5 key factors to consider for improving access to specialty care for underserved populations

December 9, 2019 | Author: Dr. Andrew Padmos

Dear colleagues,

Recent legislative efforts to improve access to health care services for underserved communities have met with varying degrees of success. While the intent of these policies is terrific, sustainable solutions must take a range of complex factors into consideration. The Royal College is engaged in reaching out to health system stakeholders, patients and communities to encourage evidence-informed discussions and thoughtful action.

Legislative support to bring health care services to underserved populations

You have probably seen in the news that several provincial governments are at various stages of developing and implementing legislation, policies and procedures that are aimed at ensuring physicians practice in underserved communities:

  • Alberta is developing legislation that, among other changes, would enable the provincial government to exercise greater control over where physicians and other health care providers practise, and the type of practice they can establish (Section 28.3 of Bill 21, 2019).
  • Quebec is operationalizing its “plans régionaux d’effectifs médicaux” (PREM) and “plans d’effectifs médicaux” (PEM) that endeavour to regulate the respective supply and distribution of family and specialist physicians.

While these and other provincial efforts bring much-needed attention to the health care needs of underserved communities, the plans are not clear on how (or if) they take into account the successes or lessons learned from other jurisdictions.

Considerations for critical conversations, collective efforts

There is an urgent need to bring key perspectives together and learn from one another. These conversations should draw on health workforce research and evidence, including data resources the Royal College is developing with stakeholder organizations. Efforts must lead to shared commitments and actions, to nurture sustainable and effective health system improvements.

The Royal College is asking system planners and decision-makers to consider the following five points as they work to improve access to specialized care for rural, remote and underserved communities:

  • Many resources are required to provide specialized care: Health care facilities need unique infrastructures, equipment and teams to deliver specialized surgical and medical care. Such resources need to be in place in rural and remote communities; otherwise, specialists who practise in these areas will be limited in the care they can provide to their patients.
  • Indigenous communities have unique health care needs: Many Indigenous communities are rural, remote and underserved. It is critically important that all health care providers receive training that enables them to provide culturally safe care. Guided by the Indigenous Health Committee, and in the spirit of Indigenous self-determination, the Royal College is in the midst of developing new cultural safety resources for educators, learners and physicians.
  • Health providers need access to ongoing learning/training: Health care providers in rural, remote and underserved communities are often called upon to provide broad and distinct care for patients. As a result, these providers must have access to ongoing development opportunities to support their skills for the range and scope of specialized care required.
  • Foundational learning in rural, remote and underserved communities is essential: Newly certified physicians have been the target of past — and proposed future — legislative efforts to encourage work in underserved communities. Canada’s undergraduate and postgraduate training programs have taken great strides in distributed medical education; however, ongoing (and possibly additional) experiential learning is needed to prepare and embolden physicians to practise in underserved communities.
  • Models of care and remuneration must support sustainable practice: Models of care must progress to better address on-call demands and provide locum services for physicians who need relief. This includes the continued development of fee-for-service and alternative payment programs that will sustain medical careers in underserved and under-staffed regions. The Royal College has formed an Access to Specialty Care Working Group to identify tangible solutions to some of the problems that lead to shortages in rural and remote areas.

Innovative policies and programs can bring specialty care where it’s needed

As this five-point list suggests, we need multi-pronged, multi-stakeholder solutions to properly address the unmet needs of underserviced communities. For example, I’m encouraged that Canada is reviewing its regulatory systems to enable more nimble and responsive licensing across multiple jurisdictions, which will reduce barriers for physicians willing to visit underserved areas. As well, communities of practice are also evolving, stimulated by eConsult, eReferral and telemedicine programs that are connecting physicians and patients in new and creative ways. These are equally important factors to consider in our future critical conversations and collective action.

All people in Canada deserve timely access to quality specialty medical care. The challenges facing underserved communities, I fear, will persist if we do not come together and strategize beyond potentially short-sighted and simplistic legislative and regulatory actions.

