The Society of Rural Physicians of Canada divides the country into 5 regions. The Central Region includes the provinces of Manitoba, Saskatchewan and Alberta. Some measure of the politics of the rural medical economics of the region are listed here. If you wish to become involved please contact the regional committee chair listed here.
The Rural Physician Action Program has been operating since 1991 to deal with the rural medical problems. It has developed a comprehensive and integrated set of initiatives for rural medical education, recruitment and retention. It offers
- With the aim of encouraging medical students and residents to consider rural practice, the RPAP provides a variety of initiatives, funding and support to raise their awareness, improve their preparedness and to increase their exposure to rural medicine. Initiatives include: RPAP's weekend shadowing experiences, RPAP's summer student experience program, rural medical interest groups (RMIGs) at both universities, the core Family Medicine clerkship rotation, rural and regional electives in the general specialties and Family Medicine, a rural-based Family Medicine residency program, the Alberta Rural Family Medicine Network, and a series of financial supports including a $5,000 award and a full tuition bursary program. RPAP also provides a matching Bonus of up to $10,000 which applies to Alberta graduates only. RPAP pays up to $10,000 matching what regions are willing to contribute.
- Recruitment and retention grants of up to $10,000 are available for innovative program ideas to promote recruitment and retention rural physicians and project ideas for physician recruitment and retention targeted at the local level.
- Recruitment Reimbursement Program. This program provides up to $3,000 towards the cost of recruitment for recent Alberta graduates or physicians from outside Alberta. The program also provides funding for physicians (and their preceptor) who need an assessment as a condition of getting a license.
- Physician Locum Services (formerly the Rural Locum Program) was initiated in early 1992 through the RPAP to provide a short term locum service to rural physicians practising in communities with four or fewer physicians. It was expanded to provide weekend relief to ensure that weekend call for participating physicians was no greater than 1 in 4, and a seniors' enhancement.. These initiatives are administered by the Alberta Medical Association on behalf of the RPAP and the Province's Trilateral Agreement.
- CME program. Aided by RPAP funding, the Continuing Medical Education/Continuous Professional Learning offices at both Alberta universities, work with rural physicians to provide high quality CME/CPL to meet the needs of rural Alberta. Programming at the two universities differ in content. However, each university provides regional conferencing and video-teleconferencing sessions on a regular basis.
- Enrichment Program. Two physician "skills brokers" help organize training requests for rural doctors. The time frame of training is between 2 weeks and 1year. Paid pro rata at $76,000 per year.
- Eighteen (18) Additional Skills Training PGY3 positions are available between the UofA and UofC through the RPAP in such areas as anaesthesia, surgery, obstetrics, GI Medicine, and palliative care. The type of training taken will depend on the resident's interests and the needs of the rural community he/she will be practicing in. A return in service commitment is required. The curricula used are similar to the training papers in the library. " Rural Physician Spousal and Family programming. RPAP offers a range of activities throughout the year, such as: local get-togethers such as luncheons, guest-speaker events or other social activities; and events at medical conferences, to give accompanying spouses (and often, children) a chance to meet their counterparts from across the province.
- Virtual Library. The Virtual Library provides free access to Internet-based medical textbooks, journals and other resources for rural physicians in Alberta.
- Rural On-Call Remuneration Program. As of 200 Rural Alberta physicians have been given a $21 per hour top up of after hours FFS for being on call in ER (under 25,000 visits). Further details are on the regional shelf of the library.
- High School Outreach Program and Physician Recruitment Website. RPAP has an active high school outreach program to encourage rural origin students to think about careers as rural physicians. It also offers www.RuralPhysicianLink.ab.ca as the "one-stop" provincial recruitment web site for rural physicians to Alberta.
The Alberta section of our Medical Links is required surfing for those who want all the details of the rural political scene in Alberta. For those who want more details about the RPAP check out The Rural Physician Action Plan referenced on our links page.
Saskatchewan has an extensive list of rural health initiatives/programs.
- The Northern Medical Services were developed in 1984 as a tripartite co-operation of Sask Health, UofS Dept FM and Medical Services Branch of Health Canada. It serves Northern Saskatchewan based in Uranium City, Ile a la Crosse and La Ronge. The format is of salaried multidisciplinary teams. Physicians are paid $121K - $140K starting plus benefits including subsidized housing.
- Locum program for relief in rural communities with 3 or fewer physicians. There is also a weekend relief locum program at $1,500 for 5PM Fri. to 8 AM Monday. The Travel Assistance Program (TAP) covers the travel costs of rural physicians travelling to other rural sites to assist their colleagues in maintaining coverage.
- Rural Practice Establishment Grant as of April 1997. $18K grant for Canadian grads moving to Saskatchewan and establishing practice in an eligible community for a minimum of 18 months. Eligible communities are under 10,000 pop. (This replaces the 1979 Medical Practice Establishment Grant Program)
- Rural Physician Enhancement Training Program. (1995) Rural Saskatchewan physicians can get retraining for return of service guarantee (2 years). Eligible training includes up to 1 year of obstetrics (incl. C/S training), anaesthesia, general surgery, psychiatry, ER or geriatrics. There are only 2 slots available but they pay $80K for re-entry physicians. 2 additional R3 slots at $40K for FM residents with return of service guarantee are available.
- Undergraduate Medical Student Bursary Program as of 1991. Currently 15 bursaries available at $18,000 with year for year return of service. Upon graduation you can buy out but you have to pay accumulated interest. Retention rate is 71%
- Medical Resident Bursary Program. Another 4 bursaries at $18,000 for a 1 year commitment to rural Sask.
- Summer Extern A week long rural rotation for Medical students between their third and fourth year funded by the Saskatchewan Medical Association.
