As BC continues to face gaps within its rural healthcare system, UBC researchers are working to amplify rural communities’ perspectives in high-level planning processes.
Since starting a year ago, the group of researchers working on the Rural Evidence Review (RER) project has been surveying rural residents from across the province on their experiences and priorities accessing healthcare. Newspapers from communities ranging from Revelstoke to Fort Nelson have been calling for participation from their local residents.
For RER Co-Director Dr. Jude Kornelsen, it’s this grassroots approach that differentiates the project from the numerous studies that have already been done about rural healthcare.
According to Kornelsen, previous systemic reviews have seen large influence from health authorities while the team now wants to engage mainly with on-the-ground stakeholders. She added that most studies she has seen also tend to come from an urban focus, losing some nuances about rural populations — which include numerous Indigenous communities — along the way.
“Rural is not just small urban,” said Kornelsen.
As the co-director of the UBC department of family practice’s Centre for Rural Health Research, she has researched rural healthcare needs extensively.
“And you can’t really group them together. ‘If you’ve seen one rural community, you’ve seen one rural community’ is something that we often say,” she added.
Edward Staples — a lead of the BC Rural Health Network (BCRHN), which provides support for RER’s research — agreed with Kornelsen. In fact, he said this is represented in BCHRN’s structure itself, which brings together 16 autonomous organizations working in 14 different communities.
Structural gaps
But they both identified similar issues when asked about structural problems that have been plaguing rural communities in BC: shortages of practitioners and inadequate transportation.
As of January 23, RER has received around 500 survey responses, with most of them coming from communities within the Northern Health and Interior Health Authorities. While the team is just starting the first round of analysis, Kornelsen predicts that the concern is going to be “first and foremost about access to [practitioners] across the board.”
“Across the province, the supply of healthcare professionals in pretty much every area cannot meet the demand,” said Staples.
“Some communities are luckier than others because they have been working for quite a while to try to address the concerns of shortages. But there are several communities that are in a crisis situation in terms of the service that’s available to them.”
For instance, the CBC recently reported that Peachland — a community in the Okanagan Valley with over 5,000 residents — will soon lose all four of its local physicians.
As a result, many residents have to travel to other communities for general and specialized care. But this process has its own challenges, such as how to ensure reliable transportation. Greyhound cancelled service in western Canada last October.
“In Vancouver, you can walk into a walk-in clinic … If you don’t have a family physician in a rural community, that’s a whole different ball game,” Kornelsen said.
“… [There are] concerns about emergency transport but also concerns about non-urgent transport. For example, getting to the regional referral centre where people might have to travel two or three hours over a treacherous road … that’s almost insurmountable to do.”
But amidst discussion about the challenges, she was also quick to highlight the resilience of rural communities and physicians.
“I think that communities out of necessity have been able to come up with a really innovative solution,” she said. “… Without a doubt, the providers in rural communities tend to be the ones that are excited in working to [their] full scope of practice and they provide comprehensive care, which is fantastic.”
From review to policy
Currently, the team is still collecting responses for the survey about healthcare priorities while starting to analyze the first round of its other surveys. It is also working with an expert panel comprised of individuals from health authorities, professional associations and the ministry of health to determine a few approaches that would align the review with provincial priorities.
Ultimately, Kornelsen hopes that by the end of the four-year process, the team would be able to use the project’s findings and focus on rural voices to inform policy discussion and planning.
“[Rural residents] are on the front line, they know what the important things are,” she said.
“ … I think that more and more people are including the vantage point of citizens and on-the-ground patients in the analysis of what they’re doing, and I think this is a really necessary direction to be taking.”
Staples hopes that the review will “provide BCRHN with the ammunition” to push for a concerted effort from different provincial bodies — post-secondary schools, professional associations and the provincial government — toward addressing the shortage in medical professionals.
“The communities across the province spend a large amount of time trying to develop recruitment programs, but they are rather pointless if there’s nobody available to actually recruit,” he said.
“And if you’re just robbing Peter to pay Paul in your recruitment efforts, it’s unfair to those communities that don’t have the same level of resources as others.”
And like Kornelsen, he stressed the need to centre rural voices in the process.
“There needs to be a dialogue that takes place between all of the stakeholders and especially the communities because ultimately, communities understand what the needs are,” Staples said.
“And until we do that, I think this problem with recruitment is not going to change.”