where competent physicians are excited to move to Northern communities and practice is ideal (see this article for some great ideas ideas http://www.cbc.ca/news/canada/nova-scotia/physician-recruitment-goderich-ontario-success-1.4538925), I think it would also be important to support individuals from the communities to become physicians through policies and support for individuals (students!) and remove barriers that may inhibit them from striving for these roles. The same way concerted effort is being put on enabling girls to enter into STEM education and careers we could support Northern residents to enter into the medical field.

  4. Dr. John Collins

    I think that choosing medical students that were raised in rural Ontario will more likely produce physicians who will return to these communities. I also think that requiring rural rotations during medical school training in all disciplines will make graduates more aware of the multiple benefits of rural practice. Finally medical school training needs to have less emphasis on technology which is not readily available in the rural areas. New graduates often now feel ill prepared to work and diagnose in areas void of these services and thus are far less likely to set up practice there.

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