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July 8th, 2013
Closure of Rural Birthing Units Associated with Increased Costs / Worse outcomes
1 in 5 Rural Women have to travel to the city for Birth
SHAWVILLE July 8, 2013 : A recent government report shows that 1 in 5 rural women
now have to travel to the city for birth.
March 23rd, 2011
Federal Budget 2011: Need for a Rural Health Strategy Remains
SHAWVILLE QC /March 23rd, 2011/ - The Society of Rural Physicians of Canada today reacted to
the federal budget and to the potential of a federal election by renewing their call for a
Rural Health Strategy...
July 5th, 2010
Rural Doctors Call for Better Rural Health
SHAWVILLE QC /July 5th, 2010/ - Today a study published in the Canadian Journal of Rural Medicine, found that one in 7 (14%) of rural physicians planned to move from their communities within the next 2 years. Given that we already know that physicians are under-represented in rural communities, this finding risks making a bad situation worse...
September 23, 2009
The Impact of Closures Concerning for Health Care in Rural Newfoundland
The Society of Rural Physicians of Canada says that cost containment can be done for rural health services without the drastic cuts the government of...
May 29, 2009
Rural Doctors Converge On Hazelton
Hazelton, BC - Today marks the opening of a major rural medical meeting in Hazelton BC. The Society of Rural Physicians of Canada (BC Chapter), in
conjunction with UBC...
July 18, 2008
The Society of Rural Physicians of Canada: Training Rural Family Physicians Not Enough
Shawville, QC - The Society of Rural Physicians of Canada (SRPC) says a recent study showing that no medical residents...
November 2, 2006
'Current wait time guarantees are not addressing the desperate health needs of rural Canadians'
The Society of Rural Physicians of Canada supports the Discussion Paper "When the Clock Starts Ticking - Wait Times in Primary Care Discussion Paper" produced by the College of Family Physicians of Canada. The document is timely and appropriate. The current wait time strategy does not however address the basic needs of rural Canadians in rural communities who...
October 23, 2006
Rural Doctors Call for Better Rural Health
St. John's, NL - Today Society of Rural Physicians (SRPC) President, Dr. Michael Jong, spoke to the House of Commons Finance Committee on the need for a comprehensive strategy on rural health care access. Dr Jong said “Canadians living in rural and remote areas are the mainstay of our country's resource producing economy, and deserve adequate health care.” He outlined a number of specific policies and actions on how Canada can...
October 3, 2006
Rural Doctors Improve Access to Medical Procedures
Shawville, QC - Family physicians require procedural skills to deliver high-quality medical services to their communities and must be competent in ambulatory and hospital procedures. Studies show that many graduates have limited experience and confidence in basic and emergency procedures. To address this gap, a leading medical organization has developed a practical procedural manual to be used by rural doctors...
September 20, 2006
Rural Canadians need and deserve equitable access to health care
Shawville, QC - The just released Canadian Institute for Health Information's report on the health of rural Canadians shows that, generally, rural residents of Canada have higher overall mortality rates and shorter life expectancies. Rural Canadians are at increased risk for death from injuries such as motor vehicle accidents and suicide. Those living in the most rural areas are the most disadvantaged. They are more likely to die from injuries, heart disease and diabetes. Life expectancy is lower in rural areas compared with urban areas...
June 7, 2006
Health - It's About Access - And Some Canadians Have None
Shawville, QC - When a prominent medical association says that ' It is about access', they are absolutely right. However when the issue is access for the poor country cousin to medicare, the president of the Society of Rural Physicians Michael Jong says "Private versus public seems like a debate from the city. This won't solve our problem."...
January 15, 2006
CIHI Report Highlights Challenge of Rural Medicine
Golden, BC - This week's CIHI Report on rural medicine in Canada puts solid numbers behind the need to address rural medical issues. "Those of us who practice in rural Canada have always known we do more with less" stated Dr. Trina Larsen Soles, President of the Society of Rural Physicians of Canada. The report particularly emphasizes...
August 15, 2005
Rural Doctors Praise Closson's Solution for Thunder Bay Regional Hospital
Grand Bend, ON - The Ontario Region of the Society of Rural Physicians praises Minister Smitherman and special advisory Tom Clossen for the work done ensuring that people in North Western Ontario will be able to get most of their medical care in the region. Some of the recommendations, such as reduction in hospitalizations for avoidable conditions at the regional hospital, and transfers of patients back to community hospitals for recovery, can and should be implemented immediately...
