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Why Ottawa should be more concerned about a rural-doctor crisis

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Last week, both British Columbia and Saskatchewan announced new cash incentives in the hope of drawing more physicians to rural areas.

B.C. will pay doctors a $100,000 bonus if they commit to practise at least three years in one of 17 designated communities – places like Bella Coola, Galiano Island, and Tumbler Ridge.

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Saskatchewan, for its part, offered physicians $120,000 over five years if they establish a practice in a community with a population of 10,000 or less.

These provincial moves are on top of a federal initiative, announced last summer: Partial Canada Student Loan forgiveness of up to $40,000 over five years for health professionals (nurses as well as doctors) who commit to practise in rural or remote areas of Canada.

But don't expect a stampede to small towns.

These programs – and every province announces variations on them fairly routinely – are well intentioned but not very effective. They are more public relations than sound public policy.

Canadian physicians earn a gross income that is, on average, $307,482. Average overhead is about 26 per cent, meaning net income is about $250,000, but that varies a lot by province and by specialty.

Offering an additional $24,000 to $33,000 a year, at least in the short term, may seem attractive, especially to newly-minted MDs saddled with a lot of debt. (About one-third of students graduate from medical student with debts in excess of $100,000 according to the Canadian Medical Association.)

But it's not money, especially not short-term bonuses, that will attract and keep doctors in rural and remote areas. Quebec has actually been the most successful at keeping doctors in rural areas because it pays significant differential fees – about 15 per cent more.

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What the research shows though is that the most effective way of drawing physicians to rural and remote areas is to give them a taste of the lifestyle. In other words, ensure that part of medical school training is in rural/remote areas and open medical schools outside big urban centres (such as the medical school in Thunder Bay, Ont.)

Much of rural Canada is exceptionally beautiful – who wouldn't want to be paid handsomely to live on Galiano Island? – but the demands on rural physicians can be crushing.

Will there be work for the doctor's partner? (And many physicians are married to other health professionals.) More importantly, when there are few (or no) other doctors around, there is no rest.

About 30 per cent of Canadians live in rural or remote areas, everything from native reserves, farming communities, fishing villages and other resource-based towns.

These populations are markedly sicker than their urban counterparts. There are far more dangers in daily living in the country, hence more traumatic injury. The rural population is also older, meaning there is more chronic illness like cardiovascular disease. Hospitals can be a long way away too.

The country doctor working around the clock is a nice romantic image, but it's not an attractive lifestyle. That's why more rural practices are closing than opening and why governments are scrambling to reverse the trend.

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Right now, a lot of healthcare in rural and remote areas is not delivered by resident doctors but by visitors on locums. (A locum is a temporary doctor in a practice or hospital.)

This is exceptionally expensive and inefficient – a locum doc can earn $2,000 per shift plus airfare and lodging. These costs are rising because provinces and territories poach doctors from each other.

One of Ottawa's principal roles in healthcare should be to ensure timely access to healthcare across the country, including closing the urban-rural disparity.

Improving healthcare in rural and remote areas should be near the top of Ottawa's agenda. But, sadly, Ottawa;s principal agenda is to wash its hands of its healthcare responsibilities, to leave everything to the provinces and territories.

As a result, the Ministerial Committee on Rural Health, established back in 2001, has essentially died a death by neglect.

In a massive, sparsely-populated country like Canada this meeting the needs of the rural and remote residents is not a new challenge, nor is it easily resolved.

But, at the very least, it requires a deliberate, co-ordinated strategy, not one-off initiatives.

André Picard is The Globe and Mail's health columnist.

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