Emergency department closings have become more common across rural Canada in recent years, posing health care accessibility concerns.Illustration by The Globe and Mail. Source image
Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.
Emergency department closings have become more common across rural Canada in recent years. While these closings have received considerable media coverage, they are just one of the distinct challenges faced by the roughly 6.6 million people living in rural communities when it comes to accessing and managing medical care.
Explore the emergency room closures in your area with our interactive map
As a family doctor who practises part of the time in Calgary and part of the time in Fort Smith, NWT, I’ve seen the realities of rural medicine up close. If you live in a rural or remote community, here are five things I’ve learned – including how you can respond as a patient.
1. Geography profoundly shapes access to health care
In Fort Smith, my patients who require surgery face an eight-hour drive to the nearest hospital where surgeries are conducted, in Yellowknife. If they require full-service health care such as heart stenting or cancer care, they face a 13-hour drive to the nearest tertiary care centre, in Edmonton. The distances are so great that patients who are not eligible for medical travel paid for by the government often don’t attend critical medical appointments.
My Fort Smith patients are not alone in this experience. The Canadian Medical Association points out that people in rural, remote, Indigenous or northern communities, although comprising about 20 per cent of the population, can access just 8 per cent of Canada’s practising physicians. Rural Canadians travel, on average, more than 35 kilometres to see a doctor and 30 kilometres to reach a hospital – more than double the distances urban residents typically face. What’s more, research shows that rural residents are less likely to visit family doctors or specialists and more likely to rely on emergency departments for care.
2. Health outcomes tend to be worse
I was astonished when I first read the medical histories of many patients I treated in Fort Smith. They had far more medical issues than my patients in Calgary – and some of these patients were younger than I was at the time, a new doctor in my late 20s. Unfortunately, my observations are not unique.
Studies have shown higher burdens of chronic disease such as asthma, chronic obstructive pulmonary disease, diabetes, hypertension and heart disease in rural and remote regions. According to a 2019 study by Statistics Canada, preventable and treatable deaths are higher in remote areas. The Canadian Cancer Society also reports that although certain cancer rates may be lower in rural areas than urban areas, cancer mortality is higher.
3. You are your own health manager: be organized and resourceful
Due to limited medical and administrative resources within the health care system, many of the patients I see in Fort Smith must track appointments, manage referrals and co-ordinate transportation largely on their own. The lack of resources for care co-ordination is unfortunately common in rural and remote parts of Canada. Since supports within the health care system are relatively lacking, patients must establish strong, reliable personal support systems (including family, friends and community volunteers), especially when medical travel is required.
In addition, ensuring you have medical travel coverage through your province or territory, or through private health insurance, can mitigate financial stress when appointments require lengthy trips.
Virtual care can also be a useful resource for people living in rural and remote communities. Services such as Joyce Health, a free, online child mental health service I co-founded, can help serve under-resourced communities. However, it’s worth noting that virtual care assumes reliable internet access and digital literacy, both of which may be spotty in remote settings.
4. Expect to be known – and plan wisely
In tight-knit rural towns such as Fort Smith, your health care team may know your family history, daily routines – even local gossip. From what I have seen, this pre-existing knowledge can be both a blessing and a curse. Familiarity can foster more efficient care. For example, the nurses I work with often know which patients are at risk of serious illness and can advise and guide them accordingly. However, familiarity can also make candid conversations about sensitive health concerns more difficult. To maintain privacy, rural patients often resort to virtual visits with providers outside their communities, such as for second opinions or for psychology appointments.
5. Your doctor’s burnout is real, yet practising in rural and remote areas also comes with rewards
Ever wonder why far fewer doctors practise in rural and remote Canada versus urban areas? Survey data compiled by the CMA points to disproportionately high levels of burnout, depression, anxiety and even suicidal ideation among rural and remote physicians. Isolation, heavy workloads and limited peer support are all factors. Unfortunately, I have seen this first hand.
I also see many of my colleagues overcome such challenges. I have been fortunate to have worked with many great physicians and other health care professionals who continue to serve their communities, driven by commitment to our patients and the intrinsic rewards of rural and remote practice.
In Fort Smith, I love that I am able to serve a community in need of medical professionals, build deeper patient relationships than what residents are accustomed to and practise medicine at a scope far broader than what I can do in the city. Sure, I must also contend with resource constraints and extreme distances from centres of additional medical support. But in the end, it is worth it – and I hope other doctors and health care providers will discover the same rewards.
Dr. Yan Yu is a family physician in Alberta and the Northwest Territories and a founder and director of Joyce Health, an online child and adolescent psychiatry clinic. He works in a wide range of clinical settings, including in rural and remote communities, and creates medical education videos in his spare time.
