Rural medicine: real action needed
CMAJ 1998;158:1269
In response to: P. Hutten-Czapski; D.P. O'Neil
Our paper was intended to describe the development and characteristics of RPAP and to present some early indicators of success. One problem in preparing a paper for publication is the gap between completion of the manuscript and publication; many events can occur during that period. Our opinion that RPAP has had a positive impact remains unchanged, and we base this belief on the facts presented in the evaluation report and on our own experiences. However, we do recognize that many challenges remain and will continue for some time, particularly in the area of physician retention.
RPAP does not have a mandate to address certain issues. The payment of physicians for clinical services, including on-call payments, is outside its scope but is currently being discussed in the negotiations between Alberta Health and the AMA.
Training in emergency medicine is only one component of Alberta's Special Skills Training Program. Those who have received training in anesthesia, obstetrics and surgery have predominantly entered rural practice, although not necessarily in Alberta. The recognition that not all of the residents who took this training were entering rural practice led to a change in policy in 199697. Special skills trainees must now obtain a return-in-service agreement from a rural regional health authority. Whether the new policy will be successful remains to be seen.
The drive to recruit physicians from South Africa and elsewhere is a new initiative. There was little discussion with the RPAP Coordinating Committee or with physician groups before the initiative was announced. We believe that this return to a traditional approach to recruiting physicians for rural Alberta will create significant difficulties for Canadian graduates wanting to practise in rural areas and that this continued reliance on international graduates will perpetuate the historical problems.
David G. Moores, MD
Professor and Chair
Department of Family Medicine
University of Alberta
Edmonton, Alta.
Douglas R. Wilson, MD
Professor
Department of Public Health Sciences
University of Alberta
Edmonton, Alta.
Sandra C. Woodhead-Lyons, BSc(HEc)
Woodhead-Lyons Consulting
Edmonton, Alta.
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