Some measure of the politics of the rural medical economics of the region are listed below. If you wish to become involved please contact the regional committee chair listed here.
The New Brunswick government has tied billing numbers to hospital privileges in 1992. While this theoretically distributes physicians into rural areas, billing number restrictions generally have not been found constitutional nor effective means to distribute physicians in Canada. The New Brunswick experience in this exemplifies the point. Urban physician growth has exceeded rural growth since 1994, and the gap between urban and rural doctor to population ratios is only exceeded by Saskatchewan. There are over 50 unfilled physician vacancies since 1999 and the province is short 300 doctors of the national average per capita. A constitutional challenge by the maritime residents union (PARI-MP) was defeated in 2000.
Despite 2 weeks of vacation pay (supply your own locum) after 3 years' service, rural work has not been made more attractive than in the city. Vacation pay is 3.8% of last years earnings at 3 years and 5.7% at 5 years of rural tenure. $25,000 for FP grads and $40,000 to specialists who return of service for 5 years in hard to recruit areas as of 1999 (up from $10,000 for moving expenses to under serviced areas.) There is a $175,000 first year guarantee for full time family practice for designated areas. Re-entry training is paid at 50% of last years gross. On call fees have become available in 1999 for general surgeons and anaesthetists. A pay raise of 16% was won in 2001 raising ED work to $100/hr in the country (up from $80). In 2003 it has increased again to $111.80.
200 of the provinces 1200 doctors are on salary (1999).
A recruitment program started about 1995 but not every area of need has got onto the list. The primary carrot is 5yr incentive contracts guaranteeing $173K min. gross FFS billings plus $10K/yr. retention bonus plus $5K moving expenses. For really small towns there is a Rural Stabilization Fund in designated areas without a hospital of $23.7K/yr. for doing call. Locum coverage ($1M/yr), CME assistance and spousal employment support are also part of the package.
Fees in December 2001 went up. Fees for office visits go up from $21.24 to $25.68 by April 1, 2003. There is a premium for patients 65 and older.
In Hospital sessional fees for covering ER start at $59/hr for very low volume ERs (less than 13,000 visits/yr.) Larger volume ER's get higher salaries maxing out at about $78/hr. Regional and Halifax hospitals are paid at $125/h. Some adjustment has occurred to ER funding in 2000 with adoption of a Mitchell funding scheme based on ER triage codes and volume. This gets plugged into a formula and this determines how many physicians are funded for the ER expressed in person hours per day.
In 2001 Nova Scotia has announced that they will pay $15,000 a year for three years to help a new graduate pay off his or her student debt if they work in a designated area of the province short of physicians. This bursary program only applies to graduates of Dalhousie or Memorial or a Nova Scotian from any Canadian university. There will be five such positions a year.
Metro areas no longer have restricted billing numbers.
Rentry training is now available for 12 specialty spots with 2 year return to service. No extended rural skills training is available.
Prince Edward Island
A new recruitment plan applies since February 2000. It includes funding for 12 family practice and specialist training rotations from Dal, 9 new medical school seats (2 in Memorial, 6 at Dal and 1 in Québec) for PEI residents, medical trainee sponsorships (starting at $15,000 pa at second year medicine), student loan assistance ($3,000 for 4 week locum commitment), location grants, relocation cost assistance ($20,000), locum support, continuing medical education, hiring a recruitment officer, enhancing recruitment resources, and incentives to attract international medical graduates. Retraining is paid at resident salary rates plus an additional $20,000 to $25,000 per annum. All incentives come with return to service commitments. A 16.5% pay increase won in mid 2001 has been implemented over 3 years. A salary option exists for specialists with paid overhead, vacation time, cme and government benefits.
Newfoundland & Labrador
Educational initiatives include the MedQuest program that exposes high school students to the medical school and Lab Quest to Labrador students to health care careers. Memorial University provides preferential scoring for students who did schooling in rural communities.
4th year Memorial University medical students and family medicine residents can apply for bursaries of $25,000 per year in return for equivalent years in return of service. The return of service is to the province and not necessarily to a rural community.
There is a 20% bonus on fee for service work in rural hospitals. Salaried physicians have a retention bonus since 2000 with varying amounts depending on GP or other specialties, duration of service and rurality. For GP's in 2006 it ranges from $2,500 for Category 3 rural after a year to $30,000 for Category 1 Rural after 3 years service. Specialists in the same communities would get $4,000 to $36,000 respectively.
Things have improved since an agreement in 2003 that nominally has the province at 95% of Atlantic parity in 2006. Contact the NLMA for evolving details: Tamie Walsh, Assistant, Health Policy & Economics at