For your health

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Meyronne, Sask. doesn’t have the same services it once did. Photo by Matthew Olson. 
The people who live in isolated communities around Saskatchewan might be staying put for nostalgia or a sense of responsibility, but they could be risking their own health by doing so.

Saskatchewan has a history of being unable to draw doctors to rural communities. It’s a trend seen Canada-wide: a report published in 2005 by the Canadian Institute for Health Information indicates that less than 16 per cent of family doctors lived in rural areas, as defined by Statistics Canada.

The numbers are worse for specialized doctors, with only 2.4 per cent of specialists located in rural areas.

“I think Saskatchewan faces a unique challenge,” health-care policy consultant Steven Lewis said. “Our rural areas don’t have very big towns. And as the demographics have shown for decades, most of them are dying.”

The doctor deficit in Saskatchewan has not gone unnoticed by the government. The provincial government created the Physician Recruitment Agency of Saskatchewan, also called Saskdocs, to “help find the right physician for the right community.” The agency helps set up doctors in urban and rural areas in the province, but its biggest benefit is helping connect trained physicians with job openings in rural areas.

The government also started the Rural Physician Incentive Program to entice doctors to come work in small-town Saskatchewan. The program provides “retention incentive” payouts to any doctors practicing in communities with a population of less than 10,000, with few specific exceptions. The program payouts increase at the end of each of the four eligible years of the program.

“Our rural areas don’t have very big towns. And as the demographics have shown for decades, most of them are dying.”
- Steven Lewis,

health-care policy consultant

The playground in the dwindling town of Meyronne. Photo by Matthew Olson. 
According to an emailed statement from the Saskatchewan Ministry of Health, Saskdocs has helped recruit almost 900 physicians to Saskatchewan since its inception in 2010. It’s one of the most accessible incentive programs provided by the provincial government to lure doctors to rural communities.

Saskatchewan Association of Rural Municipalities president Jay Meyer and Lewis both said that despite the successes of programs like Saskdocs, it don’t mean the problem is solved. Physicians are still densely packed in cities, he added, and recruiting doctors to rural Saskatchewan isn’t getting easier.

“Very few highly trained, highly paid professionals choose to relocate to small towns like Saskatchewan has,” Lewis said. “These aren’t places with four and five thousand, which have some infrastructure.”

“Most of our communities are much, much smaller, and very few people in any occupation choose to live there.”

A 2014 report from the Canadian Institute for Health Information said 79.9 per cent of people in Saskatchewan say they have a regular doctor. It’s below the national average of 85.1 per cent, and the second-lowest of any province.

Saskatchewan Medical Association president Joanne Sivertson said while the numbers have improved “dramatically,” only about 25 per cent of trained doctors are working outside the major centres of Saskatoon and Regina.

“Despite the fact that we have a very improved physician workforce, we’re still not seeing the distribution in the way it would best serve the rural or remote communities,” she said.

Sivertson noted that “the farther you are from care, the poorer the outcomes tend to be” for medical services. She said getting doctors out to rural communities isn’t as easy as monetary incentive. Families of doctors are affected by relocations as well.

“The farther you are from care, the poorer the outcomes tend to be.”
- Dr. Joanne Sivertson,

President, Saskatchewan Medical Association

Saskatchewan has undergone recent changes to the health-care system that will impact how health care is rolled out across the province. In December 2017, Saskatchewan officially amalgamated its 12 regional health authorities into the single Saskatchewan Health Authority, a move the Ministry of Health estimated would save the province $10-20 million a year.

Sivertson said the SMA wanted to make sure that not everything became centralized with the switch to a single health region.

“We wanted to assure that they were extremely careful and cognizant as they were designing the new system … we’ve gone to a single health region but there is the awareness of the different issues that face the different areas of the province,” she said.

At the introductory press conference for the new health authority, CEO Scott Livingstone said “it’s not going to be easy” to provide the exact same level of health care across the province. He also said the focus on doctor recruitment for the heavily rural southeastern and northern parts of the province has not changed and the Saskatchewan Physician Recruitment Agency’s work would continue.

“In a provincial organization where we have challenges regionally … to be able draw on the resources across a $3.8 billion organization instead of just asking your partner organizations if they can help out, would be a significant improvement,” Livingstone said.

While other provinces like Alberta have made a conversion to a single overarching health authority to save money and centralize administration, Lewis said this is not necessarily the best move to help rural communities get better access to doctors.

Lewis suggested that the government implement a “geographic quota” system where the provincial government regulates where doctors can set up practices based on the number of doctors and the population of a given area.

“The math just doesn’t add up anymore. It may be possible for the government to negotiate with the medical association more of a geographic approach to doing this, and holding the line on how many new practices would be supported in the city,” Lewis said, adding that there is precedent for this style of system in Quebec and New Brunswick.

For the time being, it can be difficult to get to a doctor or access emergency services if you live in an isolated rural Saskatchewan community. Lewis stressed that with helicopter emergency response services available, most of rural Saskatchewan is at least accessible for medical services. He noted that if urban centres continue to be over-saturated with doctors, the situation for medical care in rural Saskatchewan may improve as more doctors will need to leave cities to find work.

But with additional hospitals simply not “feasible,” Lewis said communities have to learn to pool their doctors together – as Jay Meyer suggested with other services – and accept the possible hazards of living in a rural community.

“Are you at added risk living in a rural area if you have a serious incident that’s time-dependent, like a stroke or a heart attack? Probably,” Lewis said. “It is the price you pay … that’s just life.”

Chapter 2: The museum in a wheat field

Chapter 4: Banding together

“It is the price you pay … that’s just life.”