1. Society of Rural Physicians of Canada WWW.SRPC.CA

2. The Society of Rural Physicians of Canada Bob Martel, MD Ken Babey, MD WWW.SRPC.CA

3. WHO ARE WE? WHAT CAN WE DO FOR YOU? WHAT CAN YOU DO FOR US? Society of Rural Physicians of Canada

4. Every citizen in Canada should have equal access to health care regardless of where they live. Mr. Justice Emmet Hall l- Canada Health Act Society of Rural Physicians of Canada

5. Heavy workload and responsibility Family & financial disadvantages New graduates stay in the city Negative perceptions of rural practice Vicious Cycle of Rural Practice

6. Society of Rural Physicians of Canada Goals Sustainable working conditions for rural physicians Equitable treatment of rural communities and their populations

7. Access Retention/Recruitment Technology Affordability/Accountability Political Rural Issues & Challenges

8. Access n Many services distant to local communities due to low population density; lack public transport. n Local follow-up services not accessible; home services and telephone triage limited. n Specialist back-up difficult to secure. n Decreased availability of beds in urban hospitals for referrals. Rural Issues & Challenges

9. Technology n Difficulty in accessing educational resources (CME); medical informatics infrastructure inadequate (EHRs, internet access). n Unclear remuneration/liability for consultants rendering opinions. n Unsatisfactory (costly) infrastructure for reliable transmission of suitable imagery. Rural Issues & Challenges

10. Recruitment /Retention n Rural populations increasing (10%) while number of physicians and other health professionals decreasing (10%). n Insufficient critical mass of physicians to provide sustainable working conditions; sense of isolation. n Retention difficulties; insufficient incentives to set up practice and provide diverse medical/ER services. Rural Issues & Challenges

11. Affordability/Accountability n Many services not affordable due to low patient volumes; high fixed operating costs vs. overall budget due to small size of health organizations. n With “downloading” of services, economies of scale with running of provincial programs sacrificed. Limited evidence-based decision making capabilities. Rural Issues & Challenges

12. Political n Changes in provincial/territorial health systems have impacted delivery of health care services in urban and rural settings. n Restructuring (in some regions) has resulted in hospital closures, loss of community services, limited access to selected services. n Status of primary health reform varies from location to location. Rural Issues & Challenges

13. Access n Many services distant to local communities due to low population density; lack public transport. n Local follow-up services not accessible; home services and telephone triage limited. n Specialist back-up difficult to secure. n Decreased availability of beds in urban hospitals for referrals. Technology n Difficulty in accessing educational resources (CME); medical informatics infrastructure inadequate (EHRs, internet access). n Unclear remuneration/liability for consultants rendering opinions. n Unsatisfactory (costly) infrastructure for reliable transmission of suitable imagery. Recruitment /Retention n Rural populations increasing (10%) while number of physicians and other health professionals decreasing (10%). n Insufficient critical mass of physicians to provide sustainable working conditions; sense of isolation. n Retention difficulties; insufficient incentives to set up practice and provide diverse medical/ER services. Affordability/Accountability n Many services not affordable due to low patient volumes; high fixed operating costs vs. overall budget due to small size of health organizations. n With “downloading” of services, economies of scale with running of provincial programs sacrificed. n Limited evidence-based decision making capabilities. POLITICAL n Changes in provincial/territorial health systems have impacted delivery of health care services in urban and rural settings. n Restructuring (in some regions) has resulted in hospital closures, loss of community services, limited access to selected services. n Status of primary health reform varies from location to location. Rural Issues & Challenges

14. Technology Promoters Professional Groups The Canadian Taxpayer Rural Practitioners Rural-based patients Regulatory Agencies Rural Health Services Government THE PLAYERS Educators

15. Health System Directions Past/Current State Current/Future State Episodic, Illness Orientation Individual Provider/Facility Based Patient Centered Wellness Orientation Enterprise/Region Based

16. Current/Future State Past/Current State Urban Centres of Excellence Financial Measurement Community/Closer to Home-“Rural Centres of Excellence” Financial & Quality Outcomes Measurement Health System Directions

17. Current/Future State Past/Current State Retrospective Decision Support Fee-For-Service Billing Concurrent Evidence- Based Alternative Funding Models

18. Health System Directions Current/Future State Past/Current State Fragmented Integrated Health Networks

19. Episodic, Illness Orientation Individual Provider/Facility Based Urban Centres of Excellence Financial Measurement Retrospective Decision Support Fee-For-Service Billing Patient Centered Wellness Orientation Enterprise/Region Based Community/Closer to Home “Rural Centres of Excellence” Financial & Quality Outcomes Measurement Concurrent Evidence-Based Alternative Funding Models Health System Directions Past/Current State Current/Future State Health Networks FragmentedIntegrated

20. The Canadian Reality By area Canada is 99.8 % rural 31.6% of the population live in rural regions* 14.6% general practitioners (4,135 rural; 24,848 urban) 2.9% specialists ( 769 rural; 26,144 urban) * Stats Can defines predominently rural regions as those with over 50% of communities of population density under 150 persons per sq Km Society of Rural Physicians of Canada

21. Who are we? * National Voice of Rural Medicine* Incorporated 1992 (Mount Forest, Ontario) RuralMED WWW.SRPC.CA Membership 1100 (and growing) Governing structure modeled on SOGC Canadian Journal of Rural Medicine(Peer reviewed) Society of Rural Physicians of Canada

22. How can we realize our goals? Through strategic partnerships SRPC CMA CFPC SOGC FMLAC ACMC CAGS CASCAIR RCPSC

23. A new approach to defining who is rural using the Canadian Practice Rurality Index (Leduc CJRM-Dec 1997) Society of Rural Physicians of Canada

24. distance from advanced referral centre distance from closest basic referral centre drawing population number of general practitioners number of specialists presence of acute care hospital Rurality Index Society of Rural Physicians of Canada

25. What are we? Physicians serving rural communities Broad Skill Set: Emergency Medicine, Internal Medicine, Psychiatry and Orthopedics and others. Advanced skills in: Anesthesiology Obstetrics Surgery Society of Rural Physicians of Canada

26. BARRIERS TO RURAL PRACTICE attitudes towards “the country” “learned helplessness” lack of specific training heavy workload and long hours lack of infrastructure support relative professional isolation WHY? Society of Rural Physicians of Canada

27. Approach… Communications Links Community Professional Associations Governments Education Society of Rural Physicians of Canada

28. Government Executive Director for Rural Health Lobby at national and provincial level Society of Rural Physicians of Canada

29. Education Leading national deliverer of rural CME 11th National Conference on Rural Health Kelowna April 2002 Rural Critical Care Course CME Locum Program REAP Society of Rural Physicians of Canada

30. Community Canadian Federation of Agriculture Canadian Rural Restructuring Foundation Canadian Federation of Municipalities and your home community Society of Rural Physicians of Canada

31. World Organization of Family Doctors World shortage of rural physicians Cost effectiveness of generalists vs specialists Policy on training for rural practice Society of Rural Physicians of Canada

32. RURAL MEDICINE www.srpc.ca/elective.html Where would you rather do your next elective? For an adventurous, busy, hands-on elective consider... combine family medicine, emergency, inpatients and obstetrics - why choose!!!! get lots of hands on experience - and without competition explore Canada - rural learning can happen anywhere from southern Ontario to the Northwest Territories meet some of the friendliest and most welcoming people around Rural Experience Access Program

33. Thank you WWW.SRPC.CA