the Society of Rural Physicians of Canada
LA SOCIÉTÉ DE LA MÉDECINE RURALE DU CANADA


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The Society of Rural Physicians of Canada divides the country into 5 regions. The North/West Region includes the province of British Columbia and the 3 territories. If you wish to become involved please contact the regional committee.

•   British Columbia   •   Nunavut   •   Northwest Territories   •  Yukon  •  


Kyle Sue
North


Karen Forgie
Halfmoon Bay, British Columbia 

Kyle Sue works the full spectrum of general practice in the Kivalliq region of Nunavut. Other than rural/remote medicine, he has special interests/training in Developmental Disabilities, Pediatric Pain and Palliative Medicine.

Karen Forgie works full service family practice in Sechelt on the sunshine coast.  She is also involved with UBC as a Clinical Assistant Professor to her clinic's medical students and Residents, a board member of her Divisions of Family Practice and President-elect for the Society of General Practitioners.

British Columbia

British Columbia introduced the concept of restricted billing numbers to Canada in 1985 (Bill 50). Thrown out by the BC Supreme Court they tried again with Bill 41 which was also found to violate the Charter of Human Rights and Freedoms. Despite a mixed review of the effectiveness of the program by Barer in 1988, differential payments for new graduates were introduced in 1996. They too were eventually withdrawn in August 1997.

Rurality Based Incentives

Subsequent strategy is currently more dependent on carrots and has reduced the urban rural physician gap better than any other province (see numbers). The Northern and Isolation Allowance Committee of the BCMA and MSP has a fixed budget to draw upon to provide payment premiums to certain northern and isolated physicians. The physician is assessed according to the size of his/her community, distance to major referral centres, number of specialists and number of general practitioners. A minimum number of points on this scale is needed before a physician (or community) qualifies for NIA. Payment premiums used to range from 5 - 20 % on gross MSP billings, and as of April 1999 up to a 30% bonus. Those communities receiving NIA are also exempt from the daily volume limits imposed on all other physicians in the province for payment of office visits. In 2000 Prince Rupert pop 19,000 gets 17.5% bonus. Burns Lake pop 7,000 gets 21%. Williams Lake, pop 26,000 is not in the NIA.

This program has been criticized in that the incentive depends entirely on volume and does not apply to other less isolated places. Some accommodation has occurred in 2000 with the other northern and rural communities with "retention" payments that are not volume dependent but rather vary from town to town. By example Cranbrook would get $30,000 for GP retention, $37,000 for Specialist retention. Golden would get NIA at 13% of FFS and $15,000 for GP retention and $18,750 for specialist retention. The GP percentage lift on billings ranges from 5.15-30% and the annual retention flat fee from $5,100-$36,000.

The Rural Subsidiary Agreement took effect January 2003 with the $45.4M Geographic Incentive Premium replacing the NIA. 70% of the money is as percentage premiums on FFS, 30% is a lump sum monthly payments to docs living in rural communities. The amounts are determined by a scheme that is a modified NIA program which ranks all affected communities and then divides up the pot.  As this is a retention payment Locums are not eligible.

Locums

A Rural Locum Program (RLP) helps communities with up to 3 physicians with 1 to 4 week locums since 1995 and has been expanded in 2003 to communities up to 7 physicians. Current 2018           funding pays locum doctors a guaranteed daily rate of $900, plus up to $600 round trip travel, plus 100% of WCB, ICBC, and ER, plus on-call $2,450 (6 pm Friday to 8:00 am Monday) and $300/d for 24 hr emergency on call. The locum gets the rurality topup on FFS (varies by community but can be above 10%). The host MD provides accommodations and the car if needed. The Host MD is guaranteed 40% of office billings to cover overhead. Regional specialist locum support for core specialties has been funded in 2003 for a guaranteed daily rate of $1,000 plus fee-for-service earnings over the guaranteed amount. Specialists will also get on-call payments and a travel honorarium.

