Loss of medical services and anesthetic care widening health gaps for rural communities: U of T researcher

Researchers from the University of Toronto researcher and Queen’s University 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.

Beverley Orser, chair of the department of anesthesiology and pain medicine at U of T’s Faculty of Medicine, and 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,” says Orser. “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.

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

The researchers commentary was published in 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 the problem is aggravated in rural and remote areas due to a lower number of anesthesia care providers. 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 mothers 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, the researchers say. They add that, 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. 

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 and that Indigenous communities are disproportionately affected 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, with Orser and Wilson identifying different solutions to encourage more anesthesiologists to practise 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 practise throughout Canada, replacing the regional licensing systems currently in place.

“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 practise 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,” says Orser. “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.”

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, according the researchers. This will help retain physicians in rural areas, they say.

Medical schools and residency programs 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 new 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 the 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.”