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 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.
Avatar 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
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