There are about 15 isolated places that have salaried physicians. Some of these are administered by native health boards and some by the United Church of Canada.

On Call

In 1998 a settlement on Northern on call payments had been recommended by the fact finder in the "Dobbin Report." This would involve benefits for communities with less than 10 doctors. The CME allotment would increase, and there would be more money for rural "seniority," a $20 per hour bonus on top of fee for service after hours, or a flat rate of $30/hr. A first in Canada, rural GP-surgery and GP-anaesthesia get a $5/hr bonus for being on call. The Dobbin report is available in the library as a review or in full text. In 1999 there appeared to be a bit of reluctance and inconsistency with application of funding to locums, with some being Dobbin funded and others (those on the Rural locum Program) not.

In 2000 a new rural deal was struck. In general it offers 5.5 million on top of the original 8 million obtained under Dobbin for on-call and top-up CME funding to make the rural package broader in scope. The smaller towns get $30/h plus FFS for ER, and the larger towns on NIA get $10/h. Weekday shifts for GP-anaesthesia or GP-Surgery get paid $70. Specialty surgeons in NIA areas get paid $140 per shift. Of course then they gave $10M to Prince George for an incentive plan just for that northern city which upset the apple cart somewhat.

In 2001 ER Call after hours topups are $30/h plus FFS (and $40/h on weekends) for 6 and under doc towns. 7-10 doc towns get $20/h topups for ER FFS and >10 doc towns get $10/h. GP Anaesthetists and GP Surgeons get $5/h plus FFS but can't double dip when they are on call for ER as well.

In 2003  most on call services have MOCAP (Medical On Call Availability Program), a contract to support coverage for their department 24/7.  Each group may determine how those payments are distributed. ie- an ER group may have $225,000/yr and they can decide to pay the night shift more than the day shift, or give it all to the night shifts.

Rural Education

The 2003 Rural education action plan provides $2.25 million towards training for rural doctors. Funding can be applied to education-related costs like income loss, overhead, tuition, travel expenses, accommodation and board. The program also funds undergraduate medical students gaining rural practice experience, focuses on rural doctors’ participation in medical school selection and curriculum development, and provides a first-year practice enhancement fund for new doctors and bursaries for residents willing to practice in a rural community after they graduate.

All doctors in BC get a $1800 annual CME allowance from the Doctors of BC and an additional annual amount of about $0-$5700 for rural GPs and $0-$7800 for rural specialists.  The amount of eligibility increases with the number of years in the community and is maximal in the most remote communities ($5,700 is for over 4 years in a community with over 20 isolation points). In the past receipts were required to be submitted for these monies but as of this year, both lots are paid directly to the physician annually.

Pay Scale

In BC an office visit is $31.32 based on 00100. The ER code is based on evening call-back codes 01200 + 13200 and is $98.44. A delivery is worth $577.54 Remote areas get a premium based on a point system as mentioned above.

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Nunavut

Nunavut has a population of 39,000, spanning 2 million square kilometres across 25 fly-in communities in 3 time-zones. Healthcare provision is overseen by the Department of Health in Iqaluit (the capital) but is split into 3 health regions: Qikiqtaaluk (Baffin/east), Kivalliq (central), and Kitikmeot (west). The population in Nunavut is primarily Inuit, with the exception of Iqaluit (60%).

Qikiqtaaluk region

The Qikiqtaaluk region has the territory’s only hospital—the 35-bed Qikiqtani General Hospital in Iqaluit. The hospital serves approximately 16,000 people in the Baffin region. It has a 24-hour ER, GP-obstetrics (low to moderate risk), midwifery, inpatient/hospitalist service, general surgery, colposcopy, pediatrics, tuberculosis specialists, and clinics. Various other specialists visit regularly from Ottawa.  QGH has a laboratory, inpatient pharmacy, x-ray, ultrasound, and a CT scanner (as of 2014). It has over 20 full-time physicians, in addition to senior family medicine residents from Memorial University of Newfoundland’s NunaFAM program (6 month rotations) and University of Ottawa (2 month rotations), and senior pediatric residents from University of Ottawa (1 month rotations).  Furthermore, QGH has allied rehabilitation professionals on site to serve both the community and inpatients.  Across the street from QGH is the Akausisarvik Mental Health Treatment Centre, which has visiting psychiatrists from Ottawa and provides regular counselling services. Public Health for Nunavut is also based in Iqaluit.

