The
Society of Rural Physicians of Canada divides the country into 5
regions. The Central Region includes the provinces of Manitoba,
Saskatchewan and Alberta. Some measure of the politics of the rural
medical economics of the region are listed here. If you wish to become
involved please contact the regional committee chair listed here. Below click to the province for a description of
the programs.
The Rural
Physician Action Program has been operating since 1991 to deal with the
rural medical problems. It has developed a comprehensive and integrated
set of initiatives for rural medical education,
recruitment and retention. It offers
With the
aim of encouraging medical students and residents to consider rural
practice, the RPAP provides a variety of initiatives, funding and
support to raise their awareness, improve their preparedness and to
increase their exposure to rural medicine. Initiatives include: RPAP's
weekend shadowing experiences, RPAP's summer student experience
program, rural medical interest groups (RMIGs) at both universities,
the core Family Medicine clerkship rotation, rural and regional
electives in the general specialties and Family Medicine, a rural-based
Family Medicine residency program, the Alberta Rural Family Medicine
Network, and a series of financial supports including a $5,000 award
and a full tuition bursary program. RPAP also provides a matching Bonus
of up to $10,000 which applies to Alberta graduates only. RPAP pays up
to $10,000 matching what regions are willing to contribute.
Recruitment
and retention grants of up to $10,000 are available for innovative
program ideas to promote recruitment and retention rural physicians and
project ideas for physician recruitment and retention targeted at the
local level.
Recruitment
Reimbursement Program. This program provides up to $3,000 towards the
cost of recruitment for recent Alberta graduates or physicians from
outside Alberta. The program also provides funding for physicians (and
their preceptor) who need an assessment as a condition of getting a
license.
Physician
Locum Services (formerly the Rural Locum Program) was initiated in
early 1992 through the RPAP to provide a short term locum service to
rural physicians practising in communities with four or fewer
physicians. It was expanded to provide weekend relief to ensure that
weekend call for participating physicians was no greater than 1 in 4,
and a seniors' enhancement.. These initiatives are administered by the
Alberta Medical Association on behalf of the RPAP and the Province's
Trilateral Agreement.
CME
program. Aided by RPAP funding, the Continuing Medical
Education/Continuous Professional Learning offices at both Alberta
universities, work with rural physicians to provide high quality
CME/CPL to meet the needs of rural Alberta. Programming at the two
universities differ in content. However, each university provides
regional conferencing and video-teleconferencing sessions on a regular
basis.
Enrichment
Program. Two physician "skills brokers" help organize training requests
for rural doctors. The time frame of training is between 2 weeks and
1year. Paid pro rata at $76,000 per year.
Eighteen
(18) Additional Skills Training PGY3 positions are available between
the UofA and UofC through the RPAP in such areas as anaesthesia,
surgery, obstetrics, GI Medicine, and palliative care. The type of
training taken will depend on the resident's interests and the needs of
the rural community he/she will be practicing in. A return in service
commitment is required. The curricula used are similar to the training
papers in the library. " Rural Physician Spousal and Family
programming. RPAP offers a range of activities throughout the year,
such as: local get-togethers such as luncheons, guest-speaker events or
other social activities; and events at medical conferences, to give
accompanying spouses (and often, children) a chance to meet their
counterparts from across the province.
Virtual
Library. The Virtual Library provides free access to Internet-based
medical textbooks, journals and other resources for rural physicians in
Alberta.
Rural
On-Call Remuneration Program. As of 200 Rural Alberta physicians have
been given a $21 per hour top up of after hours FFS for being on call
in ER (under 25,000 visits). Further details are on the regional shelf
of the library.
High School
Outreach Program and Physician Recruitment Website. RPAP has an active
high school outreach program to encourage rural origin students to
think about careers as rural physicians. It also offers
www.RuralPhysicianLink.ab.ca as the "one-stop" provincial recruitment
web site for rural physicians to Alberta.
Saskatchewan has an
extensive list of rural health initiatives/programs.
