Briefing Note: Strategic Priorities for the Next Federal Election

Enhancing Canada’s Rural Health Workforce Through Effective Health Human Resource Planning and a National Rural Health Workforce Strategy

Access to health care in rural communities

The crisis in rural health services is real and growing. The shortage of physicians in rural areas is having a significant impact on rural, remote, and Indigenous communities, affecting health outcomes across the lifespan. Rural physicians have a diverse set of skills, providing primary care, working in the office, hospital wards, birthing units, emergency departments, operating rooms, and long-term care facilities, among others. Barriers that patients in rural, remote, and Indigenous communities face when trying to access basic emergency services have dramatically worsened over the past 2 years, with Ontario alone reporting 868 emergency room (ER) closures in rural communities in 2023. Each week in 2024, ER closures have been reported in jurisdictions across the country. Even when the ER remains physically open, some have been forced to shift to virtual physician access only – a situation that the Canadian Association of Emergency Physicians (CAEP) has declared inadequate, and one that would never be acceptable in an urban centre. In addition to these effects, the shortage of rural physicians also has a negative impact on the availability of obstetrical and surgical services, forcing women from rural, remote, and Indigenous communities to leave their homes and families to give birth.

Despite calls from rural physicians and the communities they serve, a comprehensive health human resource (HHR) plan for Canada has not been developed. A national rural health care strategy that supports rural physicians and the teams with whom they work is urgently required so they can continue to practise medicine, enhance access to primary care, teach the next generation of health care providers, and contribute to the economic vibrancy of rural, remote, and Indigenous communities over the long term. Any plan must ensure that rural physicians have adequate time to participate in continuing professional development and maintain a healthy work-life balance so they are able to remain in communities long-term.

While rural, remote, and Indigenous communities are most directly affected by this crisis, the failure of health systems in all rural settings will continue to worsen the emerging crisis in urban settings as patients from rural, remote, and Indigenous communities will increasingly seek care in urban ERs. Urban hospitals expect rural healthcare facilities to provide care locally and minimize transfers in to the urban centre, to optimize capacity and system effectiveness. Health services in rural, remote, and Indigenous communities matter to urban health systems.

Indigenous communities are often served by rural physicians for primary, emergency, and hospital based care. Canada has an obligation to ensure culturally safe, reliable health systems and skilled health providers for these communities, as part of its commitment to respond to the calls to action of the Truth and Reconciliation Commission. A national health workforce strategy must recognize the inherent need to support specific populations, including First Nations, Inuit, and Métis communities, as well as Canada’s rural francophone population who rely on small rural health systems for their care. 

A component of delivering optimum health care is ensuring that physicians practising in rural, remote, and Indigenous health care settings can access advanced skills training, enabling them to address areas of need and provide optimum health care to populations in their communities.

Due to the rapid erosion of the health care services on which Canadians in rural, remote, and Indigenous communities rely, there is limited time to stabilize, support, and re-build rural health services before they become irrecoverable in some settings.

SRPC calls on all parties to commit to immediate implementation of the following:


Short term solutions (up to 1 year):

  1. Ensure that federal transfer payments include provincial commitments for:
    1. Recruitment and retention supports: Fund rural, remote, and Indigenous community initiatives to welcome and support newcomers and assist them in adapting to their new home, as well as to address the retention of the internationally trained health workforce and encourage them to stay in these communities and appreciate the benefits of living and working in them.
    2. Education: Strengthen rural, remote, and Indigenous community-based physicians’ education at the level of medical schools, and other health disciplines, in order to support future workforce development for rural, remote, and Indigenous communities.
    3. Pathways to licensure: Ensure pathways to licensure for internationally trained physicians, and other internationally trained health care professionals, in all jurisdictions.
  2. Build on the success of the National Advanced Skills and Training Program pilot:  Create a 5-year program with a $25 million federal investment, providing $5 million each year for the delivery and evaluation of the National Advanced Skills and Training Program for Rural Practice, to support the sustainability of rural and remote health care teams and the ongoing training requirements for rural physicians to obtain necessary skills as identified by their communities. Continued funding to ensure the sustainability of this program after 5 years would benefit rural physicians as well as other members of healthcare teams in rural, remote, and Indigenous communities. A formative evaluation prior to the end of the 5 years will support the need for the continuation of the program. 
    1. In its first year, with an investment of $7.4 million, the pilot program enabled 342 providers to develop skills for 187 communities, with at least 60 of those being Indigenous communities. 
    2. This investment has ensured that patients can receive care locally and without the costs of travel out of their community for care, resulting in cost savings to the health system as well.
  3. Implement Pan-Canadian licensure: Work with all physician regulatory bodies to implement Pan-Canadian licensure for all regulated health care providers, including physicians, to enable inter-jurisdiction mobility.
  4. Federal tax incentives: Ensure that the levers of federal funding as tools of recruitment and retention are optimized through:
    1. Expansion of federal loan forgiveness strategies beyond physicians and nurses to include other members of health care teams in rural, remote, and Indigenous communities, including paramedics, laboratory and imaging technologists and technicians, social workers, and others.
    2. Creation of a federal tax incentive for all health care providers living and working in rural areas to support recruitment and retention.

The SRPC also calls on all parties to commit to the following medium-term strategies (within the next 3 years):

  1. The development and implementation of a health workforce strategy specific to rural, remote, and Indigenous communities, and aligned with and supported by the new Health Workforce Canada agency.
  2. The creation of an agency, led by a national rural health commissioner with the mandate to liaise with other agencies of governments and to address health workforce and health systems issues in rural, remote, and Indigenous communities, including the need for a robust locum workforce to address physician shortages and closures of emergency departments and services in obstetrics, surgery, and anaesthesia.
  3. Create a fund to enable innovation in rural, remote, and Indigenous communities with technology (e.g., AI, robotics, virtual care, et cetera) to support rural workforce and rural health services delivery.

Summary: Currently, Canadians living in rural, remote, and Indigenous communities do not have equitable access to health care services. There is no national, provincial, or territorial rural health care strategy to ensure that the needs of rural, remote, and Indigenous populations are supported and met. While there are gaps in knowledge about effective health workforce recruitment and retention strategies for rural, remote, and Indigenous communities, there is much that is known and must be implemented immediately.

Engagement is needed through a set of federally, provincially, and regionally supported networks that would encourage collaboration across Canada among rural physicians, policymakers, federal, provincial, and territorial leaders, and rural, remote, and Indigenous communities. It is important for policymakers to recognize that aligning rural medical education with rural physician workforce planning can successfully influence the development of a rural physician workforce pipeline and the longer‐term retention of physicians in rural, remote, and Indigenous communities. Aligning rural medical education will require immediate and enduring effort to sustain the current rural physician workforce, which is also the clinical teaching workforce required to ensure the future workforce is trained and can be recruited.

Release: January 2025

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