Physician workload: the rural perspective

CMAJ 1998; 158:1011-2

In response to: G.B. Hutchinson

First, we accounted for what Hutchinson calls the "intensity of the visit," as well as the specialist functions that rural GP/FPs perform, by determining the average annual number of ambulatory visits for physicians practising in different settings (e.g., urban centres, the Rural South, the North). This gave us an estimate of the number of visits a new physician might expect. Our focus on visits captures the key services delivered by generalist physicians in both urban and rural settings.

Other approaches count the number of physicians serving residents
in a given area and compare physician­population ratios. Hutchinson rightly suggests that because family physicians servicing a rural area spend much of their time doing surgery, delivering babies and providing anesthesia, a ratio-based approach tends to overestimate physician contact with residents; our approach explicitly acknowledges this. Moreover, variations in the visit workload of physicians across areas seem greater than those recognized by most ratio-based methods. In Winnipeg, generalist physicians received on average 22% more visits per physician than those in the Rural South; the differential was much greater for northern physicians. Typical adjustments of target ratios for family physicians that recommend more physicians for rural than
urban areas insufficiently account for
these differences. The Saskatchewan Physician Resource Planning Task Force¹ recommended family physician ratios for urban and regional centres and for rural areas that recognized only an 18% difference from the highest to the lowest, less than the workload differences we have identified. Unless such ratios are adjusted, rural areas will be penalized.

Second, we included emergency physicians and their work in calculating physician deficits and surpluses. They were excluded only when we estimated the average visit workload of generalist physicians.

Third, one of our team (P.K., head of the Department of Family Medicine) has direct experience with rural medicine, having practised in a rural setting in Manitoba and the UK. In the Manitoba Family Medicine Program all residents gain experience in both urban and rural settings, and more than half of those graduating over the past 3 years now practise in rural areas of Manitoba.

We share Hutchinson's concern that a better way of determining physician supply requirements is needed. Our approach recognizes the unique characteristics of rural practice and goes a long way toward providing a better alternative.

Noralou P. Roos, PhD
Professor and Co-director
Manitoba Centre for Health Policy
and Evaluation
Winnipeg, Man.

Peter Kirk, MB, ChB
Professor and Head
Department of Family Medicine
University of Manitoba
Winnipeg, Man.

Reference

• Physician resource requirements for Saskatchewan. Phase I report. Saskatchewan Physician Resource Planning Task Force; 1994.

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