June 15, 2005
Report "Spun"; Against Rural Hospitals
Shawville, QC - The headlines scream "Mortality Rate Lower in Higher - Volume Hospitals" - It's not true. Unlike other countries where a number of types of surgery were found to be done better in larger hospitals, a highly publicized Canadian study showed only three rare and highly specialized procedures are better done in high volume centers. In six other highly specialized operations there was no difference in Canada...
May 5, 2005
Rural Doctors Shortages Worsen
Montreal, QC - Latest figures released by the Society of Rural Physicians show that despite earlier gains rural Canada is again losing ground and rural doctors. Today Canada is 21% rural but only 16% of GP's and 2% of specialists work there. SRPC president Dr Trina Larsen Soles says "Provinces are failing to meet the needs of their most vulnerable populations, the rural patients, as the rural urban gap increases. Neither is the federal government fulfilling its duties in health human resources nationally. Divisive tensions and lack of political will are to blame."...
April 29, 2005
McMaster Selected as Best Undergraduate Medical School by Rural Doctors
Montreal, QC - McMaster University has been awarded the prestigious Keith Award 2005 for the medical school that best selects and trains physicians who choose to practice in rural communities...
March 10, 2005
Rural Doctors Endorse Latest Ministry Offer
Grand Bend, ON - Rural physician leaders met this weekend to discuss the latest offer from the Ontario Medical Association. Dr Peter Englert, chair of the Ontario Region of the Society of Rural Physicians says "We endorse this offer. It is good for rural practice and good for the profession." All the rural friendly provisions in the old contract have been retained plus changes were made to allow even more rural doctors to bill fee for service and get rewarded for comprehensive care. The new deal will make Ontario's doctors among the highest-paid in Canada, with physicians working in remote areas eligible for pay hikes of up to 35 per cent over four years...
September 7, 2004
Rural Doctors Suggest Solution for Thunder Bay Regional Hospital
Atikokan, ON - The Ontario Region of the Society of Rural Physicians has offered solutions to allow the regional hospital to open to the region. In a submission to Mr Tom Closson, Special Advisor, Dr Hutten-Czapski says, "Rationing on the basis of an arbitrary city boundary is abhorrent." The sickest should be able to get into hospital regardless of where they live...
June 22, 2004
"Rural Canadians not getting proper treatment in this election"
Shawville, QC - "Who is speaking up in this election for the health and health care of rural Canadians?" asks Dr Trina Larsen Soles...
April 17, 2004
Université Laval Family Medicine Honoured as top Program in Canada
Québec City, QC - Université Laval Family Medicine, has been awarded the prestigious Keith Award for the most effective postgraduate rural family medicine program in Canada in 2004...
March 9, 2004
Rural Doctors Want Thunder Bay Regional Hospital Opened to the Region
Sioux Lookout, ON - The Ontario Region of the Society of Rural Physicians is calling on the government to keep regional hospitals open to the region. Dr Hutten-Czapski says, "Rural patients need access to specialized services in the city as much as do urban patients."...
January 15, 2004
OMA and Ontario Government Challenged to Deal with Doctor Shortage During Collective Bargaining
Toronto, ON - In 1996, sixty-eight Ontario communities were short 100 family doctors. Today, 118 communities have 665 physician vacancies affecting one million Ontarians, according to Ministry of Health and Long-Term Care Underserviced Area Program statistics...
June 16, 2003
The growing health care services divide
Shawville, QC - "The growing health care services divide between rural/remote and urban Canada is confirmed by the fifth annual Maclean’s health regions rating," said Dr. Jill Konkin, President of the Society of Rural Physicians of Canada. "Rural is a determinant of health that needs to be addressed by all levels of government."...
March 11, 2003
Neglected Federal Report Calls for Rural Health Investment
Haileybury, ON - The Society of Rural Physicians claims that Health Canada is continuing to ignore the needs of rural Canadians. Dr Hutten-Czapski says "Study after study indicates that rural Canadians suffer more sickness and injury and higher death rates than urban citizens and yet have the least access to services - but no one is listening."; The latest example is the report of the Ministerial Advisory Committee on Rural Health. This report has been languishing since November, only now being released. The funding of this committee has been cut from $150,000 per year to nothing for the rest of their 3 year term...
