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

(Photo Submitted by the Gord Bamford Foundation)
Lacombe’s Gord Bamford to perform a virtual concert for a good cause

The concert aims to raise awareness for Operation Santa Clause

Alberta Health Services' central zone jumped from 162 active COVID-19 cases to 178 on Friday. Five additional deaths were reported provincewide, bringing the toll to 323. THE CANADIAN PRESS/Graham Hughes
622 new COVID-19 cases set another daily high Friday

Province confirmed 622 additional cases Friday

“Pumpkin” is available for adoption at Old MacDonalds Kennels. (Facebook photo)
Old MacDonald Kennels sounding the alarm over number of cats in care

An expansion is underway at Old MacDonald Kennels

Alberta children whose only symptom of COVID-19 is a runny nose or a sore throat will no longer require mandatory isolation, starting Monday.
477 new COVID-19 cases confirmed in Alberta on Thursday

Changes being made to the COVID-19 symptom list for school-age children

Coun. Ted Dillon receives a certificate for 30 years of service from Ponoka County Regional Fire Services Chief Dennis Jones. (Photo submitted)
Ponoka councillor recognized for 30 years’ fire service

Coun. Ted Dillon presented with certificate at Oct. 13 council meeting

<strong>Spooky spectacles:</strong> Halloween decorations seen around Ponoka. Photos by Karen Douglass
PHOTOS: Ponoka ready for Halloween

Spooky spectacles: Halloween decorations seen around Ponoka. Photos by Karen Douglass By… Continue reading

(Photo Submitted by the Gord Bamford Foundation)
Lacombe’s Gord Bamford to perform a virtual concert for a good cause

The concert aims to raise awareness for Operation Santa Clause

City of Wetaskiwin Mayor presenting the AUMA Above & Beyond Award to John Maude and Susan Quinn. Ren Goode/ City of Wetaskiwin.
Wetaskiwin County residents win the AUMA Above & Beyond Award

John Maude and Susan Quinn are being recognized for their role in Wetaskiwin’s sustainability.

Conservative leader Erin O’Toole rises during Question Period in the House of Commons in Ottawa on Wednesday October 28, 2020. (Adrian Wyld/The Canadian Press)
Conversion therapy ban gets approval in principle, exposes Conservative divisions

Erin O’Toole himself voted in favour of the bill, as did most Conservative MPs

Children’s backpacks and shoes are seen at a daycare in Langley, B.C., on Tuesday May 29, 2018. Alberta Children’s Services Minister Rebecca Schulz says the province plans to bring in a new way of licensing and monitoring child-care facilities. THE CANADIAN PRESS/Darryl Dyck
Alberta proposes legislation to change rules on child-care spaces

Record-keeping, traditionally done on paper, would be allowed digitally

Prime Minister Justin Trudeau shakes hands with US Vice-President Joe Biden on Parliament Hill in Ottawa on Friday, December 9, 2016. THE CANADIAN PRESS/ Patrick Doyle
A Biden presidency could mean good news for Canadian environment policy: observers

Experts and observers say even a U.S. outside the Paris agreement may ultimately end up in the same place

People take a photo together during the opening night of Christmas Lights Across Canada, in Ottawa, on Wednesday, Dec. 4, 2019. The likelihood that most Canadians will enjoy a holly jolly Christmas season of gatherings, caroling and travel is unlikely, say public health experts who encourage those who revel in holiday traditions to accept more sacrifices ahead. THE CANADIAN PRESS/Justin Tang
Ho, ho, no: Experts advise preparing for a scaled-back COVID holiday season

Many of the holiday season’s highlights have already been scrapped or are unlikely to take place

Sen. Kim Pate is shown in Toronto in an October 15, 2013, file photo. The parliamentary budget office says a proposed law that would give judges discretion on whether to apply a lesser sentence for murder could save the federal government $8.3 million per year. THE CANADIAN PRESS/Colin Perkel
Judicial discretion for mandatory minimum sentences for murder would save $8.3M: PBO

The result would be fewer people in long-term custody at federal correctional institutions, experts say

Most Read