UBC Rural Continuing Professional Development (UBC RCPD) recently released the final report of their Rural Emergency Medicine Needs Assessment study for British Columbia. The report identifies several factors that draw physicians to rural medical practice, along with many systemic issues at provincial, health authority, and local community levels that have either positive or negative influences on physicians’ ability to provide rural EM care. The study’s investigators have made nearly 40 recommendations to address barriers and systemic gaps that are impacting the sustainability of rural emergency medicine in British Columbia.
For this study (available online at http://ubccpd.ca/rural/research), investigators interviewed rural physicians and other health care team members from across the province, and posed a series of questions to elucidate the factors that support or hinder the provision of rural emergency medical care in rural British Columbia. A significant overarching finding of this study is the importance of relationships in sustainable rural EM practice. Relationships between rural physicians and their local health care teams were found to be perhaps the most important factor in supporting the rural EM physician. Relationships between local providers, regional specialists and key urban specialty services were also identified as being very important.
“The report has been pivotal in helping all of the stakeholders understand the reality of rural healthcare,” says Dr. Tandi Wilkinson, principle co-investigator of the study, and Associate Medical Director for UBC RCPD. “The intention of this report was to improve patient care, and the study suggests ways that rural physicians, urban physicians, health authorities, medical educators, and rural community members – all of us – can play our parts in improving service delivery as well as recruitment and retention in rural BC.”
The Rural Emergency Medicine Needs Assessment report highlights that the most frustrating aspect of rural EM practice to the majority of physicians are the wide range of barriers encountered when transferring patients to a higher level of care. There are a number of areas when the interaction with the Patient Transfer Network is not serving rural physicians or their patients well. Systemic issues – including poor communication between provincial patient transport organizations and community hospitals, provision of care for patients via road ambulance, and unstable psychiatric patient transfer were identified as significant and particularly challenging.
The study also noted that rural locums and International Medical Graduates (IMGs) – who are such an essential part of rural medical healthcare that the system would collapse without them – have needs that are not currently being addressed by the system. Disconcertingly, these physicians have no effective ways to voice their needs or concerns, or to lobby for systemic changes to address their needs.
“There are so many demands made of IMGs in Canada – there are challenges with immigration, language, and culture, both social and medical culture,” observes Wilkinson. “ so it can be a real challenge for IMGs to adapt. Established rural healthcare practitioners and rural communities have a role and responsibility to assist these physicians in settlement and orientation. This isn’t taking place in a lot of BC rural communities.”
In addition to providing improved training and orientation processes for rural physicians, UBC RCPD made nearly 40 recommendations to support the sustainability of rural emergency medicine in BC. Key suggestions include:
- designing training and CPD opportunities that reflect the broad skill set of rural generalists;
- exploring ways to improve the patient transport system to be responsive to the needs of rural EM providers and patients;
- augmenting system-level support for rural locums; and,
- promoting the development of customized, local and team-based education
“This study is really remarkable because it takes a holistic view of the issues facing community hospitals,” says Wilkinson modestly. “It addresses complex issues at the level of the individual, community, health authority, and province and it recognizes that there are no ‘one size fits all’ solutions to address the needs of rural EM providers. The report provides an accurate picture of the state of rural healthcare in British Columbia – it’s provided rural practitioners with the understanding that some of the challenges that they’re facing are not unique to them. However, it also provides a clear sense of what factors contribute to positive rural recruitment and retention. If we continue this work and implement the suggested recommendations, we can build and support a sustainable rural EM system within British Columbia.”
To download an executive summary or the full version of The Rural Emergency Medicine Needs Assessment Final Report, visit: http://ubccpd.ca/rural/research.