Shortcomings in rural health services can only be solved with a rural health strategy that all levels of government embrace, say rural health experts.
Dr. Roger Strasser, dean of the Northern Ontario School of Medicine in Thunder Bay and former director of the largest rural medicine school in Australia, said it will require federal leadership, including a national rural health strategy.
“I’ve seen in Australia the leadership from the federal government, which has really improved the quality and the access to health care in rural and remote areas,” he told the House of Commons health committee March 30.
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“I can see the same success happening here in Canada.”
Quebec doctor John Wootton, president-elect of the Society of Rural Physicians, told MPs the solution to the lack of medical services in rural Canada must involve all levels of government.
“I think there isn’t an opportunity for this to be solved simply at one level,” he told MPs. “It has to be solved at many.”
The Parliament Hill hearing on rural health produced a series of recommendations on what to do and what not to do to convince health professionals to first go to and then stay in rural Canada.
Incentives to attract health professionals to rural communities are not the way to go, MPs heard.
Toronto-area Liberal MP Kristy Duncan noted that while 21 percent of Canadians live in rural Canada, 9.4 percent of physicians work in those areas.
Disease and mortality rates are far higher among rural residents than the Canadian average.
In an interview last year, former Saskatchewan premier Roy Rom-anow, chair of a royal commission on health almost a decade ago, lamented that his recommendation for a rural health fund and more emphasis on rural health has been ignored.
“And that does not include more rural hospitals because that is not a solution.”
As premier, he closed scores of small rural hospitals and paid a political price.
But the message to MPs last week is that the key is to recruit rural students to medical schools. They will be more likely to return to their rural roots.
“After a rural background, training and location of training, both at the graduate and post-graduate level, is the biggest determinant of where people will elect to practise and set up practice,” said Dr. Peter Wells, executive director of the rural Ontario medical program.
Strasser said that rural health staffing has improved in Australia because of rules that require recruiting more students from rural areas, creating medical schools outside urban areas, including rural health needs in the curriculum of medical schools and requiring some rural practice in the clinical work of all medical school graduates.
Among witnesses, there was wide agreement that community or government incentives to attract health professionals to rural areas are not the way to go. Doctors take the money and run.
Wootton said less affluent communities that offer incentives to attract medical personnel are in a race they cannot win.
“Communities are struggling to outbid each other in the incentives and the attractiveness that they present their communities,” said the doctor from Shawville, Que.
“It’s a lose-lose proposition for many rural communities who start off with few resources and are forced to use them as incentives. If we continue to depend on individual interest and the size of 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 run.”
He said incentives to attract new health professionals to a community alienate those who have chosen to be there for years without an incentive.
Strasser, dean of the only dedicated rural medicine school in Canada, said incentives attract but do not retain.
“When the incentive time runs out, then there is a tendency for the physicians to decide, well, they’re not going to stay in the community any longer,” he said.
