Residents learn about airway management at the 2012 SRPC Rural and Remote Medical Course
Dr. Jim Christenson, Head of UBC’s Department of Emergency Medicine (DEM) and a long-time emergency physician, is fully aware of the challenges facing rural family physicians working in community emergency departments (EDs). “I think that rural GPs who are covering EDs are one of the backbones of our healthcare system – I have a huge amount of respect for the work that they do. They don’t have all the resources that I have in a tertiary care referral centre and yet they have to manage a critically ill patient for longer than I would have to. It’s a very difficult and lonely job.”
Christenson believes that the DEM has a primary role, responsibility and obligation to do whatever it can to ensure that rural physicians and communities receive the support they need – whether its knowledge, critical-decision making, or skills acquisition and maintenance. The department has a mandate and a vision to train residents for rural service. However, the program is currently only graduating six or seven family physicians from its CFPC Emergency Medicine Residency program. “Our estimates indicate that if we wanted to replace all of the physicians leaving practice with somebody who’s training, we would have to graduate 55 residents a year,” says Christenson. The department is partnering with the UBC Department of Family Practice to find ways to address this shortfall in physician supply but for now, the financial support to scale up the program isn’t available.
UBC DEM is currently investigating other ways in which it can encourage graduates to practice rurally. Christenson suggests that placing trainees in smaller communities within each of the health authorities during their year of emergency medicine residency might allow family physicians to “really get a flavour for rural practice.” He also suggests identifying and placing a significant number of people in smaller communities who can act as leaders and teachers – physicians with extra training who can help manage rural EDs, who can teach other members of the rural critical care team the skills they need to provide support, who can arrange to bring courses to local communities and then become course instructors. “Once that infrastructure is in place to teach these programs, we can meet the needs of physicians who want to learn more about procedural sedation, or who want extra training in airway management. Our vision is to help rural GPs increase their skills and confidence over the years. But it takes money and support to achieve this.”
Recent discussions with the Ministry of Health and the health authorities to address increasing the numbers of skilled caregivers in rural EDs has centered around establishing credentialing and privileging process for rural family physicians. Christenson’s academic position on this issue is that, rather than expending energy, time and resources on examining community doctors and excluding them from practice if they fail to qualify for a desired skill, the focus should be on identifying the gaps, and filling the need for skills training. “Let’s get out there and support physicians working in smaller EDs by filling the gaps they identify so that they feel comfortable in that environment,” says Christenson.
In addition to recommending increased access to primary care education for rural physicians, Christenson’s department is also working to assemble a free compendium of clinical support tools that will be housed on its web site to act as a resource for practitioners. It is also discussing with other leaders in the field how to support direct telehealth linkages (preferably video) between smaller communities and tertiary care centres, so that community doctors have access to other emergency physicians when a complex case presents itself.
Christenson observes that the DEM shares a vision with many partners and must work with the Ministry of Health, the health authorities, and the Department of Family Practice to transform rural ED support. “Somehow, we’ve got to get together and figure out how to make it happen. Christenson recognizes that strong rural networks – established by organizations such as the Rural Coordination Centre of BC (RCCbc) – already exist and advocates working with these existing linkages. “RCCbc has taken the approach that it’s best to go to the rural doctors and ask ‘what do you need and how would you like to receive that information or skills practice’? I have a great deal of respect for the success of the RCCbc‘s approach. The DEM isn’t interested in saying ‘we’ll take it from here.’ We want to know how we can support the current work being done in the communities. In fact, our vision is to make sure we’re spending our time and energy and money on things that can directly affect patient care. That means strengthening the relationship with those who provide and support that care.”
Dr. Jim Christenson is an emergency physician at St. Paul’s Hospital and was appointed as Professor and Head of the Academic Department of Emergency Medicine at UBC in September 2010. He is keenly interested in developing a well connected community of emergency physicians across the province and in galvanizing the faculty in the Department to support and facilitate the best care possible in the 101 hospital emergency departments in British Columbia.
Photo courtesy of UBC Faculty of Medicine