Rural Canadians face greater disparities from lack of anesthesia care: doctors

Rural Canadians face greater disparities from lack of anesthesia care: doctors

Rural Canadians face greater disparities from lack of anesthesia care: doctors

Canadians living in rural or remote communities are at risk of poorer health outcomes due to a shortage of anesthesia services, say researchers calling for a national strategy to address inequitable access to care.

Dr. Beverley Orser, chair of the department of anesthesiology and pain medicine at the University of Toronto’s faculty of medicine, said pregnant women in some areas must travel hundreds of kilometres for maternity services.

Patients who suffer serious injuries are at greater risk of dying in rural areas that lack adequate trauma care, she said.

Orser and Dr. Ruth Wilson, professor emeritus at the department of family medicine at Queen’s University, have authored a commentary in this week’s edition of the Canadian Medical Association Journal, outlining strategies aimed at addressing inequities in care for rural patients compared with those who live in cities.

An ongoing shortage of anesthesiologists seems be worsening across the country as evidenced by job ads going unanswered, an aging workforce and discussions among those chairing anesthesia departments at Canada’s 17 medical schools, said Orser, who is also an anesthesiologist at Toronto’s Sunnybrook Health Sciences Centre, which has the largest trauma facility in Canada.

She said it will take the collective effort of governments, who will need to fund more anesthesiology training spots at universities, as well as academics and policy-makers to deal with disparities that disproportionately affect Indigenous populations.

She cited the example of pregnant women in Bella Coola, B.C., where maternity services were eliminated in 2008, forcing patients to drive six hours to Williams Lake. Those with high-risk pregnancies may have to live there at their own expense for part of their pregnancy.

“Probably one of the most important calls to action is to undertake much better workforce planning,” Orser said. “We need to understand what’s happening and what’s needed in the future and how to address it.”

Anesthesiologists manage pain before and after surgery, as well as prior to, during and following childbirth, and provide potentially life-saving resuscitation for patients on ventilators.

Family practice anesthesiologists often work in smaller communities and are general practitioners with extra training to provide anesthesia for low-risk procedures. They’re also a cheaper option.

Orser calls them Navy SEALs because some also perform minor surgery, work in emergency rooms, deliver babies and prepare trauma patients for transport to urban hospitals.

She said there’s a need to train both types of anesthesiologists across the country though family practice anesthesiologists are not employed in rural Quebec, while in Iqaluit they are the sole providers of anesthesia.

“It’s likely there’s not one solution that fits all jurisdictions but right now we don’t have it right.”

Canada could learn from Australia, where a national curriculum for family practice anesthesiologists has been developed, along with ongoing mentorship of doctors in rural areas, she said.

“They, for example, are building a program where people who work in these communities can come back to the bigger centres for two weeks in a funded position, which is really an important model because it’s tough working in these environments.”

In Canada, support from anesthesiologists to their rural colleagues is limited, Orser said. For example, while specialists from Alberta and Saskatchewan fly to their colleagues in Yellowknife, a national program with a well integrated network is needed, she added.

However, the heavy workload of a family practice anesthesiologist often means some don’t stay long in rural areas, Orser said.

Dr. Roland Orfaly, head of the British Columbia Anesthesiologists’ Society, said the province has a high need for the specialists in both large and small communities.

“In the rest of the country it truly is a rural problem. In B.C., it’s a provincewide problem,” he said.

However, Orfaly said British Columbia employs about a quarter of Canada’s 500 family practice anesthesiologists, the most of any jurisdiction in the country, likely because the province is so geographically isolated.

Orfaly supports Orser’s call for a national strategy to address the shortage of anesthesia services.

“The provincial approach, at least to the anesthesiologists’ workforce, has not been effective so we would welcome a national approach to health human resources to see if that is any more effective in helping us.”

This report by The Canadian Press was first published July 30, 2020.