The
Northern Medical Services were developed in 1984 as a tripartite
co-operation of Sask Health, UofS Dept FM and Medical Services Branch
of Health Canada. It serves Northern Saskatchewan based in Uranium
City, Ile a la Crosse and La Ronge. The format is of salaried
multidisciplinary teams. Physicians are paid $121K - $140K starting
plus benefits including subsidized housing.
Locum
program for relief in rural communities with 3 or fewer physicians.
There is also a weekend relief locum program at $1,500 for 5PM Fri. to
8 AM Monday. The Travel Assistance Program (TAP) covers the travel
costs of rural physicians travelling to other rural sites to assist
their colleagues in maintaining coverage.
Rural
Practice Establishment Grant as of April 1997. $18K grant for Canadian
grads moving to Saskatchewan and establishing practice in an eligible
community for a minimum of 18 months. Eligible communities are under
10,000 pop. (This replaces the 1979 Medical Practice Establishment
Grant Program)
Rural
Physician Enhancement Training Program. (1995) Rural Saskatchewan
physicians can get retraining for return of service guarantee (2
years). Eligible training includes up to 1 year of obstetrics (incl.
C/S training), anaesthesia, general surgery, psychiatry, ER or
geriatrics. There are only 2 slots available but they pay $80K for
re-entry physicians. 2 additional R3 slots at $40K for FM residents
with return of service guarantee are available.
Undergraduate
Medical Student Bursary Program as of 1991. Currently 15 bursaries
available at $18,000 with year for year return of service. Upon
graduation you can buy out but you have to pay accumulated interest.
Retention rate is 71%
Medical
Resident Bursary Program. Another 4 bursaries at $18,000 for
a 1 year commitment to rural Sask.
Summer
Extern A week long rural rotation for Medical students between their
third and fourth year funded by the Saskatchewan Medical Association.
Rural
Extended leave program for educational costs and foregone income up to
6 weeks. Return service contract of 1 month per week of leave.
Emergency
On-Call Coverage Program as of Jan 7, 1998. Communities that support 2
or more physicians with sufficient volume will get a bonus of $10 an
hour weeknights and $25 an hour weekends top up to the regular FFS
schedule. MD's in lower volume towns will be paid a stipend of $5000 a
qrt for covering ER. Currently this program costs $5.5
million for ER coverage in 75 communities and 410 GP's outside of
Regina and Saskatoon.
Active
recruitment overseas is done. These doctors get a 3 year provisional
licenses (Section 29 of the Medical Profession Act) or a 5 yr.
conditional license (under section 31). The license is valid for
underserviced areas only.
(incentive
program updated to 2006)
Manitoba
In 1979 a Standing
Committee on Medical Manpower was established with a number of
initiatives. These have been expanded and in late 2000, managed through
a Rural Physician Action Plan. It's clear goal is to increase the
number of graduating physicians and other health professionals who
choose to practice and live in rural and northern Manitoba.
Part of this plan was the creation of Manitoba’s Office of
Rural and Northern Health (ORNH). ORNH focuses on the
creation of programming and initiatives that increase the profile of
rural health care opportunities among rural and northern Manitoba
secondary school students and students training in health care programs
in Manitoba. In addition, the ORNH is responsible for a
variety of programs that deal with issues of long-term recruitment and
retention of existing rural and northern Manitoba health care
practitioners.
The initiatives in rural
medicine start in the first and second years of the undergraduate
program. At the end of first year, all students participate
in a one week rural/northern placement called Rural Week.
This was initiated in 2003 and has been a mandatory part of the
curriculum since the following academic year. In addition,
(up to 14) first and second year med students are eligible to apply for
a 10 week rural summer placement. This is a paid
educational/clinical work experience. All clinical clerks do
their (5 week) FM rotation in a rural/northern site and third and
fourth year students have the option of doing other electives and
selectives in rural locations.
