Introduction

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.[238] 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.[239] 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.[240] 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.[241] 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.[242]

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.

Best Practices in the Recruitment and Retention of HHR 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.[243]

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.[244] 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.[245] 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.[246]

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.[247] 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.[248]

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.[249] 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.[250]

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.[251] They articulated that this could best be done through a national conference on rural health funded by the federal government.[252] 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.[253]

Committee Observations

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.[254] 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.