Other communities in the Qikiqtaaluk region include: Arctic Bay, Cape Dorset, Clyde River, Grise Fiord (northernmost civilian settlement in Canada, on Ellesmere Island), Hall Beach, Igloolik, Kimmirut, Pangnirtung, Pond Inlet, Qikiqtarjuaq (Broughton Island), and Resolute. These communities do not have a full-time physician living in the community. They do have visiting physicians, generally from the group at QGH, who visit for approximately a week at a time. When there is no physician in the community, the nurses in the health centres receive phone support by an on-call physician at QGH.

The main referral centre for this health region is Ottawa, if too complex to be managed in Iqaluit.

Kivalliq region

The Kivalliq region has no hospital, but the Rankin Inlet Health Centre does have a few inpatient beds with 24-hour nursing for uncomplicated or respite patients. Rankin Inlet has 2-3 full-time doctors who work on a consult basis. Nurses see patients first, and physicians are consulted as needed. Rankin Inlet has 1 physician working 24 hours for Emergency, with a second physician as backup. When not doing ER, physicians will be in clinic. The Rankin Inlet Health Centre has a laboratory (for many common labs), intermittent ultrasound service, x-ray, and a midwifery service for low-risk obstetrics for the entire Kivalliq region. It also has a regular schedule of visiting specialists.

Other communities include: Arviat, Baker Lake (geographic centre of Canada!), Chesterfield Inlet, Coral Harbour, Naujaat (Repulse Bay), Whale Cove, and Sanikiluaq (in Hudson Bay, off the coast of Quebec and Northern Ontario, the southernmost community in Nunavut).  Arviat has a population of approximately 3100 which has recently surpassed the population of Rankin Inlet, due to the high birthrate. For most weeks of the year, there is a solo physician in Arviat working together with the health centre nurses. Baker Lake has a solo physician working with the health centre nurses approximately 75% of the year. The other communities have visiting physicians approximately 1 week at a time, every 6-8 weeks. When there is no physician in the community, there is a regional on-call physician who assists the nurses by phone.

The main referral centre for this region is Winnipeg. However, given frequent bed shortages in Winnipeg, sometimes patients will have MedEvacs to hospitals in other cities, such as Thompson, Churchill, and Selkirk.

Rankin Inlet, Baker Lake, and Arviat have community pharmacies, but the other communities do not. In these communities, medications need to be flown in when prescribed.

Kitikmeot region

This is Nunavut’s least populous region, which also does not have a hospital. Cambridge Bay is the hub (has its own low-risk midwifery service), with the other communities being Gjoa Haven, Kugaaruk, Kugluktuk, and Taloyoak. All of these communities rely on visiting doctors (no full-time). On-call physicians are available by phone to assist the nurses when there is no doctor in the community.

The main referral centre for this region is Yellowknife. However, more complex patients will be sent further to Edmonton.

Billing

If working as a solo physician in a community, the rate is $1500/weekday plus after-hour callbacks ($150/hr). Weekends are $600/day plus all callbacks ($150/hr). Housing and travel is provided for locums. Some of the communities have a physician house for locums, others rely on hotel rooms. If staying in a hotel, food is provided. Travel days up to 3 days per locum period are paid at $600/day. Per diem expenses during travel are also paid as per government employee rates.  A medical license costs $200/year, which is not reimbursed. One must be eligible for FULL unrestricted licensure in other provinces in order to qualify for working in Nunavut. There are no provisional licenses here.

