Rural residents concerned about the future of health care in their communities have a friend in high places.
Dr. Anne Doig, a Saskatoon physician who spent part of her childhood in small-town Saskatchewan, took over as president of the Canadian Medical Association in August.
One of her priorities in her new role will be to develop policies and programs that improve the availability and quality of health care for people in rural and isolated parts of the country.
“It is a precarious situation,” she said in a recent interview in her corner office in a downtown medical clinic.
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“I’m not saying every doctor in rural Canada is going to quit in the next five years, but it’s precarious because we haven’t given enough thought to how we can make rural medicine sustainable for the people who are trying to do it.”
She said a number of issues have to be addressed, including facilities and infrastructure, information technology, computer communication and collegial and practical support for doctors working in rural and remote locations.
“We have to be more creative in how to get the doctor to the patient or the patient to the doctor,” she said.
It’s also important to make sure medical students are exposed to practicing medicine in a rural environment, where there isn’t an MRI machine down the hall, a specialist across the street or a colleague in the next office with whom to discuss a case.
While Doig has lived and worked all her adult life in Saskatoon, she does have personal experience with rural medicine.
Her physician father immigrated to Saskatchewan from England in 1958 and set up shop in Hawarden, a small town of around 300 people at the time.
Doig, who turned five shortly after the family arrived, vividly remembers her father working for the first few months out of the back room of the local pharmacy before buying a mobile home, parking it next to the family home and converting it into a medical clinic.
Twice a day he would drive to and from the nearest hospital at Outlook to deal with patients, a 160-kilometre round trip on gravel roads.
Her father was one of a number of doctors practising in small towns in the area.
“In those days, every small town thought it had to have its own doctor,” Doig said.
In 1961, her father moved to Saskatoon and Hawarden hasn’t had a doctor since.
Doig can trace her own career back to those days. On her fifth birthday she was given a toy nurse’s kit, prompting her to tell her mother, “why did they give me a nurse’s kit, I’m going to be a doctor.”
After high school she enrolled in medicine at the University of Saskatchewan, becoming an M.D. in 1976 and starting work at her father’s clinic in 1978.
While at the university, she forged another link to rural Saskatchewan when she met Bob Cowan, an engineering student from a farm near Rosetown, Sask.
After graduation, as they considered marrying (which they did in 1979), they also had to decide whether they would one day move to Rosetown to take over the farm or stay in the city to pursue their professional careers and raise a family.
“Did Bob want to be a farmer and run a small engineering business on the side, did I want to be a rural physician or stay in the city and go into practice with my dad?” she recalls them wondering.
“Did we want to be city people or country people is what it boiled down to.”
Her decision to stay in Saskatoon wasn’t a rejection of rural medicine, she said.
During her residency, she had spent time working at the Rosetown medical clinic and it was the kind of medicine she enjoyed, exactly what a family physician is trained to do and exactly what her father did in Hawarden.
“The idea of being a rural doctor was fine with me, but we had to look at the bigger picture and set a sustainable pathway for the future.”
They stayed in Saskatoon, with Cowan traveling back to the farm on weekends and during busy times of the year to help his father, getting more involved as the years went by and eventually taking over the farm when his father died in 1994.
“I’d commute on weekends or take a few days off, and I had a great neighbour who looked after things when I wasn’t there,” he said.
Doig spent time at the farm but never drove a truck, instead tending the garden and preparing meals along with Cowan’s mother, who lived on the farm until 2005. She treated the odd injury and generally enjoyed the rural environment.
Tough decision
Finally, after doing that for 13 years, Cowan said, they faced a choice of expanding and investing in the farm or diversifying and staying small.
“We couldn’t carry on the way we were,” he said.
None of their six children were interested in farming as a career and in 2007 they sold the farm, which had been homesteaded by Cowan’s grandfather in 1905.
“Sure I miss it, but farming had changed and the investment to expand it would have been significant,” he said.
Doig said the fight to ensure accessible and quality health care for rural residents won’t be easy, but it’s something to which she’s committed.
As well, she paid tribute to the few remaining doctors who practice in a small rural town alone or with a partner.
“I take my hat off to those physicians,” she said. “I really don’t know how they manage it.”
