It's heating up out there.....

Just like the weather, rural politics are bound to heat up nationally this next week.  The Society of Rural Physicians of Canada (SRPC) and the Canadian College of Family Practice (CFPC) have been at logger heads forever it seems when it comes to training for rural communities.  The SRPC is very close to calling for a separate rural college like what happened in Australia when rural split from the national college there.

The issue is that urban training programs have “evolved” over the past twenty years… some would say “devolved”.  When I graduated, ahem a while ago, urban had procedural based family docs that were in the hospital and did a lot of obstetrics and ER.  But, specialists and the public over time have had a larger say and specialists are valued more in our society. The generalists (family, gen surg, GIM) were pushed out of the major city hospitals.  It almost happened in Lethbridge as well!  The argument now is that, with rare exceptions,  urban trained family docs are simply not prepared emotionally or procedurally for rural practice and the breadth of scope and relationship based care situated in a consistent offering of services spanning the week.

Many attempts have been made to remedy the mal-distribution of career choice and practice location in the past.  We could argue that the southern rural program in Lethbridge and Medicine Hat are great successes; but, what of the north or other more remote areas tho?

The meeting in Ottawa that Dr. M Topps and I are attending next week is framed as a “Rural Education Summit”. Many on the rural side believe it is the last chance to stop a split between the SRPC and the CFPC. I have had the chance for input over the last six months and have been consistent and clear that there must be practical, actionable steps to take after this meeting that have accountabilities.  The time for talk is over; we have studied this enough and we must take action. Unfortunately, that means someone will perceive a loss; in this case, it is likely the urban programs.  In a fixed budget world, someone has to give up something to move forward and respond with new actions to existing issues.

Personally, I don’t think anything will change as the CFPC and urban post grad programs hold all the money.  Until the federal, or maybe one of the provinces, has the courage to mandate a fixed slice of the training fiscal pie to an office solely with a rural focus, in addition to other measures such as mandated intake from non-urban based applicants or fixed billing numbers, the status quo will be preserved.  The idea of the trickle-down effect, in other words, admit enough people to medicine and rural will be served, is an obvious failure.