Oct. 20, 2020

Next government must invest in rural primary care, mental health

By Dr. Barb Konstantynowicz

The COVID-19 pandemic has exposed vulnerabilities in rural health care that the Saskatchewan Medical Association (SMA) believes need to be addressed by the next provincial government following the Oct. 26 election. Physicians recognize the pandemic is unprecedented in its scale and its scope, but now is not the time to shy away from new ideas and strategies.

Having the right number of physicians in a community is critical, but what is that number? It is the number at which rural physicians can perform clinical work, maintain an ER and have a reasonable call schedule, while providing enough of work-life balance that they don’t burn out. Recruiting and retaining physicians to rural and remote regions is an issue across Canada. That is why the SMA urges the next Saskatchewan government must make these positions as attractive as possible through adequate compensation and support so that a country doctor doesn’t feel isolated and abandoned.

The SMA believes standards of care and patient outcomes should be the same no matter where you live in Saskatchewan, from the largest cities to the smallest hamlets. Challenges in rural health care don’t just stem from an insufficient number of doctors. A lack of other health professionals affects a rural family physician’s ability to deliver timely and effective care. Some rural facilities are a vacancy or two away from short-term closures of their emergency rooms. The SMA urges the new government to put a high priority on addressing health care disparities.

Virtual care is been a priority for physicians for more than a decade, but during the pandemic has emerged as a new opportunity to connect with patients. There must be equitable access and compensation for this to continue. Virtual care has been incorporated as a temporary measure in the new physician contract, which expires March 21, 2022. The SMA expects enhancements to virtual care in the next contract.

Physicians need to provide safe virtual care – weighing a phone visit vs. an inpatient appointment – and they require access to virtual care platforms that are safe for both users. During the pandemic, bearing the cost of PPE for physicians, staff and patients has also become an issue for community-based physicians, which needs to be addressed.

The SMA is asking the next government to make further investments in rural mental health and addictions treatment. This echoes pleas by rural physicians for access to mental health and addictions treatment professionals such as counsellors, psychologists or psychiatrists, and the ability to call on their services on short notice. Lack of access is particularly acute with children’s mental health care.

All physicians are alarmed at seeing children in a mental health crisis, such as suicide, self-harm, or anxiety. A referral might mean a 12- to 18-month wait, which is too long and could result in long-term consequences for the child. Virtual care can help by providing immediate access and counselling assistance, but face-to-face point of care should be the goal following the election.

Rural care is not the only area that is challenged. Patients around the province are looking for a family physician to provide their medical home. The SMA believes the next government should commit to supporting family physicians in rural, regional and urban locations. Physicians also need ongoing support from the Ministry of Health for the competing priorities thrust on them by regulatory bodies and health system organizations, which require them to constantly keep up with best practises and quality care.

As I stated, ideally the standards of care should not be dependent on where you live in this vast province. We are in the midst of a pandemic, which has consumed our attention and resources. We must respond to that challenge, but not lose sight of the many issues physicians face on a daily basis. That is an equally great challenge for the next government.

Dr. Barb Konstantynowicz, a Regina family physician, is president of the Saskatchewan Medical Association, which represents more than 2,400 physicians in the province.

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