If working in a community with more than 1 doctor, the rate is $1200/day for clinics. Rankin Inlet pays $1500/24 hours to be on-call, with callbacks billed after 17:30 at $150/hour. Backup in Rankin Inlet pays $600/24 hours plus all callbacks at $150/hour. ER in Iqaluit pays $175/hour. OBS in Iqaluit pays $2500/24 hours. Hospitalist pays $1400/day. Anesthesia pays $2000/day. There is no fee-for-service pay structure.

There are no overhead expenses, beyond your medical license and CMPA.

If working full-time (220 days per year), the government will pay for moving expenses to/from Nunavut and they will subsidize rental housing. This would also qualify you for a Northern Allowance of $60-80,000 per year in addition to retention bonuses. They also pay for some CME every year, including travel. Keep in mind that taxes are also the lowest in the country.

If you are interested in working in Nunavut or have any questions, feel free to send questions to Kyle Sue (ksue@gov.nu.ca) and he will direct you to the appropriate person.

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Northwest Territories

In 2016, six health authorities were amalgamated into the Northwest Territories Health and Social Services Authority (NTHSSA). Previously, these were split into: Beaufort Delta, Sahtu, Dehcho, Fort Smith, Yellowknife, and Stanton Territorial Hospital (in Yellowknife). However, due to the Tlicho Self Government Agreement, Tlicho communities continue to be managed by the Tlicho Community Services Agency. The Hay River Health and Social Services Authority is in the interim also continuing its own operations until negotiations are completed to bring them within the NTHSSA. A medical license costs $200/year. In order to qualify for a license, one must be eligible for a full unrestricted license in another Canadian jurisdiction (no provisional licenses available).

Beaufort Delta

The Beaufort Delta is centred around its hospital in Inuvik. The Inuvik Regional Hospital is the only hospital in Canada above the Arctic Circle. This region serves the communities of Inuvik, Aklavik, Fort McPherson, Tsiigehtchic, Tuktoyaktuk, Paulatuk, Ulukhaktok, and Sachs Harbour. The 51-bed Inuvik Regional Hospital has 24-hour ER, inpatients, long-term care, rehabilitation, GP-obstetrics, GP-surgery/visiting surgeons, ultrasound, x-ray, laboratory, family medicine clinics, and visiting specialist clinics. The referral centres for this region are Yellowknife and Edmonton for more complex cases.

All physicians in this region live in Inuvik, and they make regular community visits to the outlying communities.

Sahtu

This region has over 2600 residents from the communities of Norman Wells, Fort Good Hope, Tulita, Deline, and Colville Lake. The Sahtu Got’ine Regional Health and Social Services Centre is in Norman Wells. This centre has a physician, nurses, a mental health and addictions counselor, social workers, home support workers, and visiting specialists (psychiatry, OT, SLP, PT, nutrition, optometry), x-rays, and a laboratory.

Dehcho

This region has over 3400 residents spread over 8 communities: Fort Liard, Nahanni Butte, Wrigley, Jean Marie River, Fort Providence, Fort Simpson, Kakisa, and Trout Lake.

Fort Simpson has a laboratory, x-ray, midwifery, 2 ER beds and 5 clinic rooms. Maximum patient observation is 6 hours before requiring a MedEvac transfer. The referral centres for this region are Yellowknife and Edmonton for more complex cases. This region is allocated 2-3 physicians, which is currently covered by locums. The physicians share call duties, and board a Cessna 206 (small chartered airplane) to provide primary health services to several communities on a monthly basis. A physician would only be in Wrigley, Trout Lake, Jean Marie River and Nahanni Butte for a day or two each month. The physician would charter to Fort Liard and Fort Providence for 4-5 days depending on the demand for health service. In each of the communities, there is accommodation available for the physician to overnight, if needed.

