Rural Medicine Show

As 5 million Canadians can't find a family doctor.  Outside the big cities, the problem is far more severe.  One in three Canadians lives in rural parts of the country - yet only one in ten of Canada's family docs and far fewer specialists practice there.  And the shortage is getting worse.  A 2010 survey published in the Canadian Journal of Rural Medicine found that one in seven rural MDs plan to leave town within the next two years. 

This week, we tackle the shortage of rural health professionals in Canada.  I talk to a GP from the UK who postponed his retirement to work in Northern British Columbia.  And when this particular small town doctor leaves unexpectedly, I speak to the regional health authority's man in charge of finding an emergency replacement.  A resident in family medicine tells me why he's bucked the trend and gone rural.  I also visit a small town in Ontario where a unique clinic gave hope to rural patients who hadn't seen a doctor in years - until the funding ran out.

Catch our show this Saturday, September 24 at 11:30 am (noon NT) and again on Monday, September 26 at 11:30 am (3:30 pm NT) on CBC Radio One. Or click below to listen right now or download the podcast:

The Village of Burns Lake is located in the heart of northern BC, about 220 km west of Prince George on Highway 16.  Surrounded by splendid nature, Burns Lake is known for fishing, hiking, and boating in the warmer months and cross country skiing in the winter.  Lately, it's also known for something else: an acute shortage of doctors.

Dr. Allan Hill is a GP from the UK who immigrated to Canada in 2007 and went straight to work in Burns Lake.  When he arrived, he was one of five family doctors who worked there, treating roughly 2,500 local residents and serving the needs of a community that Hill estimates to be close to 10,500.  One by one, the others left town, leaving Hill - who is pushing retirement age himself, as the last full time GP in town.  Hill shares on-call duties with a small number of family doctors who work mainly in other towns but who work part time in Burns Lake to help ease a heavy load that includes staffing the local 13-bed hospital and ER.

The hospital has no surgeons on staff, yet is frequently the first place paramedics bring accident victims by ambulance. 

"What we do in the emergency room is basic stabilization of more serious patients," Dr. Hill told WCBA in an interview in early August.  "Then, we move them out by ambulance to the nearest major hospital, which is Prince George."

Hill admitted to feeling anxious about not knowing whether he'll be able to save critically ill patients who arrived at the hospital. 

"I don't know if I'll be able to save them," he told WCBA.  "When I hear a phone call, if something major comes in, I do have a certain degree of anxiety.  But you get used to that."

Having to be on call frequently for emergencies means Hill has less time to practice preventive medicine and provide routine care for his patients.  "Currently, it takes 2 weeks for patients to book routine appointments," said Hill.  "That's just not acceptable."

Since I spoke with Dr. Hill in August, there's been a development.  He had planned to take a vacation in England for most of September.  A replacement - we call them locums - was found to cover his absence.  However, late last month, Dr. Hill left Burns Lake early for personal reasons, leaving the village without its only full time doctor, and leaving Northern Health, the regional authority responsible for Burns Lake, on the hook to try and find an emergency replacement.

I spole with Dr. David Butcher, a family physician and Vice President of Medicine and Clinical Programs for Northern Health.  "Northern Health has been working with Dr. Hill to build a team of replacements, particularly to cover the emergency component of Dr. Hill's practice," Dr. Butcher told WCBA.

Dr. Butcher admits that Hill's unexpectedly longer absence creates a recruitment headache for Northern Health. 

"Well, it creates a real concern in our ability to maintain consistent access to services," says Butcher.  "I happens in this situation and it happens in other situations where the physician - despite their best effort - is unable to find a replacement for their practice.  But, quite legitimately, the doctor needs to take some time off from the community."

"The ability to maintain services often comes down to the presence or absence of one physician," Butcher added. 

I asked Dr. Butcher for Northern Health's take on why it's been difficult to recruit new doctors to Burns Lake.

"Burns Lake is kind of a microcosm of rural communities," says the family doctor and Northern Health executive.  "There's a combination of remoteness, a taxing rural practice, plus a combination of new and retiring physicians."

"It's relatively easy to recruit to a stable medical community," Butcher concludes. 

"It's often hard to get the first new physician in the door."

The long-term fix is to recruit a stable supply of health professionals. Every province puts out recruitment pitches to get established MDs from other provinces and from other countries - like Dr. Allan Hill to live and work in its small towns.  Another approach is to grab'em while they're students.  The Northern Ontario School of Medicine was set up to recruit and train the next generation of doctors from rural and remote parts of northern Ontario in the hopes they'll return to those communities once they graduate. 

And, more and more medical schools train residents in rural family medicine.  Dr. Rick Mann is one of them.  You may remember Rick from last season on White Coat, Black Art as a member of our amazing panel of residents.  Last Spring, I caught up with Rick as he was finishing up a practice rotation at a family medicine clinic in Collingwood, Ontario, a small town in the heart of cottage country - on the cusp of a new career as a rural MD.

"Working in Collingwood for me offered a lot of medical education opportunities," Mann told WCBA.  "There's an element of uncertainty and independence - not knowing what's going to be coming through the door.  That forces me to learn a bit quicker and to be a bit more resilient than residents who train in urban areas."

How will Mann guard against burning out and joining the long list of young doctors who try rural medicine only to leave?

"I've come into this situation with my eyes open," says Mann.  "I came into a rural environment because I wanted to."

One thing Mann doesn't think he can solve is what to do about the many patients who don't have a family doctor.  "I think it leads to frustration both on the part of patients and on health care providers," says Mann.  "Patients need health care but can't get it.  For physicians, it becomes difficult because you're often fitting those patients in the cracks."

"This is somebody you're seeing in less than ideal circumstances," he concludes.  "Each time you see them, it''s anew.  You're not able to give them management of chronic diseases like diabetes because you're only going to get to talk to the for five minutes."

The people Dr. Rick Mann is talking about are called orphan or unattached patients - people who don't have a family doctor and are unlikely to find one any time soon.  In 2009, a clinic for unattached patients was set up in a borrowed medical space in Peterborough, Ontario -- 136 km northeast of Toronto -- funded as a pilot project through a grant from the local health authority or LHIN.  I visited the clinic in the Spring of 2010, just before the clinic ran out of money and shuttered its doors. 

In the 6 months the clinic was open, it saw 800 unattached patients, and uncovered heart disease, diabetes, lung problems, and many forms of cancer that could be often be cured if detected.  Kathryn Roka-Ulrich, the nurse practitioner who ran the clinic, is right.  In a publicly funded health care system, everyone should receive health care. 

Damn the cost:  no patient should be unattached - ever!

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