‘We have done so much with so little’: AMA says major changes needed to improve rural health care

Alberta Medical Association Rural Medicine President, Rithesh Ram, discusses investments in rural health care with Alberta Primetime host Michael Higgins.

Alberta Medical Association Rural Medicine President Rithesh Ram discusses the province’s investments in rural health care with Alberta Primetime host Michael Higgins.

This interview has been edited for clarity and length.

Michael Higgins: How do you see this commitment of dollars factoring into the sustainability of rural health care?

Rithesh Ram: The key to recruitment is retention and it is very difficult to retain physicians in rural and remote areas when the facilities and available technologies that we have to manage our patients is lacking or outdated.

This increased focus on rural medicine by this government is a welcome start to how we can improve the health of our rural, regional and remote communities. I know there were comments out there that the opposition believes that spending on rural community projects isn’t worthwhile as it’s not going to improve over urban city emergency departments. It’s these types of statements that we think is really demoralizing.

Our rural health-care workers must continue to be the focus moving forward. We need any and all funding and supports that the budget makes available to us. For decades we have done so much with so little, and I’m happy to see that there’s going to be a focus on us now.

MH: The initial phase is to evaluate 20 selected health facilities for upgrades. How does the rural infrastructure dynamic compare to hospitals in Alberta’s larger centres? To what degree does equipment in rural areas need to be modernized?

RR: That depends how many times you want me to use a multiplier there. In comparison to the technologies, the services, the investigations, the blood tests, anything that we would like to order in our patients, when it comes to when it comes to rural, remote areas, even regional areas, we are lacking in behind what the cities have.

Anything we can do to modernize that, whether that’s mobile units, whether that’s upgrading the facilities that we have and bringing them up to the standard that we would expect for any patient in Alberta, that’s what we want to have.

That no matter where you are, irrespective of geography, you will get the same proportioned health-care services that you can get anywhere, and we’re just not there. I’m hoping that this will start that trend to lead us there because we have lots of patients that can’t travel for even the most basic tests, let alone the most invasive, so this will be a wonderful thing to happen. Of course, we’ll see how it rolls out over the next three years.

MH: Where do you weigh in on actual facility upgrades being necessary to attracting new doctors to rural communities?

RR: It absolutely does. As I mentioned in my previous comment, retention of our physicians is the ultimate point to move forward in order to recruit. It’s very difficult to recruit new physicians, new grads, whether they’re coming from overseas to places that don’t have a base, that don’t have a team, that don’t show that there are people there to support you with the most difficult or the most easiest of cases. So upgrading our facilities and ensuring that we have the equipment there is vital.

The health human resource crisis, it’s multi-factorial, it didn’t happen overnight. It started with various policy changes that happened in the 1990s. At one point, I think governments actually thought they were going to have too many physicians and nurses. What a lovely time that would be to live in. But that’s definitely not going to be the case now.

It is unknown at this point if we will ever catch up to the deficit of physicians that we’re seeing everywhere. There’s the very natural hope that the new medical schools, the northern Alberta MediCal program and the southern Alberta MediCal program will be able to fill some of that gap but the gap is so large. It’s huge so we don’t know how that’s going to go.

Again, making sure that we have the facilities there, making sure that we have the upgraded technology, the actual test investigations that patients need, is a very good base and very good place to start.

MH: We’ve heard for so long now about all of the ER closures in rural communities. How successful has the government been in tackling that issue of attracting new doctors putting efforts toward recruitment?

RR: There are efforts towards recruitment and I know that they have worked with the resident association to actually develop some pieces that will help recruit new grads, new Canadian-based grads, to go into rural places in Alberta.

We’ll see how that turns out over the next couple years because it is a new program that was announced within the last few months, so they are making headway there, but again, this isn’t a problem that happened overnight.

This problem has been stemming for many, many years, and I personally don’t see how it’s going to turn around again very quickly. We need to make the head roads. We need to move forward. There are some difficult things that need to happen.

There’s the very big part that physicians, on a daily basis, have to grapple when it comes with patients and the patient demands that are coming up, and I use demands very specifically because it’s one of the most triggering comments that a physician can have.

It’s the patients that come in and demand medication, they demand treatment, they demand investigations, all for the simple one liner of because it’s free and you and I both know healthcare is not free, so we definitely need someone to stand up and provide that appropriate education on this issue, otherwise our publicly-funded system is never going to recover.