When confronted by young physicians with a bad attitude about practising medicine in rural Canada, west Quebec rural physician and Health Canada bureaucrat Dr. John Wootton likes to tell a life and death story.
It is part of his campaign to remove the rural stigma and myths that he says doctors-in-training ingest as part of their big city schooling and internships.
“I tell them about one day last year when I delivered a woman’s baby and then went down the hall to be with her father as he died half an hour later,” says Wootton. “There is a tremendous sense of community in a day like that, being with a family through life and death. It is the kind of connection doctors in specialized city hospitals and practices can just dream of.”
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Wootton, a 48-year-old doctor from Shaw-ville, Que., and executive director of Health Canada’s office of rural health, likes to tell the story because he says the medical profession is rife with mythologies about the drawbacks of rural practice.
They are attitudes that make rural medicine seem like a poor career choice, presumptions that rural doctors work too hard, are isolated, make less money, have little support, have little high-tech equipment and little privacy.
It is no wonder that rural areas often have a difficult time attracting physicians. With almost one-quarter of the Canadian population, rural Canada has just 12 percent of physicians.
Learn in school
Wootton said the myths often are perpetuated in medical schools and then in big city training hospitals.
“Most of this training takes place in city hospitals where the emphasis is technology, the benefits of the city and of specialization,” he said. “It is a very urban-centred approach and many graduates are blinkered when it comes to appreciating what happens outside the doors of those university hospitals.”
From his background as a physician in rural northern Ontario, Vancouver Island and the west Quebec Gatineau and Pontiac valleys, Wootton offers a different view.
There is community in rural areas, a variety of practice, access to big city medicine and the support of other physicians when needed while still enjoying the tangible and intangible benefits of rural living and general medicine.
From his perch on the 15th floor of the Health Canada head offices, it is a message Wootton is trying to get out to medical schools and the physician population.
But one solution he does not favor is forcing young or immigrant doctors to spend some time in rural areas as part of the payback for their licences. It is a technique tried and debated for years in several provinces.
Wootton said it reinforces the idea that moving to the country is a form of punishment or dues payment.
“I think it is part of the stick approach and it hasn’t served anyone particularly well,” he said. “I just think it gives in to a mythology of rural hardship that is totally false.”