If you have any thoughts on this issue or suggestions, I’d love to hear them. Please leave a comment.



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Andrew Padmos | December 20, 2019
Thank you, everyone, for your engagement with this important topic and thoughtful feedback. I have read through all of your comments and have shared them with our Health Policy and Advocacy team, who will continue to lead knowledge-informed dialogue on health human resources, physician distribution and access to specialty care, working alongside various other Royal College offices and partners in health care. Sincerely, Andrew
Ken Foster | December 14, 2019
As a practitioner in a small town the most helpful thing to me in this context is having an expert that I can get advice from. It is a little different from referring a patient onwards to be taken care of by the new specialist. It also usually results in a teaching moment result of significant learning that does not usually happen in the same way with referral onwards. If there were some way to connect teaching specialists with rural and remote practitioners when some question arises it would provide tremendous benefit and support. Another example of this was the textbook in paediatric orthopedics which I bought when I was working in Afghanistan. It listed the email addresses of each chapter author and so I was able to write some of these authors about weird and wonderful cases and they gave very helpful replies and support.
Andrew Padmos | December 20, 2019
Hi Ken, I will share your comment with our Office of Professional Practice and Membership. Sincerely, Andrew
Maria Filyk | December 12, 2019
I am a specialist in psychiatry and child psychiatry. I practice in Calgary. The challenge I currently face since leaving a nearly FT AHS outpatient clinic is finding affordable space in my community to rent. I am approaching the many medical clinics within walking distance of home. I can work part-time, not full, because I live with a chronic health condition. Part of caring for myself and my condition is movement hence looking for space nearby. So far the people I have spoken to have asked alot more than I want to pay given my time-determined income. Space is another challenge: most family practice clinics are not designed for group work such as I do with either families or groups of adults/adolescents. There are other spaces I may have to explore such as local churches or my community centre. And the mentally ill are an underserved population.
G Robert La Roche | December 12, 2019
A follow up to andrew’s message should be a CEO update of the RC advocacy efforts before AND after the federal elections, especially around access to care through improved high speed wide band internet services across the country and pharmacare . Also a point to consider is the aging demographic of our rural non indigenous communities as a point of concern in access of care issues
Royal College - College royal Communications | December 20, 2019
We will pass on your suggestion to our new CEO, Dr. Susan Moffatt-Bruce, who starts in January. We look forward to your continued leadership on the advocacy work of the Royal College. – Royal College Communications
Paul A. Galbraith M.D.(Hons.),B.Sc.(Med), M.Sc.( Med), FRCPC, D.A.B.I.M. ,F.A.C.P.,Professor of Medicine (Retd) | December 11, 2019
Dear Dr Padmos,, The aforementioned says all the right things and for this the College is to be commended. Remember a statement made by Henry Kissinger in 2011. “ A turbulent history has taught Chinese leaders that not every problem has a solution and that too great an emphasis on total mastery over specific events could upset the harmony of the universal”. Canada has a huge landmass and many very isolated communities. It is unrealistic to believe that these isolated communities can ever enjoy the quality of health care available in large centres. For example when a stent must be inserted into a vessel within an hour of the onset of symptoms to prevent infarction it is unrealistic to expect that this clinical action could be available in many remote communities.. Moreover professional in site services, cultural differences, family interests and governmental financial support will never be able to support the ideal situation. In my career I have seen Indigenous specialist professionals relocate to California after completion of their education. I wish the College every success in its endeavours. Paul A. Galbraith M.D.
Thomas Ungar | December 11, 2019