February 27, 2003
NGFP Communities Succeed in Attracting and Keeping Doctors
Haileybury, ON - The Ontario SRP committee's study released today shows that doctors can be recruited and retained with rural primary care contract models. The survey showed that unlike many rural areas where about a quarter of the doctors leave a year, attrition rates in Northern Group Funded Practices have fallen to 11% per year...
November 28, 2002
Rural Doctors Pleased at Romanow's 1.5B$ Strategy for Rural and Remote
Shawville, QC - The Society of Rural Physicians is pleased at commissioner Roy Romanow's Recommendation to target $1.5 Billion...
Le 23 octobre 2002
90 p. cent des médecins estiment que l'exode des médecins va accélérer - Enquête de la SMRC
Shawville, QC - La Société de la médecine rurale du Canada vient de publier les résultats d'une enquête démontrant que 90 p. cent des médecins ruraux au Québec estiment que le fait de menacer leur autonomie professionnelle va accélérer l'érosion des effectifs médicaux. Le Dr Maurice Lamarche, président de la Société des médecins ruraux du Québec, a affirmé que « ce qui est le plus troublant, c'est que 45 p. cent des médecins envisagent de se déplacer vers une autre province, et 28 p. cent envisagent la retraite comme résultat direct de la législation proposée récemment au Québec.»...
October 23, 2002
90% of Rural Doctors Feel doctor attrition will increase - Society of Rural Physicians Survey
Shawville, QC - The SRPC released survey results that show that amongst respondents 90% of rural doctors in Québec feel that threatening their professional autonomy will lead to increasing doctor attrition. Dr Maurice Lamarche, Québec SRP president said, "What is more troubling is that 45% of doctors are considering a move to another province, and 28% considering retirement, as a direct result of recent or proposed Québec legislation."...
October 2, 2002
Rural Doctors Support Newfoundland Strike
Burin Bay Arm, NF - The Society of Rural Physicians of Canada (SRPC) regrets that the Government of Newfoundland and Labrador has pushed its physicians to the point where withdrawal of services is the only avenue open to them. Rural physicians have had much to contend with over the past few years. Dr Joshua Foley, SRPC exec from Burin Bay says "There are too few doctors which has led to heavy workloads, burnout and high turnover rates. The income disparity between Newfoundland physicians and those of the other provinces of Atlantic Canada have increased the problems."...
Le 17 septembre 2002
"Nous avons besoin de médecins qui veulent du milieu rural":médecins de la périphérie
Shawville, QC - La Société de médecins ruraux du Québec (S.M.R.Q.) est ravie de l'attention que porte le ministre de la santé et des services sociaux François Legault aux problèmes du système de santé en milieu périphérique mais est-ce que les Québécois et Québécoises veulent être traités par des médecins qui ne veulent pas être là en premier lieu, des médecins qu'on a obligés à être à ces endroits? Présentement, la législation planifiée va conscrire les jeunes médecins à travailler dans les régions malgré eux. Le président de la S.M.R.Q., le docteur Maurice Lamarche dit "Ce dont nous avons besoin, ce sont des médecins qui veulent travailler dans les régions et à qui on enseignera les compétences requises."...
September 17, 2002
We Need Colleagues Who Want to be Here - Say Rural Doctors!
Shawville, QC - The Québec Society of Rural Physicians (SMRQ) is pleased with MSSS minister François Legault’s attention to the health challenges of remote regions, but do rural Québecers really want to be cared for by doctors who don’t want to be there? Currently planned legislation will conscript young doctors to work in the regions against their will. SMRQ President Dr. Maurice Lamarche says "What we need is to train doctors who want to work in the regions and give them the skills that are required."...
August 2, 2002
Small Surgical Programs in BC Threatened Again
Golden, BC - "This is really pretty ironic," stated Dr. Trina Larsen Soles, BC Chapter President for the Society of Rural Physicians of Canada. "3 years ago the only doctors in the province being funded for on-call were the ones in small rural communities. Now the Ministry of Health has plans to replace on-call funding for rural surgical programs with a call-back scheme. The plan does pay doctors if they come in to do a surgery, but no longer insures that anyone is in town to provide the service. This is a significant decrease in the level of services our communities have come to expect."...
