Loss of Medical Services and Anesthetic Care Widening Health Gaps for Rural Communities

Jul 27, 2020
Ciara Parsons

Dr. Beverly OrserDr. Beverly Orser

A University of Toronto researcher and a Queen’s University researcher say Canada needs a national strategy for improving anesthesia services in rural and remote regions, due to a lack of anesthesia care providers in these areas.

Dr. Beverley Orser, chair of the Department of Anesthesiology and Pain Medicine at the University of Toronto’s Faculty of Medicine, and Dr. Ruth Wilson, a professor emeritus at the Department of Family Medicine at Queen’s University, explain that rural and remote regions are losing surgical and obstetric services, partly because there are not enough health care providers who can offer anesthesia services. 

“We know that if a person lives in a rural or remote part of Canada, they have a higher chance of dying if they experience trauma or a major illness. Canadians living in rural and remote communities tend to have more health concerns and have poorer health outcomes, compared with those who live in cities,” says Orser.

“Rural and remote communities need more anesthesia care providers, and we wanted to identify solutions on how to improve address this gap and improve access to care.”

Commentary by the researchers was published today the Canadian Medical Association Journal.

In the report, Orser and Wilson explain that nationally, Canada has a shortage of anesthesia providers, who care for patients undergoing surgery and assist with perioperative pain management. 

The researchers say in rural and remote areas the problem is even more aggravated, due to a lower number of anesthesia care providers in these areas. Some patients must travel hours to receive care in urban centres, because there are no health care providers who can provide these services locally. 

“Pregnant mother should not have to travel hundreds of kilometres to receive maternal care from regions that previously offered maternity care. Everyone in Canada should have access to the basic care services they need, as close to home as possible” says Orser. 

“It’s time to address the gaps in health outcomes that people in rural and remote communities are experiencing, by developing a strategy to remove the barriers they face.”

Rural and remote areas are some of the most underserved regions in Canada in terms of their access to health care, say researchers. While almost 18 per cent of Canada’s population lives in rural and remote areas, only eight per cent of Canada’s workforce of physicians serve this group, note the researchers. 

They also note that less than one per cent of the Canadian Institute for Health Research’s funding is awarded to the study of rural research. The researchers say Indigenous communities are disproportionately impacted by a lack of access to anesthesia care providers. The report calls for better workforce planning and studies to measure the gap between what services are now available and what services are needed.

To ensure rural and remote regions of Canada are equipped with the medical expertise required, Orser and Wilson have identified different solutions to encourage more anesthesiologists to practice in remote and rural areas.

For example, researchers say that medical licensing authorities should consider a national medical licence, that would allow physicians unrestricted access to practice throughout Canada. It could replace the regional licensing systems that are currently in place, they add.

“Getting a medical licence in each province and territory is a lot of work. There’s tremendous barriers, such as cost and administrative issues,” says Orser. 

“If we had a national medical licence, physicians might be able to form special relationships with various service regions that would allow for better models of support for these communities. Unrestricted access to practice across Canada could encourage more physicians to take their expertise to rural and remote areas.”

Another solution would be to create better mentorship and continuing professional education opportunities for physicians providing anesthetic care in rural and remote regions. 

“Physicians working in rural areas need to be supported. So, we need to think about how we can appropriately integrate them into the broader anesthesia community, so they have opportunities for retraining, networking and places to get support when conducting highly detailed work with limited resources,” says Orser. 

Professional associations and academic health centres must take an active role in creating programs that support longer-term peer mentorship amongst physicians providing anesthesia services and specialty trained anesthesiologists, say the researchers. 

This will help retain physicians in rural areas, they add.

Medical schools and residency programs, say researchers, can also play a key role in helping to address the issue of providing adequate care to rural and remote regions. 

The researchers say that the goal of providing more trained anesthesia care providers in rural areas may mean developing educational strategies, like admitting more medical students from rural areas. Medical schools should also be engaged in providing meaningful rural medical education experiences that are supported by rural mentors, say researchers. 

“Institutions like universities play an important role in helping to promote social accountability and offering leadership to identify long-standing problems in our health care systems,” says Orser. “We need to structure our health care systems so that we are solving the problems experienced by vulnerable people, and those who have poor health outcomes.” 


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