Thank you for this but can the RCPSC please consider for item 5" Models of care and remuneration must support sustainable practice" to expand the concept of under-served populations beyond just "rural and remote areas" . The very ill Inner City population where I work is not conducive to Fee for Service as they often do not have their health card and often do not show for appointments due to mental illness, addiction, and other socioeconomic factors. Also the providers need allied health staff support beyond solo specialist care. I can't easily recruit or retain physicians to work with this highly acutely ill population of significant cost and impact to society due to lack of a sustainable specialist model of care and remuneration, even though they are in the centre of the country's largest city. When there are alternate funding models offered they are less attractive and non-competitive to specialists out of keeping with a population of higher risk and acuity needs.
Royal College - College royal Communications | December 20, 2019
Thomas, you raise an excellent point. We will be more deliberate to clarify in our future communications on this topic that under-served patient populations are not exclusive to rural and remote areas. – Royal College Communications on behalf of the Royal College Health Policy and Advocacy Team
Naomi Miller | December 11, 2019
Now retired, I previously worked at Princess Margaret Hospital / University Health Network Toronto and I recall a patient discharge discussion to try to arrive consensus about discharging patients from Princess Margaret Hospital follow up in order to free up more time for new patients. The advantage of this is to free up more time for new patients The disadvantages may include: - patients wish to continue follow up in higher acuity centre than they need - remuneration for follow up may be overall greater for institution than new patient clinics ( as a pathologist I have no personal knowledge of how clinic funding words but I heard this ) - more stressful for health care professionals to have greater percentage of new patients - more expensive for institution with more investigations per new patient than follow up Regardless - patients who do not need to receive specialist care should not monopolize services at the expense of new patients who do need this
Lesley Barron | December 11, 2019
While I agree with these points, I think centralized referrals are a critical aspect of access to care to decrease wait times.
Mark Etkin | December 11, 2019
Just a comment on your mention of nimble and responsive licensing. I am a psychiatrist, and recently applied to the BC College of Physicians and Surgeons. Their process was slow, had significant red tape, and time-consuming; the College employees responsible for working with me were poor communicators, not transparent, and seemingly intentionally non-responsive and unhelpful. The process seemed like applying for probation while in jail for a capital crime. Perhaps that's too harsh, but the process was so frustrating that I was tempted at several points to drop out. My application had nothing outstanding about it, and was eventually approved. Then I had to go through a further somewhat lengthy process to gain approval to be employed by the Vancouver Island Health Authority, then another process to be able to obtain a MSP (medical services plan) billing number, then another process to be able to bill for "sessional work". Then I spent 2 days learning the VIHA EMR system, which is quite good, but required extensive learning in areas that I had no subsequent requirement to use. Then I had to learn another EMR to work at the community clinic I worked at. Then, as there is no easy way to actually bill MSP, I had to figure out how to do that - with no help provided by the MSP itself. This response is merely to let you know that "nimble and responsive" doesn't quite describe the process. -Mark Etkin MD FRCPC
Andrew Padmos | December 20, 2019
Hi Mark, I agree and I’ve heard similar concerns expressed by many Fellows. True nimbleness and responsiveness is the objective. As you’ve outlined so clearly, there are many obstacles and a lot of work has yet to be done to clear them! - Andrew
Tad Pierscianowski | December 10, 2019
All the above is a desirable objective but let us face the reality that universal access to all levels of medical care is a pipe dream in a country not only as large as Canada but one with such isolted and at times extemes of weather. To suggest otherwie is dishonest and in itself an impediment to attaining improvement over what is available presently. A more realistic approach would be to set minimum standards of available medical services related to identified regions within the country. It would then be the decision of individuals to reside in those regions that are able to provide the level of care that they need or wish to have access to. Rural and isolated areas come with advantages and disadvantages. When one makes a decision where to live one has to be cognizant and accepting of these issues.
Andrew Padmos | December 20, 2019
Hi Tad, I agree that we will always face limitations but, in my experience, we constantly strive to overcome them. We need to if we hope to serve patients with unexpected health care needs for those who, for any number of reasons, cannot move to more resource-rich areas. I still believe, despite Canada’s climate and land mass, that we can leverage human and technological resources to the advantage of patient populations in all under-served areas (including those in urban centres). - Andrew
