An earlier version of this article stated that the Ministry of Health paid out an average of $170,000 towards recruiting and retaining the province’s rural doctors. That’s not true. The sum is actually about $45,000 per doctor. That’s because the Ministry has an expansive definition of “rural,” under which the province has nearly 2,500 rural doctors. The reporter used a figure from the Canadian Institute for Health Information, according to which there are fewer than 700 rural doctors. The reporter regrets the error.
By: Frank Green
Sherri Quam started having serious mental health problems after her daughter died in a car accident two years ago. She moved from Mackenzie to McBride to get a new start. But she kept having to relive the tragedy. When she went to renew her prescriptions, she often got appointments with doctors she didn’t know and who didn’t know her. And she had to tell them about her daughter’s death to explain why she still needed the medications. She told the story about half a dozen times.
“You’re hysterical and upset and they’re flipping through their notes to see what the last doctor wrote,” Quam said. “You’re leaving the doctor in tears.”
The turnover of doctors can have serious consequences for people’s health. It destroys what researchers call “continuity of care,” which is what happens when a doctor and a patient get to know each other over time.
And studies have shown that less continuity correlates with negative health outcomes. Patients with less continuity are less likely to take their medications properly, according to a 2013 study out of Taiwan. And a 2015 study of patients in Alberta and Saskatchewan found that those with less continuity were more likely to end up in the emergency room for problems that a doctor’s appointment could have fixed. And numerous studies concluded that patients with less continuity tend to be less happy with the care they get.
Quam decided to stop taking some of her medications about six months ago because she didn’t want to didn’t want to risk having to tell the story again if she got another strange doctor. The medications had helped, she said, “but it’s not worth it.”
And Kassi Scarlett gave up telling doctors as much as she used to because the turnover made it feel pointless. She doesn’t bother with her or her family’s medical history, or her diet, or what her life is like. She just lists her symptoms. And she feels it’s compromising her care.
“In 15 minutes they’ve gotta get a full history. They’ve gotta figure out what’s wrong with me. And they don’t know me,” Scarlett said. “I don’t feel like in 15 minutes a doctor who’s a stranger to me can do that.”
Locals estimated that more than a dozen doctors have worked out of McBride’s two-doctor hospital over the last five years. (McBride notwithstanding, levels of continuity of care are actually about the same in rural and urban areas, according to a recent study from the Canadian Institute for Health Information.)
There are two reasons for McBride’s churn. The first is simple math. When you only have two doctors, losing even one means chaos. The community relies on temporary doctors during the search for a long-term replacement. And the remaining doctor has to work more to patch the holes in the scheduling. That’s exhausting, and it can drive them to quit or retire, which worsens the churn.
The second reason is that small, isolated towns like McBride struggle to recruit new doctors, so the churn can last longer than it might in an urban area.
“The difference between doing well and struggling is one person,” said Dr. Ray Markham, who’s practiced in the Robson Valley for 14 years. “And when you start getting into chaos it’s harder to bring a new person in.”
It’s an expensive problem. British Columbia’s Ministry of Health spent more than $110 million last year on recruiting and retaining rural doctors, which averages out to just over $45,000 apiece. Townspeople in Nakusp even bought a house to offer it rent-free for a year to a doctor who’d agree to practice there long-term.
But there still aren’t enough rural doctors. More than 20 percent of Canadians live in towns with fewer than 10,000 people, but those towns have just 10 percent of the doctors, according to the Society of Rural Physicians of Canada.
And while rural doctors are far more likely to have grown up in rural areas, rural kids are also underrepresented in medical schools. For example, Ontario’s population is 13 percent rural, but only seven percent of the applicants to its medical schools were, according to a study from 2005.
There are new scholarships for people who want to be rural doctors. And there are several new academic programs designed to funnel students into rural practice.
But small towns will continue to suffer through the kind of turmoil McBride’s dealing with right now, said Dr. John Soles, president of the Society of Rural Physicians of Canada. Smooth transitions and readily available doctors are nowhere in sight.
“Is that something we can hope for? Yes,” Soles said. “Is that something we can expect? No.”
