Time to borrow from B.C.? Why this rural healthcare model could work in Northern Ontario

Northern Ontario’s healthcare challenges could be eased by a model created, implemented and validated in British Columbia, according to a new paper from the Northern Policy Institute, an independent think tank focused on shaping socio-economic policies that affect communities in Ontario’s north.The report, Rural and Remote Physician Services Coordination in Northern Ontario, looked at the Rural Coordination Centre of British Columbia, a Vancouver-based group that started about 16 years ago with four rural doctors and two staff members and has since grown in a network made up of hundreds of healthcare professionals, administrators, policymakers, academics, community members and linked sectors such as non-profit organizations and industries.The paper’s author, Bryanne de Castro Rocha—a senior policy analyst at the institute—told CTV News one of the main reasons doctors stay away from Northern Ontario is the limited ability for physicians to consult with their peers, and get second opinions and support in complex cases.By comparison, the programs set up by RCCBC connects physicians to specialist advice and support. It also coordinates physician services, supports professional development, facilitates rural and northern-focused medical training, and manages locums for clinical deployment, de Castro wrote in her paper.As an example of a successful RCCBC program, the paper cited one called Real-Time Virtual Support, which links doctors, midwives, residents, nurse practitioners and nurses to specialist and peer advice through video calls. These connections are available through “peer pathways” that fall under the instant access category—available 24/7 for cases involving emergency medicine, pediatrics, maternity and newborn—and quick reply.Peer pathways in the quick reply category are available weekdays during business hours and cover dermatology, hematology, myofascial pain, neurology, rheumatology and thrombosis.Read: Provincial locum pool, expanded scopes of practice for NPs and midwives among wish list for Northern OntarioB.C. rural doctors can get access to these virtual pathways through Zoom—with an account issued by a B.C. provincial or regional health authority—or by phone. “Calling a (Real-Time Virtual Support) virtual provider is like calling a friend,” RCCBC states on its website. “They offer friendly, compassionate, non-judgmental, and culturally safe support while understanding the context of providing care in rural places.”The service is certainly well-used. An RCCBC report on its virtual support program—posted on the group’s website—showed 14,424 calls were made to instant pathways providers in the first three quarters of its 2023/24 reporting period. The previous year saw 15,460 calls in total over four quarters.The Northern Policy Institute paper also highlighted RCCBC’s rural locums initiative, which centralizes and shares information and resources for locums. These include job postings, information on how to access continuing medical education or how to get a mentor—”all available through partners, but for which RCCBC has centralized information,” the paper stated.In 2022-2023, the initiative—available through partners but with information centralized through RCCBC—attracted 17 health providers interested in working as a rural locum and got 66 members signed up to a rural locums initiative forum. RCCBC does have its own programs for rural locums: one that matches residents looking with rural and remote locums and connects applicants to funding to offset travel and accommodation costs, and another that provides a virtual discussion form for B.C. rural locums.Read: A palliative care crisisDe Castro Rocha noted that Northern Ontario does have a number of “exciting programs” designed to improve rural and remote healthcare, including virtual critical programs, emergency department peer-to-peer and simulation-based education that prepares health professionals for medical situations that might not occur as often in rural settings.“While these initiatives exist and are likely helpful, there is no unified framework to connect them nor a single point of information to assist physicians in discovering relevant resources,” wrote De Castro Rocha. “Organizations or initiatives independently share information on their respective web pages and social media channels. This fragmentation poses a challenge for students and physicians exploring rural medicine who may not be familiar with these resources, and the absence of coordination and shared information can also lead to gaps and unnecessary duplication.”Another notable deficiency, added De Castro Rocha, is the lack of accountability to ensure “initiatives are implemented and goals achieved” on a case-by-case basis. RCCBC’s programs are funded primarily by the province, with B.C’s Joint Standing Committee on Rural Issues serving as the primary funding and structure support for RCCBC.“The creation of joint standing committees on health that are able to funnel funding from the provincial government to and support the governance of ‘grassroots approach[es]to enhance patient care and improve professional satisfaction for doctors is compatible with the funding system in Ontario,” wrote De Castro Rocha.Read: Locuming: avoiding the pitfalls

Time to borrow from B.C.? Why this rural healthcare model could work in Northern Ontario

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