Manitoba has both a rural and an urban family medicine residency
program. The rural program has residents completing their
first year training in Winnipeg with the second year being done in the
rural communities of Dauphin, Ste. Rose du Lac and Brandon.
FM residents in the urban programs are required to do a 2 month rural
rotation during their 2nd year. There are no urban
disincentives.
The
Province of Manitoba has a number of return of service
options. Third and fourth year medical students are eligible
for a $15K (per year) forgivable loan in exchange for return of
service. If the program is accessed in third year the return of service
is to rural Manitoba and if it is accessed in fourth year the return of
service is to anywhere in Manitoba. Residents in the Family
Medicine program can access one more year of return of service in the
amount of $20K. Rural and northern RHAs and a number of
communities, health foundations and clinics are also providing
(similar) return of service options to medical students in addition to
those available through the provincial program.
Rural candidate re-entry positions are being funded in a variety of
areas for those that wish to do additional training. A General Practice
Anesthesia Training Program through the Department of Anesthesia trains
primary care physicians to provide GP/anesthesia services.
Programs are also available in ER training and
obstetrics/gynecology. In 2006 a $50K grant was created for
those practicing physicians that are accepted into a re-entry program
and agree to practice in a rural community after they complete the
training..
The Manitoba Locums Tenens Program (MLTP) is a joint initiative of the
Manitoba Government (through the ORNH) and the University of
Manitoba’s Northern Medical Unit. The program
provides rural health care facilities with a suitably approved
physician for requested periods of time. Locum Tenens
coverage is provided in rural communities of four physicians or less.
A locum tenens program that pays 643$ per day exists ($698 in
locations North of 53deg 0'lat). The Northern Medical Unit
(1996) assists really small towns with
salaried doctors at $150K with no overhead.
In 1995 a Conditional Register was developed by the CPSM to allow IMG
physicians not meeting the regular licensing requirements to a
restricted practice in underserviced areas (by ministerial
designation). There is provision for conversion to regular
licensure. The requirements for being placed on the
conditional register have just (2006) been modified to include a 3
month assessment period for IMGs. In 2001 Manitoba’s Medical
Licensure Program for International Medical Graduates (MLPIMG) was
established which offers a 12 month training period in exchange for a
return of service in a rural/northern area. MLPIMG helps licence up to
15 IMGs annually.
In the summer of 1997 a sessional funding model had been developed for
remunerating emergency room practice. ‘General’
rural hospitals (the larger hospitals) have on site coverage, 24 hours
per day and are remunerated on an hourly basis. Physicians in
hospital emergency rooms with fewer than 5,000 visits ("B" level) are
paid a per diem for 24h weekday coverage and at another rate for day
weekend and holiday coverage. Billings for obstetrics, surgery, and
anesthesia are additional, as is a 4 hour clinic that can be run
concurrently. In hospitals with under 10,000 visits ("A" level) the
rates are somewhat higher.
A differential rural and northern fee schedule applies. There is no
‘add-on’ for Winnipeg, 2.5% for
Brandon, 5% south of the 53rd parallel, and 10% for north of
the 53rd.
Manitoba added training positions for medical students and residency
positions to be phased in starting in 2001, restoring enrolment to from
75 to 85, as existed before the 1994 cutbacks; then by 2006 first year
enrolment has increased to 100. The ratio of first year
medical students to population will be 1:11,000 above the current
Canadian average.
Nine of the Univ. of Manitoba FM residency positions are rural, with a
base in Dauphin. Medical schools admissions policy is
currently under review; one of the goals is to make changes reflecting
the AFMC emphasis on ‘social accountability’.
All practicing Manitoba physicians get up to a $2,600 (in 2006)
allowance for CME.
Grants for setting up rural practice in Manitoba in 2006 will be
$25,000 for four years. To be eligible for the grant,
candidates must be Canadian trained family physicians who have
originated from Manitoba and who are eligible for full registration
with the College of Physicians and Surgeons of Manitoba.
Candidates must also sign a return of service agreement and return one
year of service in a rural community for each year of financial support.
