‘The same challenges’: Lessons from remote Canada

What can health professionals working in the rural and remote areas of countries in opposite hemispheres learn from each other?
 
That was a question for RACGP Rural Chair Associate Professor Michael Clements when he attended the Annual Rural and Remote Medicine Conference in Canada last month.
 
Held in Winnipeg, capital of the Canadian province of Manitoba, the event hosted health leaders sharing experiences and the latest advances and best practice in rural healthcare.
 
Associate Professor Clements was invited to discuss the challenges of attracting and retaining junior doctors in rural and remote communities, drawing on the experience of the RACGP since training and trainee workforce distribution returned to the college’s remit.
 
He said he was not surprised to recognise many of the issues faced by his Canadian counterparts.
 
‘They’re having challenges in staffing and finding enough doctors wanting to work in the rural and remote communities where they are most needed – and their First Nations health needs are certainly dramatic,’ he told newsGP.
 
‘They’ve got very geographically spread-out communities across a very large land mass, which is probably more of a challenge than we’ve got – even though I come from remote Queensland.’
 
Discussing clinical work in the north-east of Canada, Associate Professor Clements said he was again struck by the similarities.
 
‘I was talking to one of the doctors that works up in the Arctic Circle, it sounded very much like my own clinics in remote Australia, where I’d fly out for two hours to a tiny town of 500 people, do a clinic and fly home,’ he said.  
 
‘And they’re doing exactly the same things, they’ve got exactly the same challenges, it’s just that the temperature is inversed.
 
‘Also, I’m worried about crocodiles and they’re worried about polar bears.’
 
However, Associate Professor Clements also noted significant differences, in particular a Canadian system geared towards being free at the point of use for all residents.
 
‘As one of the attendees told me, the Canadian Government decided that everybody should get healthcare, and so now nobody gets good healthcare,’ he said.
 
‘The fee that they get, that the Federal Government chips in, is so woefully inadequate that the only towns where they’ve actually got doctors are where the provincial governments are chipping in.’
 
Having also recently met with rural clinicians at an event in New Zealand, Associate Professor Clements says the experiences he heard about made him grateful for Australia’s system – and more nervous about changes that could happen in the push to increase bulk-billing rates.  
 
‘I’ve lived and worked in London as well, so I’ve seen the countries where governments follow through on the threat and the promise of universal healthcare,’ he said.
 
‘Some of the stories are really quite stark: towns without doctors, of course, and towns without even allied healthcare; people waiting very long periods of time, or having to travel very long distances to try and get into a doctor.
 
‘That was more of a surprise to me than I expected, and it did make me appreciate the fact that one of the strengths of our health system is that we do have co-payments.
 
‘We do have the ability for people to contribute to their healthcare when they can afford to.’
 
The RACGP Rural Chair also found some substantial differences in the approach to training.
 
‘They go straight into family medicine training from university, and the training for family physicians is run by the universities,’ he said.
 
In his talk about moving to a national structure, he gave examples of GPs in training who combine working in major metropolitan areas with rural placements.
 
‘They’re very provincial, that’s not common [in Canadian training]. I came back feeling like that was a strength of our program,’ he said.
 
Beyond the systemic and practical comparisons, Associate Professor Clements said there was a sense of solidarity at the event, as people swapped tales of recruiting struggles and burnout.
 
‘There was a recognition of the stress and strain that everybody is under, but there was a real acknowledgement and celebration of the rural doctors and trainers that are out there delivering these services,’ he said.  
 
‘It was a very positive attitude.
 
‘People were very proud of what they do for their rural communities, and there was a sense that they needed to look after each other if they were going to look after their communities, which was just wonderful.
 
‘There was a real sense of belonging in that group that I think we can learn from and embrace.’
 
Such was his experience that he does not hesitate to recommend the event, which is supported by the Society of Rural Physicians of Canada.
 
‘I’d certainly encourage any Australians thinking of going to any of their conferences that there’s a lot to be gained, because the systems are very similar in so many ways,’ he said.  
 
‘Not that we want Australians to leave and go and work over there, but a bit of information sharing and locuming in both directions and supporting our Canadian doctors should be high on our priority list.’
 
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