Xenia Kirkpatrlck | December 10, 2019
Is it possible to search the obituary archives? If so, could you explain how?
Royal College - College royal Communications | December 20, 2019
Hi Xenia, there are a few ways you can search our obituary archives. Visit http://newsroom.adh.pbp.mybluehost.me and click “News” on the top bar. A list of subcategories will appear on the next screen. If you click “In memoriam” you will see editions from April 2019 (when we launched the newsroom) and onwards. You can also use the search function on the newsroom site if you know the name of the physician. If we can be of further assistance, please reach out to newsroom@royalcollege.ca – Royal College Communications
James Robertson | December 10, 2019
Isn’t it time just to do the right thing instead of talking about it again and again Doi- I work on 20 reserves
Mateen Raazi | December 10, 2019
This is a very timely and helpful statement from the RCPSC leadership. The challenge of appropriate specialty care for under-served communities requires a nuanced and multi-pronged approach to ensure that all Canadians receive the best possible care within our resource constraints. I would suggest that specialty-specific discussions need to be facilitated at various levels (RC Specialty Committees, National Specialty Societies etc.) in order to develop the framework necessary for addressing these issues. The RC Specialties have much to contribute towards the efforts needed to better serve all Canadians.
SENTHIL THIYAGARAJAN | December 10, 2019
Hi Dr.Padmos Thanks fo the wonderful article. The Royal College needs to take the leadership for developing guidelines to assist numerous family practitioners engaged in specialist work like anesthesia, obstetrics, emergency medicine. There are so many grey areas which leads to unsafe practices by minimally trained physicians doing specialists work and eventually compromising patient safety. There are hundreds of "unqualified" family physicians involved in anesthetic care and chronic pain in the out of hospital clinics with very little to absolutely no oversight of their practice. Instead of ignoring this widespread, unsupervised and poorly regulated practice, Royal College should bring in guidelines to clarify what an uncertified physician can do with regard to specialist services (which needs Royal College certification and adequate training). If a mere 12 month ( which in effect is 10 months if you factor in the weekends and holidays ) training in anesthesia or chronic pain is enough with no Royal College certification to practice , we should stop bothering training our residents for 5 years and should allow them to practice when they can't pass their Royal College Exams.It's a hypocrisy that we won't allow a resident who completed 5 years training but did't pass the Royal College certification to practice. But it is quite ok to allow a family physician who has just done 10 month of "anesthetic" training to work unsupervised with no restrictions on their practice An oversight will prevent family physicians who give up their entire family practice and only do full time specialist services for which they are not trained for. There is no doubt we need more family physician for our patients.
Andrew Padmos | December 20, 2019
Hi Senthil, I will share your comments with leadership throughout the Royal College, including our offices of Specialty Education, Professional Practice and Membership, and Health Policy and Advocacy. You touch on important concerns we’ve heard from other Fellows, issues that need a system-wide response from professional organizations like the Royal College, medical regulators, government funders and others. - Andrew
G. William N. Fitzgerald | December 10, 2019
Excellent points. Re: Remuneration, MONEY TALKS! Practitioners in remote and rural regions have much greater responsibility, see unscreened, undifferentiated patients and problems, have thus a much wider scope of practice, much more onerous on call requirements and usually restricted ability to refer on and often much higher costs of living. Remuneration, and benefits should recognize and reflect this.
jaswnat guzder | December 10, 2019
in my long years of practice as a child and cutltural psychiatrist at mcgill working to establish cultural consultation services i have seen very little interest by the college in our work at mcgill in establishing cultural formulation and cultural safety teaching as a key part of our training for national or international work. i am looking at the uneven nature of teaching and training across the country. i have recently begun to work with indigenous peoples on vancouver island and teaching at ubc : i see that indeed the level of awareness of cultural formulation skills in an important area like vancouver is still very fragile and non homogenous, to say nothing of other regions. we have a long way to go . i am invited to do training internationally ( i am now in italy doing training) but in canada these requests are rare, i did some work with queens several years ago, grand rounds once at ubc some time ago, but in general the interest in our long work and writing from our mcgill center is rare.saskatchewan ngo,s were interested some time ago.