Le 15 août, 2002
Loi 114 (also in english as Bill 114)
Shawville, QC - La loi 114, nous la déplorons. Toutefois en tant que médecins du milieu rural ou périphérique, nous avons besoin de médecins qui font de l'urgence. Le plus de médecins qui en font, le moins chacun devrait se sentir sollicité...
May 1, 2002
Memorial Family Medicine Honoured as top Program in Canada
Kelowna, BC - Memorial Family Medicine, has been awarded the prestigious Keith Award for the most effective postgraduate rural family medicine program in Canada in 2002...
May 1, 2002
Université Laval Produces 18% of Canada's Rural Doctors
Shawville, QC - Université Laval in Québec city, produces 18% of all Canadian trained family doctors practicing in rural and remote regions. A study published today by the Canadian Journal of Rural Medicine shows that 113 of the 271 graduates of Laval Family Medicine from years 1994 to 1998 were in rural practice two years past graduation...
May 1, 2002
Family Medicine North #1 for Canada's Rural Doctors
Shawville, QC - Family Medicine North in Thunder Bay, produces the largest proportion of rural doctors of all Canadian family medicine programs. A study published today by the Canadian Journal of Rural Medicine shows that 51% graduates of Family Medicine North from years 1994 to 1998 were in rural practice two years past graduation...
April 26, 2002
SRPC Presidential Address to Health Minister and Delegates
Kelowna, BC - We at the Society of Rural Physicians have learned and grown over the last 10 years from a handful to a membership of 1300. This annual conference is now our largest ever with over 240 registrants across 10 concurrent workshops sessions covering a spectrum of topics that rural docs (and nurses) need. The growth shows how much interest rural medicine generates and how important and unique the discipline is...
April 22, 2002
Rural Doctors Discuss Common Concerns at Annual Conference
Kelowna, BC - The lack of sub-specialists and high technology in remote areas across the nation means country doctors are required to work in small groups in settings that necessitate a broad spectrum of clinical skills. Rural doctors from across the country will be convening in Kelowna to share stories and discuss solutions of practicing in this environment...
April 3, 2002
Rural Doctors Applaud Decision to Keep Obstetrics
Parrsboro, NS - Dr Peter Hutten-Czapski, president of the Society of Rural Physicians of Canada applauds civic leaders in Queens who decided to keep Liverpool Obstetrics open. "Keeping the unit open ensures continued high quality care for the community. Letting maternity care go is the first step of turning the hospital into a nursing home." Being able to keep up the skills to attend births means that there is a cadre of doctors and nurses committed and available to deal with many potential complications any time of the day or night. This same team keeps the OR and intensive care areas of the hospital in a constant state of readiness...
March 7, 2002
No Beds For Rural Canadians
Haileybury, ON - The Calgary Health Authorities decision not to accept "out of city" referral even when it has remaining beds and leaked plans in Princeton BC to close the Operating Room highlight an increasing obvious catch 22 for rural Canadians. These are not isolated instances and throughout Canada the local hospital's capacity to provide service is decreasing as the willingness of referral hospitals to take on patients from "out of city" also decreases. The Society of Rural Physicians of Canada says we need a national rural health strategy to protect rural patients from being caught in the cracks...
March 5, 2002
Decreased Access to City Hospitals for Rural Southern Albertans
Jasper, AB - The Calgary Regional Health Authority has attempted to address increasing pressure on its resources with a recently developed policy on accepting patients from other regions when the number of available hospital beds fall below certain levels. However, this now means that rural residents may be turned away from Calgary hospitals even if there are beds available...
March 5, 2002
Interior Health Threatens Rural Residents
Golden, BC - "We have been waiting for the axe to fall," states Dr. Trina Larsen Soles, president of the BC Chapter of the Society of Rural Physicians of Canada. Dr Larsen Soles explained that since the restructuring was announced in January, BC rural doctors have been trying to find out details of proposed service cuts to rural communities. Until now, Interior Health has refused to discuss any details. With the misdirected fax about elimination of the operating room in Princeton, there is finally some specific information available. The plans are as bad as the doctors feared. There are currently a small number of rural communities which have functional operating rooms. These offer crucial surgical services to small communities, mostly provided by general practitioners with extra training in surgery and anaesthesia. One of the most important of the surgeries performed is C-section. Having C-section capability allows a wide variety of women to deliver babies in their own communities. Dr. Michael Klein, Head of Family Practice Obstetrics at BC Women's Hospital says,"Maternity care is downgraded with the loss of operative birth capability. Maternity and newborn care is recognized too late as being the lynch pin for sustainable community life. Once that service is no longer available, the community itself becomes dysfunctional and unstable. Ultimately all medical services in rural communities are threatened." Dr John Bosomworth of Princeton stated, "Our communities will be very lucky to retain any docs at all should current trends continue."...