Fort Smith

This region serves 2400 residents in Fort Smith, Fort Resolution, as well as the Northern Alberta communities of Thebacha N’ere (Bordertown), Fort Fitzgerald, and Peace Point. The hospital in Fort Smith has a 24-hour ER, clinics, birthing rooms (serviced by midwives), hemodialysis, x-ray, and laboratory. There are 4 physicians covering this region. Acute patients are stabilized and transferred to Yellowknife or to Edmonton if more complex.

Yellowknife / Stanton

The Yellowknife region has over 20,000 residents in the communities of Dettah, Fort Resolution, Lutsel K’e, NDilo, and Yellowknife.

Stanton Territorial Hospital offers a full spectrum of health care services for patients throughout NWT and the Kitikmeot region of Nunavut. It has a 24-hour ER, 20 bed Medicine Unit, 10 bed Pediatrics Unit, 10 bed Psychiatry Unit, 12 bed Extended Care Unit, 13 bed Obstetrics Unit, 4 bed Intensive Care Unit, 4 chair dialysis unit, and 10 bed Surgery Unit. There are several permanent specialist services (pediatrics, obstetrics/gynecology, internal medicine, general surgery, anesthesiology, orthopedics, ophthalmology, psychiatry, ENT, radiology) and 11 visiting ones. Diagnostic imaging services include CT, x-ray, ultrasound, and fluoroscopy. The referral centre for more complex cases is Edmonton.

The new Stanton Territorial Hospital is currently being built. Due to the high costs of this hospital, the building of new health centres in some communities have been delayed.

Tlicho

Tlicho covers communities of Behchoko, Whati, Gameti, and Wekweeti. There is no hospital in this region, only community health centres staffed by nurses. The referral centre is Yellowknife or Edmonton for more complex patients.

Hay River

Healthcare in Hay River is split between the H.H. Williams Memorial Hospital and the Hay River Regional Health Centre. At the 19 bed Health Centre, there is an ER, inpatient beds (adult and pediatric, palliative care, respite care, perioperative care, recovery room), x-ray, ultrasound, hemodialysis, laboratory, clinics, midwifery, rehabilitation, and visiting specialists. Homecare, social services, and long-term care are at the H.H. Williams Memorial Hospital.

This region serves Hay River’s 3600 inhabitants and Enterprise’s 100 inhabitants. The referral centre is Yellowknife or Edmonton for more complex patients.

Billing

Most communities pay sessional rates (e.g. $1300/day plus on-call at $158/hr in Hay River), but fee-for-service also exists, particularly in Yellowknife. Current FFS rates are available here: https://www.hss.gov.nt.ca/sites/hss/files/resources/insured-services-tariff.pdf

Each region manages its locums separately. Contact NWTphysicians@gov.nt.ca for more information (or  HRHSSA_Physician-Recruitment@gov.nt.ca for Hay River).

For full-time work, there are recruitment/retention bonuses, moving assistance, and a northern allowance. More details available at: http://www.practicenorth.ca/

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Yukon

There are hospitals in Whitehorse (54 beds), Dawson City (6 beds), and Watson Lake (6 beds). Whitehorse has 50 GP’s and 7 Specialists. Watson Lake has 2 GP’s. Dawson City has 3 GP’s. Mayo also has a physician. Other communities (Carcross, Teslin, Carmacks, Pelly Crossing, Destruction Bay, Haines Junction, Beaver Creek, Faro, Ross River, Old Crow) rely on Community Health Centres, with care mainly delivered by community health nurses and visiting physicians. Details on services available at each Community Health Centre are available here: http://www.ykhealthguide.org/community/community_centres/.

Whitehorse is the main referral centre for the other communities, and Vancouver for more complex cases. Resident specialist services in Whitehorse include General Surgery, Obstetrics/Gynecology, and Psychiatry.

A medical license costs $200/year, which is reimbursed fully.

Billing

For locum opportunities, please see: http://www.yukonmd.ca/locum.php

To learn about working in the Yukon, please see: http://www.yukonmd.ca

Fee-for-service pay schedule available here: http://www.hss.gov.yk.ca/paymentschedule.php

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