Walter Burgess | December 10, 2019
I am retired now. I came from a very rural background, taught school for six years in towns of 1600 or less before I went into medicine and ultimately in Psychiatry. I practiced in a city of about 250,000 and had a clinical appointment with the Department of Psychiatry for 30 years. During that time I did some rural service as part of my practice while I worked for the Provincial Government. Economically, fee for service practice would not work for service to those rural communities. When I switched to fee for service practice, referred patients from the rural areas would come through in any weather while city patients would often cancel during storms! The majority of my patients were multiproblem patients and I had to collaborate with a number of other specialists regularly. I did ultimately question how valuable my service was to the rural areas in terms of efficient service. As I review my history, I don't think one model fits all sizes. Specialties vary with specific needs and we do seem to end up in more specific niches in our specialty over time for a variety of reasons. Very generalist practice would best suit the needs of rural work and would require appropriate financial support to cover the inefficiencies and travel risks of traveling to rural populations. Sending residents to rural areas would be helpful as part of their training. Communication strategies are evolving but cannot replace in room assessments for all patients. Specialist meeting with groups of rural physicians in their area would be worthwhile to determine their needs and thoughts on service delivery that would help them the most. I would suggest testing out a variety of approaches over time to establish what works at what cost and what is theoretical good but not practical or effective. Geographical factors will have to be a consideration. HOWEVER, I DOUBT THAT FORCING SPECIALISTS TO WORK IN RURAL AREAS WILL WORK AS NEW BRUNSWICK IS NOW REPORTING
Royal College - College royal Communications | December 20, 2019
Hi Walter, thank you for sharing your insight, which clearly carries the wisdom of a career spent in the service of rural and remote communities. This is exactly the kind of perspective we will bring forward to those who are genuinely trying to find ways of meeting needs of people who live in underserved areas. – Royal College Communications on behalf of the Royal College Health Policy and Advocacy Team
Raymond Torbiak | December 9, 2019
1. Could immigrating Canadian physicians who meet the College standard be given a 5-year posting in a remote practice as part of a service commitment to Canada, and in support of developing the North? 2. Canada should, because of our Geography, make maximum use of remote/virtual visits and remote patient monitoring, especially in OB, chronic care, and postop patient groups. 3. The concept of national licensure has become more than corridor chat, and is overdue. Provincial oversight could continue in some form, but a centralized annual renewal system would facilitate inter-regional locum and virtual services. Physicians would save money on duplicated fees, and save time on renewal paperwork.There is a startup company in Toronto that specializes in regulatory compliance and renewal software; it's all they do. (They're called Thentia. Disclosure: I'm an investor. The RCPSC should also consider using them.) They would be ideal in setting up a national framework, maintaining a member database, and recording miscreant physicians whose licenses are suspended, so that inter-jurisdictional moves don't allow these people to evade justice.
Kunnathu Geevarghese | December 9, 2019
Sir, Your deliberations on this topic are note worthy. I am a fellow who retired after many years of practice in Canada & USA. I am seriously involved with Cancer Pain Management in India. Though I am located in one of the large cities in India, appears that the whole country of India appears under served. Therefore, I am also getting involved in starting a one year training program for young physicians in Pain Medicine. I thought I would like like to let you know..
Andrew Padmos | December 20, 2019
Thank you, Kunnathu. I wish you all the best with the important work you are doing in India. -Andrew
Minoli Amit | December 9, 2019
Perhaps the college could organize a number of Specialist forums across the country to look at workable solutions to providing better access to rural communities- and supporting the physicians who chose to work in rural areas. Quebec has some innovative programs for support.
