Governments and universities are striving to ensure doctors wind up where they’re most needed. The University of British Columbia has opened a satellite campus in Prince George, 775 km north of Vancouver, that trains students in rural medicine and tries to entice them into entering residence in the area. Lakehead and Laurentian universities jointly opened the Northern Ontario School of Medicine in Thunder Bay in 2005, and UWO has a program that requires students to spend at least one week at a rural practice. Med schools have also started giving priority to applicants from outside of cities—students who are more likely to return to the countryside.
Meanwhile, the government of Manitoba is investing money to provide bonuses to doctors working outside cities, and Alberta has established a rural physician action plan. The government of Ontario has created a model for physician group practice, called Family Health Groups, which pair a minimum of three doctors with nurses, nurse practitioners, social workers and dietitians to share workloads and provide better overall care.
But despite all the work, and the increasing interest in family practice among students, O’Hanley thinks the challenges will only get more severe, at least in the short term. He says too many doctors are due for retirement, and that their replacements are cut from a very different stock. “We don’t produce docs who’ll work 80 to 100 hours, and that’s probably a good thing, but it affects patient care,” he says. “Some old-time GPs are getting replaced by three or four people.”
Moore, 25, is part of that new breed. His experience in Chilliwack taught him about the challenges of family practice and the problems inherent with working in the countryside, but he doesn’t plan on working many 80-hour weeks. “You can set your own hours and the scope of your own practice, which is really attractive,” he says. “Family medicine is what you make it.” Moore points to the example of a friend who spends half his time working as a doctor, and the other half running a water-rafting business.
Practices like that are good for individual MDs, as O’Hanley says, but they mean the system needs more doctors to replace the ones who seemingly never took a break. And the situation is made even worse because of bad planning in the ’90s, when provincial governments acted on recommendations from the 1991 Barer-Stoddart report, which urged them to save money by graduating fewer doctors and relying more on other health care workers, such as nurses and dietitians. Governments listened, and cut funding to med schools to reduce seats. That only served to prolong and increase the severity of the MD shortage.
“The medical schools across Canada are in fact ramping up their enrolments,” says Dr. Anne Doig, president of the Canadian Medical Association. “But it’s a slow process.” She says the solution is complex. Schools have to increase recruitment; governments must increase funding, revise payment schemes, and pay more attention to ensuring an even distribution of doctors. And they must provide more incentives and better support for doctors going into rural medicine. “The long-term picture is, we’ll get there,” Doig says. “It’s not going to be a two- to five-year solution. It may be a 10- to 15-year solution.”
Moore agrees. “It is in a crisis,” he says. “But it is getting better.”
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