Stats Can under-represents rural shortage

I suspect that Statistics Canada's interpretation of the data presented in a recent CMAJ news article¹ under-represents the shortage of rural practitioners. Marc Hamel of Stats Can feels that the data do not indicate that people in rural areas have more trouble finding a doctor. However, I think the data are misleading, in that practitioners in small communities cannot “close” their practices to new patients —there is simply nowhere else for patients to go. Thus, even though people in rural communities may report that they have a family doctor, there is no mention of how easy it is to get an appointment with that doctor. That rural doctor probably has a significantly longer patient list than the average nonrural practitioner, as well as other responsibilities that decrease the time available for office appointments.

A quick straw poll in my own region of northeastern British Columbia seems to support this. In the 2 larger communities of Fort St. John and Dawson Creek, with several medical clinics serving over 30 000 people each, very few doctors are taking new patients. In contrast, in the small communities of Chetwynd, Fort Nelson and Tumbler Ridge (each of which has only one clinic), all doctors are seeing new patients.

Therefore, although at a superficial level it may appear easier for patients to find a family doctor in smaller communities, these communities have significant physician understaffing relative to their larger counterparts and therefore inferior access to care. I don't think it is too much of a stretch to suggest that the apparent small difference in finding a GP between rural and urban settings actually under-represents the true difference in access to medical care.

Paul Mackey Rural Physician Fort St. John, BC