Camille Bains, The Canadian Press

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

As of Friday, Alberta has under 10,000 active COVID-19 cases. (Image courtesy CDC)
Alberta reports 2,271 new COVID-19 cases, Red Deer cases rise slightly

Across Alberta, there are 666 people in hospital with COVID-19, including 146 in the ICU

Alberta Health Services locked the Whistle Stop Cafe at Mirror on Wednesday morning after owner Christopher Scott refused to comply with health orders.
Photo by Paul Cowley/Advocate staff
AHS shuts down Whistle Stop Cafe for defying health orders

Health inspectors and RCMP locked doors early Wednesday

Premier Jason Kenney (File photo by THE CANADIAN PRESS)
Chedda’ Heads Grilled Cheese Truck owner Dawson Strome and truck manager Allison Dolan look out from the service window on the truck. (File Photo)
Sylvan Lake’s Food Truck Thursdays expected to return with some changes

The Town is amending the Mobile Vending and Busking Bylaw which has a few changes for the event

A vial of Oxford-AstraZeneca COVID-19 vaccine is seen at a facility in Milton, Ont., on Wednesday, March 3, 2021. An Alberta woman in her 50s has died from a rare blood clot disorder after receiving the AstraZeneca vaccine. THE CANADIAN PRESS/Carlos Osorio - POOL
Alberta confirms blood clot disorder death linked to AstraZeneca vaccine

Both AstraZeneca and Johnson & Johnson vaccines have been linked to VITT in a very small number of cases

FILE - In this March 3, 2021, file photo, a vial of the Johnson & Johnson COVID-19 vaccine is displayed at South Shore University Hospital in Bay Shore, N.Y. (AP Photo/Mark Lennihan, File)
Johnson & Johnson COVID vaccine can be given to adults 30+ who can’t wait for mRNA: NACI

Panel says single shot vaccine can be especially useful for populations unable to return for second shot

A wild rabbit grazes in Nanaimo, B.C. in this Feb.2, 2018 photo. Rabbit owners in Alberta are being warned about a deadly virus that was identified in a southern Alberta household last month. THE CANADIAN PRESS/Dirk Meissner
‘Like a flash fire:’ Rabbit owners warned about outbreak of deadly disease in Alberta

The disease is confined to rabbits and cannot spread to humans

A lady wears a vaccinated sticker after receiving a COVID-19 vaccine at a vaccination clinic run by Vancouver Coastal Health, in Richmond, B.C., Saturday, April 10, 2021. THE CANADIAN PRESS/Jonathan Hayward
Canada may find it challenging to reach herd immunity from COVID-19, experts say

Level of immunity among the population changes with the variants, especially the more transmissible strains

B.C.’s provincial health officer, Dr. Bonnie Henry. THE CANADIAN PRESS/Jonathan Hayward
Dip in COVID-19 cases with 572 newly announced in B.C.

No new deaths have been reported but hospitalized patients are up to 481, with 161 being treated in intensive care

A dose of the Pfizer COVID-19 vaccination is prepared at a mobile clinic for members of First Nations and their partners, in Montreal, Friday, April 30, 2021. THE CANADIAN PRESS/Ryan Remiorz
Pfizer-BioNTech vaccine approved for kids 12 to 15 years old in Canada

The vaccine was previously authorized for anyone at least 16 years of age or older

Prime Minister Justin Trudeau listens to speakers appearing by video during a news conference in Ottawa on Tuesday May 4, 2021. THE CANADIAN PRESS/Adrian Wyld
Canada will align policy on ‘vaccine passports’ with international allies: Trudeau

Trudeau says Canadians could begin travelling outside the country again by summer

Ranging from 11 to 20 in age and representing seven provinces and one territory, the plaintiffs are appealing a Supreme Court judge’s decision to dismiss their lawsuit last fall. (David Suzuki Foundation)
15 youths not backing down in their fight to sue Ottawa over climate change inaction

The group has filed an appeal after their lawsuit was struck down by a Federal Court judge last fall

A 2021 census questionnaire. (Black Press Media file photo)
2021 census responses due May 11

By law, every household must complete a census questionnaire

Calgary Mayor Naheed Nenshi attends a senior’s home in Calgary on Tuesday, April 14, 2020, amid a worldwide COVID-19 pandemic. Nenshi says he’s frustrated to hear that tickets given to people for breaching COVID-19 public health orders are being thrown out in the courts.THE CANADIAN PRESS/Jeff McIntosh
‘Incredibly frustrating:’ Calgary mayor wants courts to uphold COVID-19 measures

Large groups without masks have been gathering in Calgary public spaces in protest of health measures

Most Read