Rural Healthcare: Still Under-Resourced

Friday, October 25, 2024

Steps Still Need To Be Taken, Says Rural Physician

By Mary Loggan

“Rural healthcare continues to be ignored, under-resourced, and is a very different healthcare than is delivered in urban areas. Rural medicine and urban medicine are very different, and present different challenges.”

That statement comes from Dr. Rithesh Ram, Rural Generalist Medicine specialist and president and founder of Riverside Medical in Drumheller, Alta.

Indeed, some farm families continue to grapple with limited healthcare options across rural communities here in Ontario.

According to the Canadian Institute for Health Information (CIHI), rural and remote areas continue to have fewer physicians per capita compared to urban centres.

In 2022, some 27 per cent of rural Canadians reported difficulty accessing a family doctor, compared to 13 per cent in urban areas. The shortage of physicians in these regions often results in longer wait times and reduced access to necessary services.

Ram sees the shortage of medical professionals as related to “the false notion that urban experience is more valuable than rural experience, and that physicians only practice in rural areas because they are unable to ‘make it’ in the city.”

Ram also takes issue with any assumption that “in rural areas we have the exact same resources and availability of services that they do in urban areas.”

The CIHI points out that geographic isolation poses one of the most significant issues for rural Canadians. Many farmers must travel long distances to access healthcare services, which can be particularly burdensome for those with chronic conditions or mobility issues.

Emergency healthcare services in rural areas are frequently under strain as well. Many rural communities have fewer emergency medical services (EMS) and hospitals equipped to handle complex cases.

“The current system funnels investigations funding to the urban centres, where you have 200 hundred times the number of specialists roaming the hallways who have been trained to diagnose problems without specialized tests,” Ram explains.

“Rural and remote areas should be provided the ability to perform tests and get answers that would either prevent patients from being transferred to the city needlessly or identify patients that must be sent to the city immediately to prevent morbidity and mortality.

“For example, in our town, it makes no sense why our CT scan is available only Monday to Friday from 9 a.m. to 4:30 p.m.

“Which means every patient who comes at 4:30 on a weekday, or any patient who comes on the weekend, must be transported to the city for a scan.

“The majority of those scans result in non-urgent results, which means the patient and ambulance were inconvenienced for many hours when they could have – within minutes – received the scan in our centre.

“Not to mention the significantly higher cost of continuing with the status quo.”

The CIHI points out that rural hospitals are more likely to face closures or service reductions compared to urban hospitals. This can lead to delays in emergency care and increased risk for patients in critical situations.

Mental health services in rural areas are often limited due to a shortage of professionals and the stigma associated with mental health issues. According to the Canadian Mental Health Association, rural communities face challenges such as fewer psychiatrists, psychologists, and counsellors, resulting in longer wait times and reduced access to care. The lack of local resources can contribute to increased rates of untreated conditions.

So are there any solutions?

Telehealth – the use of digital information and communication technologies to access healthcare services – has emerged as a potential solution to some rural healthcare challenges in recent years. It allows patients to consult with healthcare providers remotely, reducing the need for lengthy travel.

During the COVID-19 pandemic, the use of telehealth in Canada expanded rapidly. According to the Canadian Medical Association, telehealth consultations increased significantly during the pandemic and helped reach underserved populations. They point out that continued investment in digital infrastructure and internet connectivity is necessary to maximize the benefits of telehealth.

But Ram warns of limitations.

“Virtual and telehealth cannot replace the physical exam. If we wanted to expand the number of tests – labs, investigations, et cetera – then virtual and telehealth would do just that, which of course increases utilization of the ERs and healthcare spending.

“Virtual and telehealth are important patient safety tools for very remote areas, but there should be near zero use in cities and towns that should have a sustainable patient medical home.”

According to the CIHI, to attract and retain healthcare professionals in rural areas, financial incentives and support are crucial.

Programs such as the Rural, Remote, and Northern Recruitment and Retention Strategy offer financial support to healthcare providers who work in underserved regions.

Additionally, increasing funding for rural health programs and providing financial support to rural hospitals can help sustain essential services and improve care availability.

Ram also explains the importance of “adequately funding equipment and healthcare personnel for the work that they have been doing so that we can retain our healthcare workforce.”

He says “there need to be rural modifiers as a start for everything provided. When a physician is looking for a job, the financial incentives and overall salary of rural positions must be high enough so that there is a draw of workers from urban to rural.”

Improving rural health requires addressing broader social determinants such as education, transportation, and housing. Investments in community development, transportation infrastructure, and educational opportunities can contribute to better health outcomes. Collaborative efforts between healthcare providers, community organizations, and policymakers are vital in creating a holistic approach to rural health, the CIHI says.

Many steps still need to be taken. Enhancing public health education and outreach can empower rural residents to manage their health proactively. Tailored health education programs, preventive screenings, and community health initiatives can improve health literacy and encourage early intervention. Programs such as the Canadian Public Health Agency’s Rural Health Strategy aim to increase awareness and understanding of health issues in rural communities.

Ram advises rural Canadians to speak up about healthcare issues.

“Be loud and repetitive. Force involvement by your municipal governments and provincial politicians. If they do not hear the message repeatedly, nothing will happen.” BF