February 18, 2002
System Not Training Doctors What they Need to Practice Rurally
Haileybury, ON - A study published today shows that we need to do a better job of training doctors for rural medicine. Newly trained doctors are lacking the skills to provide the comprehensive care needed in rural areas. Dr Peter Hutten-Czapski, president of the Society of Rural Physicians says that we need significant reform in the training programs to prepare doctors for the challenges of rural medicine...
February 6, 2002
Romanow Rural Deficient - say Country Doctors
Haileybury, ON - Romanow has issued his interim report on the future of health care in Canada today with a disappointingly urban bias. He has relegated discussion of rural issues that affect 30 percent of the Canadian population to three paragraphs in a 87 page report...
January 30, 2002
Kirby Commission on Health on the right Track - say Doctors
Haileybury, ON - The Society of Rural Physicians of Canada congratulates Senator Kirby and his committee on their work published yesterday on health care. "It is pleasing to see recognition that the 30 percent of Canadians that are rural have unique health care needs not being well met by the current system. It is only by defining the problem can we start to address the solutions," remarked Society of Rural Physicians President Dr Peter Hutten-Czapski...
July 11, 2001
Northern Physicians Retention Initiative a Step Forward - Rural Doctors Say
Dryden, ON - Today's announcement of a government plan that gives northern doctors an bonus to help retain them recognizes the commitment that Northern physicians have to their communities despite increased workloads. It doesn't address the difference in working conditions between urban and rural physicians, nor the retention problems in rural communities outside the north...
July 4, 2001
Rural Doctors Against NB Hospital Closures
Neil's Harbour - The Society of Rural Physicians of Canada cautions the New Brunswick government from centralizing hospital services to the degree recommended by the Premier’s Council. Dr Bernie Buffett, SRPC Atlantic chair says, "Change is indeed needed but not by reducing services to the already underprivileged"...
June 4, 2001
A National Rural Health Care Strategy Needed - Canadian Senate Told
Ottawa, ON - The Society of Rural Physicians of Canada presented expert testimony on the state of rural health care to the Kirby commission last week. President Dr Peter Hutten-Czapski showed that there is a rural urban gap, and despite a rural medical school and increased enrolment in medical schools of 348 seats, the gap will continue to grow. Dr Hutten-Czapski says "Rural doctors are a national resource, rural health is a national issue and a national approach is needed to co-ordinate solutions."...
May 23, 2001
The Northern Rural Medical School Starting to Roll
Thunder Bay, ON - Dr Peter Hutten-Czapski of the Society of Rural Physicians of Canada flew to Thunder Bay May 23rd to take part in an meeting with the northern mayors regarding moving forward with the new Northern Ontario Rural Medical School (NORMS). He says that, "Rural doctors in Ontario's north feel strongly that the north needs to get on with a rural school, and work co-operatively and see what can be accomplished."...
May 17, 2001
Rural Doctors Say: Ontario Needs More than just a Rural School
Dryden, ON - The Ontario Society of Rural Physicians applauds health minister Clement's vision in forming a new northern and rural medical school. "This plan gives us a light at the end of the tunnel, but we have to get there." says Dr Carl Eisener of Dryden. "Doctors in ten years is good, but we need them now."...
May 14, 2001
Dr Magee Physician Advocate for License Portability
Shawville, QC - A number of prominent doctors have set up a legal defense fund to protect the rights of doctors to practice medicine freely throughout Canada. Dr Peter Hutten-Czapski says "The agreement on internal trade has given the professions free mobility throughout Canadian provinces, it is high time to apply this to medicine. We are establishing a physician advocate and a legal defense fund so that we can help doctors and licensing authorities go through the channels necessary to open provincial borders to the extent guaranteed by law."...
