Rural areas must have the same access to skilled health professionals as those in urban areas, Roy Romanow said in his sweeping health-care report, which recommends ensuring equal service regardless of whether a patient lives in a large city or a remote outpost.

In his report released Thursday, the federal health commissioner recommended that a portion of several proposed funds — the Rural and Remote Access Fund, the Diagnostic Services Fund, the Primary Health Care Transfer and the Home Care Transfer — be used to ensure that skilled health professionals are available to Canadians in all rural and urban areas, and be used to ensure that the country has an adequate supply of doctors and nurses.

Rural areas have long complained that it is difficult for them to attract and keep doctors, especially specialists, at their facilities.

In releasing his report, Mr. Romanow spoke of the way health services were provided for rural Canadians in the past.

"If you needed an operation ... you sold your farm so you could pay," Mr. Romanow said during a press conference in Ottawa. "You waited and you prayed for the best."

To encourage physicians to work in remote or rural areas, Mr. Romanow recommends incentives for those providing comprehensive care.

He also talked about the importance of primary health care in Canada's health system.

"Primary health care is essential to transforming Canada's health care system," Mr. Romanow writes in the report.

Dr. Calvin Gutkin, executive director of the College of Family Physicians of Canada, told globeandmail.com that the group is "very pleased to see the support for primary care and the role of doctors and nurses."

Mr. Romanow also recommended in his reforms to primary health care that nurses and doctors work in teams alongside other health providers such as pharmacists.

This will mean better care for patients, said Kathleen Connors, RN, the president of the Canadian Federation of Nurses, in a statement.

"Nurses, doctors and other health care providers working in teams will cut waiting times and patients' frustrations," Ms. Connors said.

Regarding health-care personnel, Mr. Romanow's report also talks about wage issues for doctors and nurses but warns that the incomes of doctors and nurses are already at the upper end of that of the OECD countries.

"This leads the commission to urge provider associations and governments to consider the impact of future negotiations on the sustainability of medicare," he said in the report.

Dr. Gutkin said he wasn't particularly concerned about that aspect of the recommendations.

While he says doctors and nurses must be paid adequately for services provided, a more important issue is to ensure that there are enough doctors and nurses to give health care services.

Dr. Gutkin said that Mr. Romanow's report was "a bit light overall in terms of the urgent, immediate need" for more doctors and nurses in Canada.

Mr. Romanow said there are other issues that have an impact on the delivery of service in Canada besides the quality of doctors and nurses.

He stresses the importance of managers in the health system, saying their job is often "overlooked" but "is vitally important" to the overall organization of services across the country.

He warned that often, these managers are working under worsening staff cuts and budget constraints.

He also spoke of the need to improve the number of doctors and nurses in the system and suggested that could be done by implementing a comprehensive information database that would "collect, analyze and provide ... reports" on issues related to recruitment and distribution of health professionals.