- Rural Extended leave program for educational costs and foregone income up to 6 weeks. Return service contract of 1 month per week of leave.
- Emergency On-Call Coverage Program as of Jan 7, 1998. Communities that support 2 or more physicians with sufficient volume will get a bonus of $10 an hour weeknights and $25 an hour weekends top up to the regular FFS schedule. MD's in lower volume towns will be paid a stipend of $5000 a qrt for covering ER. Currently this program costs $5.5 million for ER coverage in 75 communities and 410 GP's outside of Regina and Saskatoon.
- Active recruitment overseas is done. These doctors get a 3 year provisional licenses (Section 29 of the Medical Profession Act) or a 5 yr. conditional license (under section 31). The license is valid for underserviced areas only.
In 1979 a Standing Committee on Medical Manpower was established with a number of initiatives. These have been expanded and in late 2000, managed through a Rural Physician Action Plan. It's clear goal is to increase the number of graduating physicians and other health professionals who choose to practice and live in rural and northern Manitoba. Part of this plan was the creation of Manitoba’s Office of Rural and Northern Health (ORNH). ORNH focuses on the creation of programming and initiatives that increase the profile of rural health care opportunities among rural and northern Manitoba secondary school students and students training in health care programs in Manitoba. In addition, the ORNH is responsible for a variety of programs that deal with issues of long-term recruitment and retention of existing rural and northern Manitoba health care practitioners.
The initiatives in rural medicine start in the first and second years of the undergraduate program. At the end of first year, all students participate in a one week rural/northern placement called Rural Week. This was initiated in 2003 and has been a mandatory part of the curriculum since the following academic year. In addition, (up to 14) first and second year med students are eligible to apply for a 10 week rural summer placement. This is a paid educational/clinical work experience. All clinical clerks do their (5 week) FM rotation in a rural/northern site and third and fourth year students have the option of doing other electives and selectives in rural locations.
Manitoba has both a rural and an urban family medicine residency program. The rural program has residents completing their first year training in Winnipeg with the second year being done in the rural communities of Dauphin, Ste. Rose du Lac and Brandon. FM residents in the urban programs are required to do a 2 month rural rotation during their 2nd year. There are no urban disincentives.
The Province of Manitoba has a number of return of service options. Third and fourth year medical students are eligible for a $15K (per year) forgivable loan in exchange for return of service. If the program is accessed in third year the return of service is to rural Manitoba and if it is accessed in fourth year the return of service is to anywhere in Manitoba. Residents in the Family Medicine program can access one more year of return of service in the amount of $20K. Rural and northern RHAs and a number of communities, health foundations and clinics are also providing (similar) return of service options to medical students in addition to those available through the provincial program.
Rural candidate re-entry positions are being funded in a variety of areas for those that wish to do additional training. A General Practice Anesthesia Training Program through the Department of Anesthesia trains primary care physicians to provide GP/anesthesia services. Programs are also available in ER training and obstetrics/gynecology. In 2006 a $50K grant was created for those practicing physicians that are accepted into a re-entry program and agree to practice in a rural community after they complete the training..
The Manitoba Locums Tenens Program (MLTP) is a joint initiative of the Manitoba Government (through the ORNH) and the University of Manitoba’s Northern Medical Unit. The program provides rural health care facilities with a suitably approved physician for requested periods of time. Locum Tenens coverage is provided in rural communities of four physicians or less. A locum tenens program that pays 643$ per day exists ($698 in locations North of 53deg 0'lat). The Northern Medical Unit (1996) assists really small towns with salaried doctors at $150K with no overhead.
In 1995 a Conditional Register was developed by the CPSM to allow IMG physicians not meeting the regular licensing requirements to a restricted practice in underserviced areas (by ministerial designation). There is provision for conversion to regular licensure. The requirements for being placed on the conditional register have just (2006) been modified to include a 3 month assessment period for IMGs. In 2001 Manitoba’s Medical Licensure Program for International Medical Graduates (MLPIMG) was established which offers a 12 month training period in exchange for a return of service in a rural/northern area. MLPIMG helps licence up to 15 IMGs annually.
In the summer of 1997 a sessional funding model had been developed for remunerating emergency room practice. ‘General’ rural hospitals (the larger hospitals) have on site coverage, 24 hours per day and are remunerated on an hourly basis. Physicians in hospital emergency rooms with fewer than 5,000 visits ("B" level) are paid a per diem for 24h weekday coverage and at another rate for day weekend and holiday coverage. Billings for obstetrics, surgery, and anesthesia are additional, as is a 4 hour clinic that can be run concurrently. In hospitals with under 10,000 visits ("A" level) the rates are somewhat higher.
A differential rural and northern fee schedule applies. There is no ‘add-on’ for Winnipeg, 2.5% for Brandon, 5% south of the 53rd parallel, and 10% for north of the 53rd.
Manitoba added training positions for medical students and residency positions to be phased in starting in 2001, restoring enrolment to from 75 to 85, as existed before the 1994 cutbacks; then by 2006 first year enrolment has increased to 100. The ratio of first year medical students to population will be 1:11,000 above the current Canadian average.
Nine of the Univ. of Manitoba FM residency positions are rural, with a base in Dauphin. Medical schools admissions policy is currently under review; one of the goals is to make changes reflecting the AFMC emphasis on ‘social accountability’.
All practicing Manitoba physicians get up to a $2,600 (in 2006) allowance for CME.
Grants for setting up rural practice in Manitoba in 2006 will be $25,000 for four years. To be eligible for the grant, candidates must be Canadian trained family physicians who have originated from Manitoba and who are eligible for full registration with the College of Physicians and Surgeons of Manitoba. Candidates must also sign a return of service agreement and return one year of service in a rural community for each year of financial support.