According to 2006 Census
data, 20% of the Canadian population lives in rural areas, which are defined by
Statistics Canada as including towns and communities with a population of 1,000
or greater that are also outside of areas with more than 400 persons per square
kilometer. Studies
by CIHI have indicated that populations in rural areas experience on average
poorer health outcomes than the rest of the Canadian population, as both women
and men living in these areas have lower life expectancy rates and face overall
higher mortality risks related to circulatory diseases, injuries and
suicide. Researchers link these health outcomes to the fact that rural residents of
Canada are more likely to face poorer socio-economic conditions, to have lower
educational attainment and exhibit less healthy behaviours related in
particular to smoking and eating. In addition, access to health care in rural areas remains a
persistent problem, which is due in part to insufficient health professionals
located in those areas. In
2004, approximately 16% of family physicians and 2.4% of specialists were
located in rural areas and small towns in Canada, while 21.1% of the Canadian
population resided in those same areas.
This chapter highlights
innovative initiatives currently underway that are aimed at increasing the
number of health professionals providing care to Canada’s rural populations. It
also identifies potential avenues for federal leadership in addressing health
human resource issues in rural areas.
According to witnesses
appearing before the Committee, there are three main factors that are most
strongly associated with students entering rural practice after education and
training: having a rural upbringing; positive clinical and educational
experiences at the undergraduate level; and targeted training for rural
practice at the postgraduate level, including residency programs that prepare
medical students to practice in rural areas.
The Committee heard that
these three factors were being addressed in Canada through the establishment of
medical schools dedicated to practice in rural and remote areas. For example,
the Committee heard that the Northern Ontario School of Medicine (NOSM) has
developed a model of medical education and health research that aims to prepare
graduates to have the knowledge and skills necessary to pursue a medical career
in northern Ontario or a similar northern rural, remote, Aboriginal or francophone
environment. It
does so by focusing on selecting students that have a particular interest in
rural medicine, as well as reflect the populations that they will eventually
serve. Approximately 90% of the students have grown up in northern Ontario,
while between 40 to 50% are from rural and remote areas and 6 to 11% are
from Aboriginal communities. The NOSM also offers a curriculum that focuses on rural medicine,
interprofessional education, and Aboriginal health. The Committee also heard that
the Rural Ontario Medical Program offers targeted training programs in family
medicine that are located in rural communities, these programs often result in
trainees pursuing their residencies in those same areas in 85% of cases.
In addition to developing
innovative education models for rural medicine, witnesses also outlined
strategies that would improve the retention of physicians in rural areas. This
included providing health professionals with the opportunity to undertake
clinical teaching through rural medical schools that keep them engaged in the
community. Furthermore, witnesses stressed the need for continuing education and training
for rural health professionals either through distance learning programs or facilitating
the provision of supports such as locums that enable physicians to travel in
order to upgrade their skills.
Finally, witnesses discussed
the importance of financial incentives in the recruitment and retention of
health professionals in rural areas. Witnesses articulated that financial
incentives need to focus on providing higher levels of compensation to rural
health professionals because of their broader scopes of practice and higher
levels of responsibility, rather than perceptions regarding the possible constraints
associated with living in rural and remote areas. Moreover, witnesses articulated that
financial incentives should be distributed throughout the careers of health
professionals living in those areas, as the provision of large sums at the
beginning do not encourage retention over the long term and create divisions,
when established health professionals in the same community do not receive the
same levels of financial compensation.
Witnesses highlighted the
need for stakeholders to collaborate to promote best practices in the
recruitment and retention of health professionals in rural and remote areas,
including examining the rural health education models across the country and
best practices in other jurisdictions. They articulated that this could best be done through a national conference on
rural health funded by the federal government. They further suggested that the findings
and recommendations emerging from this conference could then serve as the basis
for a pan-Canadian rural health strategy.
The Committee recognizes
that the federal government does not play a direct role in health care delivery
in rural and remote areas, except in the case of on reserve First Nations and
Inuit communities. However, the Committee supports witnesses in their view that
the federal government could support collaboration with interested jurisdictions
in the area of rural health and health human resources. The Committee’s study
revealed that there are excellent health education models that are promoting
rural medicine across the country. The Committee also learned that these types
of rural health education models serve as concrete examples of some of the
recommendations and guidelines on recruitment and retention of rural health
professionals that will be presented to the upcoming World Health Assembly held
in May, 2010. The
Committee therefore recommends:
Recommendation 23:
That Health Canada host a national conference on
rural health to bring together stakeholders to discuss best practices and
develop recommendations in rural health, education and the recruitment of
health human resources.
Recommendation 24:
That Health Canada provide targeted funding to support
initiatives aimed at increasing the number of students pursuing careers in
rural health, such as: scholarships and bursaries for students of rural
background that would like to pursue health careers in rural areas.
Recommendation 25:
That the F/P/T Advisory Committee on Health
Delivery and Human Resources consider establishing a working group dedicated to
examining and responding to best practices in the recruitment and retention of
HHR in rural and remote areas, including: the guidelines and recommendations
presented by the WHO’s expert panel at the World Health Assembly in May 2010.
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