The following letter is addressed to Dr Turner, but intended for publication here.

In the interview with you, published in the BCMJ of October 2003, (45[8]:376-381), you make some mention of rural and remote areas. Then you go on to say that “…I suspect that the people who are working there now have sufficient encouragement. I don’t see that as an area that needs work.”

Does Granger Avery, past-president of the BCMA, agree with you?

If the incentives to work in rural and remote areas were anywhere remotely adequate, the flood of recruits would be striking. The reality is otherwise. For example, the doctors of Creston serve an area population of 15000 roughly, and we have 10.5 FTE doctors. The Interior Health Authority (IHA) states that the patient:doctor ratio ought to be 1000:1, which leaves Creston short 4.5 FTE family doctors (plus we have one very part-time specialist pediatrician). When we are on duty in our local ER, we see a significant number of patients who cannot find a local doctor.

Turning the picture around the other way, if the incentives for work in rural and remote areas were adequate we would not have the turnover of doctors, mostly migrating to larger centres, which we have experienced—see attached appendix showing which doctors left and where they went [we cannot print the appendix due to space constraints; it shows that since 1970, Creston has lost 28 physicians to locales inside and outside of BC—ED.].

Creston is not alone with this picture. I am informed that virtually all other communities in the IHA are experiencing similar problems—too many patients, too few doctors, and an inability to retain in rural practice the majority of doctors. With our isolation from major urban centres (and I do not count Kelowna as such), we have to be considerably more reliant upon our own skills, with all the extra stress that entails.

How naive of you to think that the new Northern Medical School will have any significant impact upon the provision of doctors for work in rural and remote areas. Perhaps you might be right—but not in BC, most likely not even in Canada.

I am writing this as a doctor who came to Creston in October 1970 and who has not migrated elsewhere. But I remain embittered by the continued ineptness of the BCMA over the past more than 30 years to grasp the nettle of what is needed to sustain reasonable conditions of practice in this province.

We retreat again and again. The tone of the Negotiator does nothing to allay my fears that we are poised for yet another retreat with, as usual, rural doctors getting the short end of the stick. Worse, since the rural doctors have to work extra hard to service their populations, and are forced to see ever-more patients, this will expose ever-more hardworking, honest, and honorable doctors to harassment of government audits and accusations of dishonesty if the seventh proposal is to be believed.

You made no mention of this evil, and evil it is.

Please give me some reason to believe that the tide has turned. You have not done this so far.

—Erik T. Paterson, MD
Creston

Dr Turner responds 

Dr Erik Paterson’s letter implies that I have little understanding of rural issues, or more precisely, retention of physicians in the rural areas of the province. In fact, in his attempt to quote me in order to make his point, he actually misquotes me. I stated in my interview with the managing editor of the BCMJ that physicians who are currently working in rural areas have sufficient financial encouragement to remain, not that they have sufficient encouragement period. I am well aware of resource shortages, hospital issues, and health authority interference in all areas of the province that make it difficult for physicians to practise, just as I am well aware of the physician shortages, in both rural and urban settings, that increase the pressure felt by my colleagues.

Since becoming president in June, I have traveled around this province speaking with many physician groups—especially in the rural communities. Rural physicians expressed to me their concerns working in areas far removed from the major centres. Local hospital issues and health care delivery changes implemented by the regional authorities were by far their most important concerns—and the issues that may ultimately drive physicians away. Financial incentives to remain in their current practice were never at the top of the agenda. Further, the last Representative Forum that was held indicated that physician input into system reform was the most important issue to rural physicians and indeed to all physicians.

The BCMA is taking an active position in regard to recruiting physicians to rural areas. For the next 2 years and with nearly $1 million in funding negotiated by the BCMA with the Ministry of Health Services, the Joint Standing Committee on Rural Issues has retained HealthMatch BC to concentrate on attracting physicians to rural practice in BC. Within 2 weeks of this writing [mid-November 2003], a foreign recruitment mission to the United Kingdom is planned in which HealthMatch BC executives and a rural BC physician will speak to British physician groups in an effort to recruit.

I would like to affirm my belief that the Northern Medical Program will indeed have a positive impact in regard to recruiting new physicians to the northern communities. Since studies show that doctors tend to practise in the regions where they receive their training, the importance of the Northern Medical Program cannot be over-emphasized. In the long term, we cannot continue to rely on overseas recruitment.

Finally, through the BCMA’s successful negotiation of the Rural Subsidiary Agreement of 2001, and in conjunction with UBC, financial support has been provided giving undergraduate medical students several opportunities during their education to experience medical training in rural communities.

I would hope that Dr Paterson’s concerns are somewhat mitigated knowing that his association is just as concerned as he is regarding retention and recruitment in the rural areas, and is working hard to diminish the challenges there.

—John Turner, BM BCh
BCMA President