Andrew Padmos | December 20, 2019
Thank you, Minoli. I’ll share your feedback with the Office of Professional Practice and Membership. As you know, this office coordinates the work of our Regional Advisory Committees which might provide a useful forum for discussing and sharing potential solutions. -Andrew
Michael O'Reilly | December 9, 2019
I am a late career specialist; Cardiology and Internal Medicine. I have had a unique career; the first half was in a regional non-academic hospital and the second in a university academic center. There is truth in everything you say but the issues major issues around 'under-serviced areas is simpler, at least to start. Many resources are required to provide specialized care: Resources are needed. That's it. They aren't unique, they just need to be there. There is a real problem in focusing resource distribution to larger centers. Too many non-academic centers struggle to make the case to funding agencies (Provincial Governments) that they need basic equipment for specialty work. Indigenous communities have unique health care needs: Agreed. But this is the minority of the problem. Deal with this on it's own value. It essentially has all the issues of other under-serviced areas PLUS the uniqueness of indigenous culture and socio-economics. Health providers need access to ongoing learning/training: This singularly is an issue for the College. Where are you on ongoing training? Once the specialty exams are complete, the RCPSC is conspicuously absent from the professional learning arena. Other than providing a repository for cataloging member activities but seem to be absent on the front end of needs assessment and delivery. Verifiying activities is the easy stuff. Planning and delivering quality continuing education is the hard stuff. Foundational learning in rural, remote and under-served communities is essential: Under-serviced areas are never going to populated adequately serviced by sub-specialists. The work horse of under-serviced areas is the generalist. Train more generalists. Stop adding years of training to the training of generalists. Demand more efficiency from training programs; not longer training. Models of care and remuneration must support sustainable practice: Yes.
Andrew Padmos | December 20, 2019
Hi Michael, the Royal College’s Office of Professional Practice and Membership was created, in part, to seek out effective ways to support Fellows in their professional work. I will share your feedback with Doug Hedden, who leads this office. - Andrew
Richard W Arnold | December 9, 2019
Dear Dr. Padmos: Have you had any input regarding ways of getting Physicians to practice in B.C. I am a retired physician (Radiology and Nuclear Medicine) living in the Parksville-Qualicum area. I was associated with getting funding/building of an Integrated Primary Care Centre in Parksville several years ago. We have Urgent Care Physicians attending on an ad hoc basis, and have several excellent well received Nurse Practitioners on site, but after 6-7 years we have not attracted one Family Practitioner to that Primary Care center. I fear that much of our problem is from Administration at that site who seem to be setting all sorts of rules and regulations out for potential young Docs that are overwhelming, and unattractive. Still, we have a group of older physicians often in solo practice, who are soon to stop their practices, and a large population of retired residents here who do not have a doctor. It is a perfect storm. More and more people are locating here, The percentage of those having a doctor is steadily droping. Do you have some advice for action on our part? We could use some help!! Regards, Richard Wm. Arnold
Royal College - College royal Communications | December 20, 2019
Thank you for this important case study, Richard. Unfortunately, it is a familiar story. We're not sure what the Royal College can do to alleviate growing pressures in specific communities but we’d like to talk with you and see if we can provide useful leads. Staff in our offices of Professional Practice and Membership, and Health Policy and Advocacy, are tuned into a number of potential health system resources. Please contact us so that we can arrange a call: healthpolicy@royalcollege.ca – Royal College Communications on behalf of the Royal College Health Policy and Advocacy Team
Rich Kostyk | December 9, 2019
RCPSC must also recognize that the effectiveness of rural/northern care is impacted by the attitudes of primary care providers towards care that is provided locally by general specialty versus subspecialized specialty urban care. RCPSC needs to work with CCFP to support generalist RCPSC members especially with internal medicine as many family physicians think only subspecialists in urban centres have the necessary knowledge and skills to support them and those who work in more removed settings are somehow inferior.