May 4, 2001
Rock funds CME/Locum Project
Shawville, QC - Health minister Rock announced $245,000 funding for the SRPC CME/Locum project during meetings with SRPC exec member Dr MacLellan in Shawville...
April 30, 2001
Family Medicine North Honoured as top Rural Medicine Program in Canada
Hockley Valley, ON - Family Medicine North: NWO (Northwestern Ontario Family Medicine Residency Program), has been awarded the prestigious Keith Award for the most effective postgraduate rural family medicine program in Canada in 2001...
April 17, 2001
Rural Doctors Against Fyke Hospital Closures
Wynyard - The Society of Rural Physicians of Canada cautions the government from centralizing hospital services to the degree recommended by the Fyke Commission. The commission has recommended closing 71% of Saskatchewan hospitals which will increase travel time to a hospital to over an hour, in good weather, for 12% of the population...
April 16, 2001
Canada Needs More Medical Students from Rural Areas
Shawville, QC - "Rural Canada won't get its fair share of doctors until a fair share of rural students gets into medical school" says Dr Peter Hutten-Czapski, president of the Society of Rural Physicians of Canada. In a survey published today in the Canadian Medical Association Journal, the authors found only 10.8% of Canada's medical students lived in a rural area at high school graduation, compared to 22.4% of Canadians...
April 15, 2001
Rural Canada Relies on GP’s for Surgical Care
Shawville, QC - Rural Canadian's in four western provinces rely heavily on their GP’s for surgical care. In a survey published tomorrow in the Canadian Journal of Rural Medicine, the authors found only 22 Canadian certified specialist surgeons distributed amongst all of the 76 rural surgical programs in Manitoba, Saskatchewan, Alberta, and British Columbia. Most of the rural patients requiring appendectomy or cesarean section were cared for by 128 GP's with additional training in general surgery...
April 11, 2001
Rural Doctors tell Romanow of need for a National Rural Health Strategy
Sudbury, ON - The Society of Rural Physicians of Canada presented expert testimony on the state of rural health care to the Romanow commission today. SRPC President Dr Hutten-Czapski says "No matter what the future of health care brings, we will have not served Canadians well unless they have access when they need it to a doctor in their community. Canadians deserve a national strategy to start making doctors and other health professionals for the places where they are most needed."...
April 11, 2001
High Tuition will keep Rural students out of Medicine ON-SRP In Support of Tuition Freeze
Dryden, ON - The Ontario Society of Rural Physicians has come out in support of a tuition freeze for Ontario's medical Students. Dr Eisener of Dryden says, "The best hope for doctors in rural Ontario are children of rural Ontarians." Studies from Manitoba and Ontario show that rural origin students are two to three fold more likely to eventually enter rural practice than urban origin students. "In our town very few people will be able to afford a debt of $100,000."...
February 26, 2001
Rural Doctors Pleased at Rural School, Worried if it is Enough
Dryden, ON - A government report recommends three new medical campuses - to combat a predicted critical shortage of doctors. However the Ontario Society of Rural Physicians expresses concern that it is not enough...
November 21, 2000
Numbers Falling Again Says Rural Physician Chair
Golden, BC - A recent study by the Society of Rural Physicians shows that small communities in BC are losing doctors. The number of physicians in communities which qualify for the Northern and Isolation Allowance has decreased by 1.7% since June, and another 2% are planning to leave in the next 6 months...
November 13, 2000
Doctors Endorse Rural Medical School
Dryden, ON - The Ontario Region of the Society of Rural Physicians have endorsed the concept of a Rural Medical school. While such a school may only add 12 or 14 doctors a year to rural Ontario it will raise the bar for the other medical schools...
February 2, 2000
Alliance of Municipalities and Doctors Proposes Rural Health Action Plan
Toronto, ON - An alliance of Ontario's municipalities, chambers of commerce, and both rural and new physicians today asked the Ontario Medical Association and the Government of Ontario to implement a Rural Health Action Plan as part of their 2000 negotiations. The Plan aims to help eliminate the physician shortage crisis in Ontario's rural and underserviced communities...
September 30, 1999
New Rural Funding Plan Helps Toronto Area Hospitals and NOT those in Northern Ontario
Haileybury, ON - A new rural incentive plan designed to attract physicians to rural emergency rooms is set to start October 1st. But funding to promote access to care is being directed to the communities that are those closest to Toronto and with the most doctors...
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