Half as many physicians in rural communities

There only are half as many physicians per 1,000 people in rural and small-town Canada compared to larger urban centres, according to a recent report put out by Statistics Canada.
The consequence of having significantly fewer doctors and specialists usually means patients must travel further distances to receive specific medical care.
Local dentist Dr. Mary Ellen Kennedy has seen the effect on her practice and patients that often are referred to specialists who are more than a four-hour drive away.
“My friends who work in the city can refer their patients to someone two blocks away, or sometimes in the same building, whereas my patients—if I have to refer them to anyone, they’re going to Thunder Bay or Winnipeg,” Dr. Kennedy said.
A recent study done by the Canadian Institute for Health Information (CIHI) showed that in 2004, only nine percent of Canadian doctors worked in rural and small-town Canada.
The proportion of specialist physicians also was much lower in comparison to bigger cities.
“There are two mitigating factors here. One is my practice is very, very busy and my patients wait a very long time to see me,” Dr. Kennedy noted.
For procedures that are time-consuming, like root canals, Dr. Kennedy tends to refer her patients to other doctors because she simply doesn’t have enough time.
“I don’t have time to do them, but if my patients insist that they don’t want to go out of town, then they’ll have to wait until I have time to actually do the root canal,” she remarked.
If people want or need care immediately, Dr. Kennedy always does what is necessary to get them out of discomfort and pain. But if it requires a significant amount of time, she’ll often opt to refer the patient to a specialist if they can’t wait until her schedule clears.
Within the CIHI study, researchers found rural family doctors offered a broader range of clinical procedures urban family doctors did not provide. In order to meet the needs of rural populations, doctors have taken on more procedures that are given to specialists in a city setting.
Local optometrist Dr. Bruce Lidkea has noticed a significant change in the practice of optometry, as well.
“Certainly, yes, my practice has shifted from being more of an optical business to certainly more of a medically-based business,” he noted.
The current trend for medical graduates still favours physicians moving to and practising in urban areas. Some of the reasons included a closer proximity to amenities for their families and greater opportunities for growth.
For Dr. Kennedy, being in a small town has more benefits that outweigh the convenience of practising in a city.
“The pros of practising in a small town are the people are very nice, you get to know your patients, and they’re appreciative of what you do,” she enthused.
She also noted working in a northern town can be more lucrative.
“The cons are you don’t have access to the specialists, although I must say that we are lucky in that Dr. [Barry] Anderson has done a lot of mouth work . . . he is excellent and in town.”
Dr. Anderson is a local surgeon who has done oral work and biopsies for some of Dr. Kennedy’s patients.
“We’ve really lucked out with him because where he came from, he did oral work so he’s very good and knowledgeable,” she noted.
Having a surgeon in town is inherently beneficial, but there still are many other procedures, like difficult extractions, periodontal disease, and complicated root canals, that require patients to travel to see specialists.
The average wait to see Dr. Kennedy for a regular check-up and cleaning would be anywhere from one-two weeks. However, if you had to get fillings done, it would take much longer.
If specialist medical attention is required, the CIHI study found that distances between rural Canadians and specialist physicians was considerable.
On average, rural communities were more than 100 km to several hundred kilometers away from the nearest specialist or physician.
Comparatively, in urban centres, using a pediatrician, for example, it was roughly three km to a specialist compared to 149 km in a rural community.