Rural communities face doctor shortage: Where are Canada's country doctors?

If it wasn't for staff putting in a few extra hours - working a few extra shifts, enjoying a few less days off - it couldn't maintain its level of service.

Dr. Jean Fairfield, the hospital's Chief of Staff, says the situation is quite serious.

The hospital currently needs a third doctor for the emergency room, as well as general internists and an anesthesiologist.

There is also a shortage of nurses, which at times means the hospital is staffed by a bare minimum of people.
"There is no risk of closing the ER for now," Fairfield said. "We have a dedicated team who do the extra work and keep the centre running. But as time passes we have to be careful we don't become at risk. We have never got to the point where we need to close the ER, but we have to avoid that at all costs."

National shortage
Fairfield said many communities across Canada are facing a shortage of doctors.
In recent months Hawkesbury has embarked on a massive campaign to recruit more medical staff.
Hospital workers have placed ads in medical journals, visited job fairs and campaigned on campuses across Ontario and Quebec.
A brochure also quotes Dr. Lyne Arsenault, who has worked in Hawkesbury more than ten years.
"I have been in Hawkesbury since 1997 and I have no regrets. I have an office in the community and am involved in hospital activities. I most appreciate the collegiality among doctors and the diversified medical practice that a small community hospital offers," she writes.
Another tactic is offering cash rewards for referrals.
Since June 2007, Hawkesbury's hospital staff, physicians, volunteers and members of the Board of Directors have been eligible for a $5,000 bonus if they recommend a doctor who ends up being hired and working one year in Hawkesbury.
The bonus is now available to anyone in the general public - effectively turning the search for doctors into a town-wide contest.

Doctors must be "jack of all trades"
Fairfield said there are a number of reasons doctors are hesitant to work in rural areas.
One recurring concern is a lack of peer support.
In today's medical climate - where malpractice litigation can bankrupt a hospital and end a doctor's career -many doctors prefer to stay within a narrow field of expertise.
In rural areas, however, they must be jacks-of-all-trades.
"Doctors don't feel comfortable acting alone. In a big city you have a big group to fall back on," Fairfield said.
Dr. Giang Duong, who is Hawkesbury's newest General Practitioner, agrees that working in a rural hospital can be more of a challenge.
"There are less specialists to provide backup. You have to use your knowledge more," he said.
However, Duong said he shares Arsenault's view that doctor-patient relationships are better in small towns.
"You are helping people you know," he said.
Fairfield said the hospital's recruitment campaign is primarily about selling the municipality. The brochures feature pictures of local golf clubs and ski trails, as well as sailing and cycling.
‘We have a lot of graduates in medicine who are very urban people. These are people who might be attracted to the National Arts Centre or even the Ottawa Senators. They are not necessarily going to look favourably on relocating to Hawkesbury when they could live in Toronto or Montreal. We have to market ourselves as a place to relocate," Fairfield said.
Other incentives for doctors include higher salaries, signing bonuses, and relocation assistance.

Provincial government
Glengarry-Prescott-Russell MPP Jean-Marc Lalonde met with local mayors and community groups on July 14 to discuss medical recruitment.
Lalonde says he is campaigning for the provincial government to retool its Underserviced Area Program which allocates recruitment grants.
Currently the program is based on the numbers of doctor-per-capita. Lalonde argues this is not favourable to small communities.
A press release from Health Force Ontario (a branch of the Ontario government which links the Ministry of Health and Long-Term Care with the Ministry of Training, Colleges and Universities) reads as follows:
"The UAP, established in 1969, was designed to help northern and rural communities that had chronic problems recruiting and retaining physicians and other health care providers. (...) Within a matter of a few years, the number of designated underserviced areas in the south began to overwhelm the number in the north. By 2008, almost three out of every four ‘underserviced' areas were in southern Ontario. Although the UAP was created to help rural and northern communities, currently only one dollar of every five the program spends on recruitment goes to the most northern and rural Ontario communities. The UAP was originally designed to create a more level playing field for northern communities in the competition for physician services by giving them incentives not available in southern communities. Now that many of these communities are eligible for the same incentives, it is almost impossible for northern communities to compete for physicians."
As an example, the press release states that a physician in Ontario would receive the same incentives to establish a practice in Hawkesbury as in a larger urban community like Burlington with a population of 164,000.
The Ontario government is currently considering the creation of a new Rurality Index, which would change the standards of the UAP to benefit small communities.
In the meantime, hospitals like the Hawkesbury and District General Hospital will have to dip into their own budgets to pay for promotion and incentives.

Nursing shortage
Diane Forgues, who is a Senior Advisor for Human Resources at the Hawkesbury hospital, says a shortage of nurses is also a concern.
In the next five years, Forgues said, it is expected that almost one quarter of nurses will retire across Ontario.
"It's very physical work. Not every nurse can work on the front lines until they are 65," she said.
The Hawkesbury hospital has partnerships with the University of Ottawa, and is also campaigning for nurses at campuses and job fairs.
But as is the case with doctors, recruitment is not meeting goals.
The hospital is now offering a $500 cash bonus to anyone who recommends a nurse who will agree to work in Hawkesbury for one year.

Top photo: Young doctors like Giang Duong are a precious resource in Canada. Rural communities are increasingly trying to woo them with high salaries and incentives. Duong is originally from Montreal but has now worked three months in Hawkesbury. Philippe Morin photo