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CBC (June 11) Rural healthcare advocates say new rules will hurt attracting doctors to small Ontario

Rural healthcare advocates say new rules will hurt attracting doctors to small Ontario towns

A national organization that advocates for doctors who practise in rural communities says new rules in Ontario will make it harder to attract young emergency room doctors to small centres.

The College of Physicians and Surgeons of Ontario brought in regulations earlier this year that stipulate family doctors practising in an urban hospital need up to an extra year of clinical supervision to work in the emergency department of a facility in a rural community.

That change is part of new rules surrounding physicians changing their scope of practice.

The extra hurdle will make it more difficult to attract emergency room physicians, particularly younger ones, to smaller centres, said Dr. Margaret Tromp, the president of the Society of Rural Physicians of Canada.

"Because emergency departments are integral to rural hospitals, our concern is some of these people may choose to not go to rural areas or may go to other provinces," she told CBC News.

Family doctors with experience in emergency rooms — but not specific certification in emergency medicine — commonly work in ERs in urban, and especially, rural hospitals. The new regulations do not apply to residents or recent graduates with significant experience in rural ERs.

A rural hospital is a facility in a community of less than 30,000 people and is more than 30 minutes away from another centre with a population of more than 30,000.

Rural ERs unique, but have supports

Doctors have historically been able to make the transition from urban hospitals to rural facilities, that documents from the college of physicians said may be more limited in terms of staff and other resources, through a number of supports in smaller centres.

Those include mentoring, telemedicine, specialized accreditation committees and partnerships with larger medical facilities, according to the provincial regulator, adding that it recognizes "the informal support system" that helps ER doctors in rural communities.

But due to requests from, what the college called, "many physicians with little or no prior experience who wanted to change their scope of practice to include emergency medicine," provincial and national regulators drafted the new rules.

During the supervision period, doctors will be required to have a specified backup in place for the first three months, along with frequent chart reviews. In addition, the clinical supervisor will report back to the college after 12 weeks. After that period, the college may allow those reviews to be done quarterly for the rest of the year.

A spokesperson with the college of physicians told CBC News that specifics of each doctor's supervision period "will need to be adjusted for each unique situation."

'Very discouraging'

The more formal system isn't sitting well with Tromp, who said that it will be tough for young physicians who did their residencies in urban centres. In addition, she said doctors will have to pay for their clinical supervision.

"To be told that, as a general rule, if you do your emergency training outside of a rural centre, that [regulators] don't think you can work in a rural centre is, I believe, very discouraging," she said.

"I think it is the idea that you've come out, you've spent two years, you've just been evaluated, you've finished many rotations in many areas ... and when you want to go to a small town, you're being told, 'well, we're not sure you're good enough for this," she said.

Tromp said people currently doing residencies have told the society the rules put "a damper on their enthusiasm for going to a rural area."

Tromp said physicians are trained to be "self-reflective" and not enter areas of practice in which they're not comfortable.

She added that the society's concerns are around the clinical supervision of new graduates, not doctors who haven't been in a rural ER for some time.

Tromp said the society wants the policy put on hold until more research and review can be done.

The college said it will "continue to work with our partners to clarify our expectations and ensure that physicians have the support to successfully practice in this complex and critical environment." 
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