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

Andrew Padmos
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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Avatar Xenia Kirkpatrlck | December 10, 2019
Is it possible to search the obituary archives? If so, could you explain how?
Royal College - College royal Communications Royal College - College royal Communications | December 20, 2019
Hi Xenia, there are a few ways you can search our obituary archives. Visit https://newsroom.royalcollege.ca 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
Avatar 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
Avatar 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.
Avatar 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 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
Avatar 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.
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