Douglas Courtemanche | December 9, 2019
Andrew, I really appreciate this thoughtful summary. I have been involved in the team care of children with cleft lip and palate in BC for almost 30 years. Out program at a tertiary care children's hospital needs the same support that you describe. Despite evidence based arguments for increasing resources to meet the standard of care our team has been unable to convince our hospital, our health authority or our provincial ministry of health that these patients deserve the care they require. It's all about the money... Some suggestions about how to use these concepts to drive necessary change would be welcome. Any fellows who have advice...
Nick Myles | December 9, 2019
One of the examples could be a lack of access to cervical cancer screening, which is available only in 8 jurisdictions in Canada. The jurisdictions without such access may find it overwhelming to set-up their own independent screenign programs, but this can be done in partnership in a format of service contracts with the provinces where such programs have been implemented and running successfully for several decades. It is unrealistic to expect an easy access to high level MD pathology and cytotechnology or virology expertise in all remote communities. Therefore, while the specimen collection could and should be done on site in remote areas, the analytical component and interpretation should be provided by qualified staff in more centralized locations with more stable provision of high quality expertise within the existing quality assurance programs. The finances should be allocated on per capita basis and the service contracs awarded though the existing transparent bidding mechanism for public services.
Thomas Lesiuk | December 9, 2019
The question of physician recruitment to underserviced areas is not a new one. It’s been studied over and over. I remember the discussion when I was in medical school. I thought it looked obvious even then. The problem is lack of transparency in what are the actual drivers. Why is it that we as physicians only occasionally state the case as it is? Yes in an ideal world a service provider without work would step up to provide service to an area of need and so there would be no underserviced areas. Yes physicians are expected to be altruistic to some degree, so regularly provide service under less than ideal conditions. So is it now going to be the legislated standard that physicians will be made to provide service to areas that they would not choose to. Does this mean that a physician that refuses to provide service to the assigned underserviced area will not have a job and be viewed as somehow flawed. Service provision to underserviced areas means ...yes sufficient renumeration to compensate for the lack of the social factors present , which in absence produce the underserviced area. As well that any physician who chooses this type of service may indeed be only transiently present. So a replacement stream needs to be factored in. Providing appropriate health care coverage to underserviced areas can be improved some, but at high cost. Technology is the greatest assistant in improving the delivery of healthcare at a distance. The reality is that distance from care can most effectively improved only by decreasing the distance. That is until we can teleport like on Startrek.
Louis Francescutti | December 9, 2019
Well thought out....great reading.
Beverley Orser | December 9, 2019
Dear Dr. Padmos, Thank you for your leadership on this important topic. Here in the Department of Anesthesia, University of Toronto, we are trying to understand how we can better serve Canadians who live in rural and remote regions of the country. We are delighted that the College is tackling the challenging issue. Provided below is a call to action for the members of our department and others. Would the college like to have a representative participate in the first working group? It would be very helpful to have their input to our discussions and planning of the symposium. Best wishes, Bev Orser Chair, Department of Anesthesia, University of Toronto Anesthesia in rural and remote regions of Canada working group Please join us for a working group to discuss anesthesia and pain medicine services in rural and remote regions of Canada. The purpose of the meeting is to better understand how the Department of Anesthesia at the University of Toronto can better support patients and healthcare workers involved in the provision of anesthesia and pain care in rural Canada. Our county is large and diverse, encompassing 10 million square kilometers. Approximately 21% of Canadians live in rural Canada, yet only 9.4% of physicians work in rural communities. Clinical practice can be challenging as the burden of disease is greater and outcomes are poorer in rural populations. We seek to understand how to better train and support, deploy and retain anesthesia care providers who work in rural settings. The goal of the