Bad rural medicine

Lawrence Solomon
National Post
April 25, 2002


Tired of pushing a pencil, or maybe a broom, for a living? Why not trade it in for a stethoscope and try your hand as a family doctor? If you’re likely to work in rural areas – a priority with much of Canada’s medical establishment – the crushing barriers that most face getting into medical school don’t apply to you. Just the opposite.

No special aptitude for medicine? Don’t fret. Your "life experiences" will be taken into account, special pre-med educational programs can prepare you for the rigours of study and, if that isn’t enough, you’ll be accepted with grades that would doom other applicants.

"A lot of people think you have to be Einstein to get to medical school," says Richard Hebert, assistant dean of Admissions at the University of Ottawa. Not so. U of O’s medical school takes students with lower grades if they come from the province’s low-population eastern, northeastern or northwestern regions – or just about anywhere but the populous Ottawa and Southwestern-Ontario regions.

"Good marks aren’t everything," elaborates Mr. Hebert, whose school also discounts the traditional notion that medical school applicants should have volunteered in hospitals or another medical setting, or done some research in a laboratory. "If you’re from Wawa, which doesn’t have a tertiary-care hospital, you shouldn’t be penalized for that. If you volunteer as a coach in hockey or softball, that could substitute. We want someone who’s social, open to people, who takes the time to know there’s a conflict in Afghanistan, in the Middle-East."

Does that someone sound like you? If so, you’re in luck. To ease the burden of those burgeoning medical school fees that bleed most med students, any number of government programs are there to help. Under Ontario’s Return-of-Service Program, for example, your tuition and living expenses – to a maximum of $40,000, all of it tax-free – will be reimbursed. All you need do is commit to practise in an underserviced northern community upon graduation for three or four years, akin to the fashion in the 1970s and 1980s of putting in a stint with Oxfam or CUSO in a deprived Third World community. While you’re at it, sign up for the Underserviced Areas Program Incentive Grants, which offers another $40,000, again tax-free. After honing your newly acquired skills on our rural folk, you’ll be free to move to the big city as an experienced doctor.

Or, if you’re willing to stay put, you can sign up for the Northern Physician Retention Initiative, worth $7,000 a year. And for Northern Group Funding Plans, which provide top-ups of $3,667. And for the Continuing Medical Education Program for Rural and Isolated Physicians ($5,000). Or perhaps for the Locum Program for Rural Physicians, Scott Sessional Fees, and dozens of other programs that are likewise designed to do one thing: to cajole, coerce or otherwise convince large numbers of Canadian doctors to live and work somewhere other than where they want to live and work.

"You’re dealing with approximately 22% of the Canadian population living in rural areas and only 10% of the doctors practising in rural areas," explains Dr. Henry Haddad, the Canadian Medical Association’s president who, along with many others, deplores the long-standing crisis of medical care in rural Canada. Dr. Haddad argues that a national strategy is needed to get doctors into the rural and remote areas that so desperately need them. That’s only the beginning of the challenge, however.

"Even more than recruitment, the problem is one of retention of physicians," he explains. As a study published last week in the Canadian Medical Association Journal shows, most medical students come from affluent, well-educated families, making them unlikely to relate well to less privileged working class communities. If doctors in rural areas don’t have family ties or some other special circumstance that pin them down, they tend to head for large centres that hold the attractions that educated professionals crave: bookstores and art galleries, restaurants and coffee shops, nightlife and shopping districts.

Hence the push to recruit doctors from down the socioeconomic scale. "Incentive programs to lure physicians to rural areas haven’t been successful," says Irfan Dhalla, co-author of the CMA Journal study.

There is some merit to this argument. Rather than put more money still into rural programs, as the rural health lobby is now asking the Ontario government to do, rural recruitment may be more successful – 60% to 70% of students that come from the north return there upon graduation. Nevertheless, the case for rural medical programs is profoundly wrong-headed.

For starters, the severe shortage of physicians in rural areas relative to urban areas is a fiction, the result of jumbling together statistics for specialists such as plastic surgeons and cardiac specialists, most of whom would never be expected to practice in low-population areas, with statistics for family physicians. Unjumbling the stats, we find that 17% of family doctors practice in rural areas and that many others practice nearby, in urban areas to which rural residents commute daily. For these daily commuters, urban doctors, whom they can visit during business hours, tend to be far more convenient.

But even if there were an imbalance, the real cause stems not from too few rural physicians but too many rural residents. Doctors aren’t alone in being bribed to live where they do; so is everyone else in rural Canada. To maintain an artificially large rural population, governments ply rural residents with subsidized gasoline and electricity, cut their property taxes, reduce their telephone costs, underwrite their water and sewage bills, provide them with free policing, even lower the cost of their liquor.

Stop the rural subsidies, to ensure that people who live in rural areas do so voluntarily, and the health of those who remain can be better served, and at lower cost. That’s the best medicine, even if it means you can’t play doctor up north.

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