Supporting generalism among rural doctors

In many Canadian rural communities, there are not enough people to support a wide range of medical specialists, leaving gaps in care. So when the community or the local hospital needs doctors who can work in emergency medicine, anaesthesiology, cardiology, minor surgery, psychiatry, addiction medicine or obstetrics, a family physician will often step in. “Rural communities depend on physicians who have a very broad skill set to deliver on the needs of the community,” says Dr. Sarah Newbery, associate dean of Physician Workplace Strategy at the Northern Ontario School of Medicine and a family physician in Marathon, ON.This is the role of the rural generalist, a family physician who sees patients in their office, but also works with an expanded scope—supported by training, mentorship, experience and hospital privileges—plus they take a population-based approach to health.When family doctors do more, it fills gaps. Dr. Newbery notes that having two or three doctors cover the ER is risky compared to several on rotation—you’re less likely to be caught short when someone goes away or is ill. The Society of Rural Physicians of Canada (SRPC) states that part of its mission is “championing rural generalist medical care,” and says comprehensive care, among other benefits, helps avoid the cost and risk of having patients leave the community to get care. “We have a need right now to advocate for how important comprehensive care is,” says Dr. Sarah Lespérance, president of the SRPC and a family doctor based in Petitcodiac, NB. “In rural areas that often means an expanded scope of work.”In a way, rural generalism is old school. “We’ve begun to equate family medicine with primary care. But family medicine is meant to be comprehensive and broad,” says Dr. Newbery.Anyone can work as a generalist with a broad scope of practice, in theory, but in reality, there’s more need in a rural context. “Rural and urban medicine are, in many cases, very different,” says Dr. Jill Konkin, professor of family medicine at the University of Alberta who provides care on rotation in Fort Chipewyan in northern Alberta, and does locums for rural generalist physicians.She was part of the Postgraduate Medical Education Collaborative Governance Council’s Generalism Working Group, which issued a report in 2018 that outlines six factors that could encourage or inhibit the support of generalists, which it states are “important for an efficient and effective health delivery system.”In 2021 NOSM launched the Rural Generalist Pathway to better support undergraduate medical students in adopting a broader scope of care. The school just launched a mentorship program for those in the program, offering them close access to physicians working in rural environments.She says the Rural Coordination Centre of B.C. supports rural generalism on the ground. “This is a flagship for the way to do it. They’re the envy of the rest of the country,” says Dr. Newbery, as the centre offers ways for students, residents and working doctors to gain additional skills, plus supports them in offering a broad scope of care.Another way rural generalists are getting more support is via the SRPC, which launched the National Advanced Skills and Training Program for Rural Practice in spring 2023. It offers funding for 30 days of training to help rural doctors skill up to become more comprehensive. Rural generalism recently became a formal specialty in Australia, with its own college, a National Rural Health Commissioner, along with training opportunities such as fellowships and continuing education. It’s getting attention elsewhere as well. A 2023 piece published in the British Medical Journal quotes England’s chief medical officer as saying that for generalists could better support aging population and their multimorbidities.In Canada, those championing the importance of supporting rural generalism in education and practice want some kind of formal recognition. “When we can label it, we can understand it,” says Dr. Newbery.That, in turn, can help inform approaches to training at all levels, plus more funding, fair compensation and more clinical support via technology or access to consulting physicians. “It will be a way to market it. It could be a tool for recruiting people. I think there’s benefit to highlight how exciting this is as a career,” says Dr. Lespérance. “We also struggle with getting skills recognized in other jurisdictions and getting the kind of credentials and privileges you need to practice your full scope.”What would recognition look like? Dr. Lespérance thinks adopting a kind of specialist certification might work. “There have been off and on conversations about rural medicine needing its own college,” says Dr. Newbery. Dr. Konkin says the colleges seem resistant to formally recognizing rural generalists. She thinks the idea of labelling it a subspecialty makes little sense, as it’s fundamentally general medicine.While on the policy side, rural generalism remains a buzzword in Canada, on the ground, it’s an essential approach to care in often underserved areas. “Considering it a field in some way is all about acknowledgement and value,” says Dr. Konkin. “Most of my rural colleagues do this daily—they’re already rural generalists. They have been done a disservice by assuming that a family doc is a family doc is a family doc.”

Supporting generalism among rural doctors

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