What Kind of Support Do Canada’s Rural Physicians Need?

Physicians who choose to practice in remote and rural areas of Canada need considerably more support, including the ability to take sick or elder care leave when needed, according to a new analysis.

Rural generalist physicians are increasingly leaving their posts to seek better working conditions and avoid burnout, according to the analysis. This phenomenon is leaving people who live in rural communities without essential medical care.

“For rural clinicians, there needs to be an attractive remuneration model that acknowledges the breadth of the work that we do, which includes office-based care, emergency services, and inpatient services,” author Sarah Newbery, MD, associate dean of physician workforce strategy at Northern Ontario School of Medicine, Ontario, Canada, told Medscape Medical News. Newbery also is a rural generalist with Marathon Family Health Team and North of Superior Health Care Group in Marathon, Ontario. 

The analysis was published on November 18 in CMAJ.

Teaching and Training

“We have been trying to highlight the idea that you have to train in rural to be rural because in terms of being a generalist, that is really important,” said co-author Aaron Johnston, MD, associate dean of distributed learning and rural initiatives at the University of Calgary’s Cumming School of Medicine, Calgary, Alberta, Canada. 

“This can be tough when you’re a small community and you don’t have enough doctors. It’s hard to think about taking on teaching or training as well, but teaching and training are the root of stability, both medium- and long-term, in supplying physicians for that community,” he added.

The authors of the analysis propose the following items to provide additional support to rural physicians: 

• Contracts that include time for teaching, academic activities, and support for professional development
• Access to team-based care with addiction counselors, physiotherapists, pharmacists, social workers, home care nurses, and more, as needed
• Locum support for taking leave, whether for vacation, parental leave, elder care, or illness
• Flexible work hours, manageable call schedules, and other provisions that foster work-life balance and prevent burnout
• Engagement by local communities in hiring and welcoming new physicians.

They also note that international medical graduates can mitigate the shortage of physicians in Canada. They urge that graduates of international medical schools be welcomed into remote communities.

The opportunities for medical students to train in rural areas are becoming more limited because few rural physicians have the time to teach them.

“As medical students, we want more exposure to rural practice, because the role of the rural physician is very broad when you have to cover all these areas,” said coauthor Aria Rezapour, a 4th-year medical student at the University of British Columbia in Vancouver, British Columbia, Canada. “When you train in an urban setting, you don’t get exposure to all the different things that rural doctors do, so it is important for students to have more elective time and opportunities for rural visits.” 

“For rural doctors, sometimes the needs of the community can seem overwhelming, but talking to people who are deeply connected to their community can be very helpful,” said Johnston. “It’s important for physicians to experience the community, and not just their medical practices.” And it’s important that new doctors be welcomed into the community, he added. 

Newbery underscored the need for more locum support. “We tend to think of locums as a way of helping physicians get out of the community, either for vacation, education, or maternity leave. But I think we need to think of locum support as a way of retaining physicians in the community,” she said. When physicians can’t trust that they will be able to take a break when necessary, they won’t stay. “So, we need good, reliable locum support,” she said.

‘A Wonderful Career’

“As a doctor who works in rural and remote parts of the country, I certainly agree with what they recommend, in terms of what’s needed for supporting sustainable rural practice,” said Sarah Lespérance, MD, clinical assistant professor at Dalhousie University in Halifax, Nova Scotia, and director-at-large of the College of Family Physicians of Canada.

“The skills you are using and the scope of what you do as a rural generalist are broad. Essentially, you’re a family doctor, you need to deliver babies, you may be working in a clinic, you might be working in the emergency room, and you are doing that in an environment where you don’t have the advanced equipment that you are more likely to have in an urban area. It’s a different set of skills. You need to learn those skills, and so you need to work and train with the people who are doing that work so you see what is required,” said Lespérance.

“It’s a wonderful and fulfilling career. But to make it sustainable, you need [the support], and we need to train and support the teachers who are doing that training. I see this as an essential message from this analysis.”

Newbery, Johnston, Rezapour, and Lespérance reported having no relevant financial relationships.