evening is to better understand the current landscape of healthcare and service gaps in rural Canada and to identify education and research opportunities. We will also discuss the planning of a 2-day international and interdisciplinary symposium, which will be held in 2020. Featured participants include: • Dr. Ruth Wilson, Co-Chair of the Rural Road Map Implementation Committee (College of Family Physicians of Canada); Professor Emeritus Department of Family Medicine, Queen’s University; rural family physician (Yellowknife) • Dr. Alexander (Sandy) MacDonald, former Director of Medical Affairs in Nunavut, Iqaluit • Dr. Vaibhav Kamble, Program Director, Family Practice Anesthesia We invite residents, fellows, faculty experts with a variety of backgrounds to attend the working group meeting. Event information: Date: Monday, January 13, 2020 Time: 5:00 – 7:00 pm Option #1 – In-Person Option #2 - ZOOM Video/Teleconference Postgraduate Medical Education Faculty of Medicine, University of Toronto 500 University Avenue, 6th Floor Boardroom A Toronto, ON M5G 1V7 Join Zoom Meeting https://zoom.us/j/682499675 Meeting ID: 682 499 675 1 647 558 0588 Canada Meeting ID: 682 499 675 Please register for this event below by clicking RSVP. Sincerely, Beverley Orser Vaibhav Kamble Ruth Wilson
Andrew Padmos | December 20, 2019
Thank you, Beverley. Members of our Health Policy and Advocacy team plan to connect to this important meeting via Zoom. We are grateful for the invitation. - Andrew
joihn sullivan | December 9, 2019
These issues are not new. We continue to discuss broad strokes re resources ,distribution and payment methods but we are missing one important piece ie what is a full time practitioner and what is an acceptable work load. We want physicians to be free to choose where they practice and also to define their own workloads and availability. There are too many moving parts here to provide accurate man power resources. We need accurate data re patient workloads nationally(which is available) and only then can we predict future needs. Medical schools need to be held accountable for training the wrong mix of providers. We all know that the true crisis is primary care and yet we seem unable to produce adequate numbers of grads in this area.If we fail to do this governments will continue to hive off areas where we as a profession are failing own patients. Witness recent trends is NS re pharmacists prescribing for UTI and BCP and the expansion of NP's
LES ROSOPH | December 9, 2019
I work in North Bay, Ontario. It is hard to get family physicians to go further north. Options include training people from there to go home or allowing Canadians who train overseas who want to come back to do so, in exchange for a 5 year plus commitment. We do need specialists in some fields further north, but we need the hospitals who house them to have adequate funds. Why should my patients wait 1 year to see Endocrinology or Rheumatology or Allergy? These are specialties my patients required but the northern hospitals say that they are underfunded and cannot have them on staff. We have no Cardiology in North Bay but part of that is that the hospital feels that they cannot financially support all that goes with a team of Cardiologists and support staff. I believe our best chance to improve northern care is to train people who have already agreed to come north when they finish. However if the individuals decide that they do not want to go north, the financial penalty should be significant so that people don't try to beat the system. Recruiting physicians to a rural setting after they have finished training is a drain on our resources. Those individuals who see the big city as most desirable are unlikely to come or stay. Let's train northern physicians to go north. Thank you.
Janet Walker | December 9, 2019
One thing that would greatly improve the situation, is in my opinion, making provincial licensing easier and reciprocal. For example, I have practiced in 8 provinces /territories. When I tried to reactivate my license in one province , the process was too lengthy and cumbersome. Not to mention costly. It was therefore easier to retire at the age of 51 rather than help out. If our exams are national, why is provincial licensing so restrictive.
Marvin Tile | December 9, 2019
When I was involved in the OMA in early 1970s, we did a major review of attitudes in Ontario by Goldfarb consultants. We clearly found that Ontario's wanted primary and secondary services close to home, GP, Obstetrics, etc., but would travel anywhere for tertiary care, Cardiac extensive trauma, etc. For various reasons , this was not published at the time. Attempts to bring uncommon tertiary care to remote communities cannot work for many obvious reasons; but improving Primary and secondary care is logical. Also, early on, we connected Sunnybrook to many remote sites "the Red Phone" (now video) to help the nurses and doctors with early care in difficult situations