The Rural Voice, 1996-11, Page 23Situation critical?
An 18 per cent cut to hospital budgets and the
difficulty attracting doctors throws the future of
rural health care in doubt
By Janice Becker
Since the days when the family
doctor travelled the
concessions, little black bags
bouncing on the buggy seat beside
him, rural residents have been used
of seeing improvements in the
quality of health care they received.
From miracle drugs to local hospitals
to free medical care, the move has
been always toward the better.
But suddenly, in a time of
government deficits and tax cuts, the
talk is of possible hospital closings,
and just getting a doctor to locate in a
rural community is *huge challenge.
The expectation that things will
improve is being replaced by worries
that the health care we've been
accustomed to will no longer be
available.
The most visible controversy has
come with the moves by the
provincial government of Premier
Mike Harris to "readjust and
reinvest" health care dollars by
appointing a commission with the
power to amalgamate and close
hospitals if necessary. The move is
causing discussion, distress, distrust
and heated tempers at public
meetings for hospital restructuring
across the province. But just as big a
crisis is the unwillingness of many
doctors to set up practice in rural
areas because their workload is
bigger than in a city practice.
Doctors, as with any professional
or working person, expect to be paid
adequately for their labours, commit-
ment to the job and personal
sacrifices made to see the job done.
In many cases, rural doctors are
asked to invest considerable money
into a community to either buy into a
partnership or set up their own
practice. There is an underlying sense
of long-term commitment required.
This may not necessarily be what
young doctors are looking for, said
Dr. Mark Woldnik, chief of staff at
Seaforth Community Hospital and
co -recruiter for the hosptial's clinic
facility.
Physicians want to determine if
they like the location and practice
before committing considerable
funds, he said.
This factor alone may be a
daunting one to overcome for many
communities, unable to provide a
health centre or clinic where
numerous practitioners share costs,
thereby easing set-up costs for a new
practice.
Another much-discussed deterrent
for doctors locating in rural areas, is
the expanded demand on their time
and resources. A physician is not able
to be only a general practitioner
(GP). Emergency room service is
required, sometimes resulting in an
on-call schedule which insists on
availability every three nights,
depending on the number of doctors
in the community. As the pressure
from many hours of service add
stress to the physicians' lives, a
practice in an urban centre becomes
much more attractive.
The next question arises. For those
who do commit to rural health care
and are willing to deal with the great
range of services requested of them,
is the remuneration adequate?
If the provincial government would
make changes to the way physicians
are remunerated, everything would
fall into place, said Fraser Bell,
executive director with the Huron -
Perth District Health Council.
While a city doctor may serve one
night per month on-call, it could
result in several dozen visits and
considerable billing to OHIP. A rural
doctor, by comparison, who in all
likelihood, will handle a wider range
of cases because of inaccessibility to
support services, may cope with
fewer cases in more nights of on-call
duty per month. With less billing, the
physicians insist their greater time
investment is also valuable.
In an effort to alleviate some of the
disparity, the Conservative
government implemented a scheme,
last December, which would provide
rural doctors with a $70 per hour
compensation package for night,
weekend and holiday emergency
room duties.
This is the objective of the present
government, said Helen Johns,
Huron -Bruce MPP and assistant to
Health Minister Jim Wilson. "Our
government is reinvesting the funds
(which are being moved from
hospital budgets) to long-term care
and other health care needs."
"There is not an 18 per cent cut
(over three year) across the board,"
she said. "Hospital (budget
reductions) will be more than
compensated for by the move in
money."
However, there is uncertainty of
exactly were that "moved money"
will go. "There has been no
commitment that the money removed
from Huron -Perth hospitals will go
back to those communities," said
Bell.
Though there has been one positive
sign in the announcement of dialysis
equipment for Stratford and further
talks for a similar Huron County
facility, a one-to-one ratio in the shift
NOVEMBER 1996 19