Physician Services in Rural and Northern Ontario
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Enhancing the effectiveness of health care for Ontarians through research Physician Services in Rural and Northern Ontario ICES Investigative Report January 2006 Physician Services in Rural and Northern Ontario ICES Investigative Report Authors Joshua D Tepper, MD, MPH Susan E Schultz, MA, MSc Deanna M Rothwell, MSc Benjamin TB Chan, MD, MPH, MPA January 2006 Physician Services in Rural and Northern Ontario Publication Information Publication Information Published by the Institute for Clinical Evaluative Sciences (ICES) © 2005 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the proper written permission of the publisher. How to cite this publication Tepper JD, Schultz SE, Rothwell DM, Chan BTB. Physician Services in Rural and Northern Ontario. ICES Investigative Report. Toronto: Institute for Clinical Evaluative Sciences; 2005. Institute for Clinical Evaluative Sciences (ICES) G1 06, 2075 Bayview Avenue Toronto, ON M4N 3M5 Telephone: 416-480-4055 www.ices.on.ca Institute for Clinical Evaluative Sciences i January 2006 Physician Services in Rural and Northern Ontario Authors’ Affiliations Authors’ Affiliations Joshua D Tepper, BA, MD, MPH Former Associate Scientist, Institute for Clinical Evaluative Sciences Assistant Professor, Department of Family and Community Medicine, University of Toronto Susan E Schultz, MA MSc Senior Research Coordinator, Institute for Clinical Evaluative Sciences Deanna M Rothwell, MSc Senior Biostatistician, Institute for Clinical Evaluative Sciences Benjamin TB Chan, BSc, MD, MPH, MPA Adjunct Scientist, Institute for Clinical Evaluative Sciences Chief Executive Officer, Health Quality Council, Saskatchewan Adjunct Professor, Department of Community Health and Epidemiology, University of Saskatchewan Institute for Clinical Evaluative Sciences ii January 2006 Physician Services in Rural and Northern Ontario Acknowledgments Acknowledgments ICES wishes to thank the following individuals for their key advisory role in the production of this report. Internal Critical Review Andreas Laupacis President and CEO, Institute for Clinical Evaluative Sciences Douglas Manuel Scientist, Institute for Clinical Evaluative Sciences Astrid Guttman Scientist, Institute for Clinical Evaluative Sciences External Critical Review (selected sections) Lynn Bury and Charlotte Kirby Professional Association of Internes and Residents of Ontario Lisa Harris and June Dyson Ontario Medical Association Peter Hutton-Czapski Society of Rural Physicians of Canada–Ontario Chapter Programming and Biostatistics Cindy Li Senior Analyst, Institute for Clinical Evaluative Sciences Kinwah Fung Analyst, Institute for Clinical Evaluative Sciences Minh Le Duong-Hua Analyst, Institute for Clinical Evaluative Sciences Knowledge Transfer Paula McColgan Vice President, Policy and External Relations, Institute for Clinical Evaluative Sciences Camille Marajh Manager, Institute for Clinical Evaluative Sciences Laura Benben Senior Web and Graphic Designer, Institute for Clinical Evaluative Sciences Institute for Clinical Evaluative Sciences iii January 2006 Physician Services in Rural and Northern Ontario About ICES About ICES Ontario’s resource for informed health care decision-making ICES (Institute for Clinical Evaluative Sciences) is an independent, non-profit organization that conducts research on a broad range of topical issues to enhance the effectiveness of health care for Ontarians. Internationally recognized for its innovative use of population-based health information, ICES knowledge provides evidence to support health policy development and changes to the organization and delivery of health care services. Unbiased ICES evidence provides fact-based measures of health system performance; a clearer understanding of the shifting health care needs of Ontarians; and, a stimulus for discussion of practical solutions to optimize scarce resources. Key to ICES’ research is our ability to link anonymous population-based health information on an individual patient basis, using unique encrypted identifiers that ensure privacy and confidentiality. This allows scientists to obtain a more comprehensive view of specific health care issues than would otherwise be possible. Linked databases reflecting 12 million of 30 million Canadians allow researchers to follow patient populations through diagnosis and treatment, and to evaluate outcomes. ICES brings together the best and the brightest talent under one roof. Many of our faculty are not only internationally recognized leaders in their fields, but are also practising clinicians who understand the grassroots of health care delivery, making ICES knowledge clinically-focused and useful in changing practice. Other team members have statistical training, epidemiological backgrounds, project management or communications expertise. The variety of skill sets and educational backgrounds ensures a multi-disciplinary approach to issues management and creates a real-world mosaic of perspectives that is vital to shaping Ontario’s future health care. ICES collaborates with experts from a diverse network of institutions, government agencies, professional organizations and patient groups to ensure research and policy relevance. Institute for Clinical Evaluative Sciences iv January 2006 Physician Services in Rural and Northern Ontario Contents Contents Publication Information ................................................................................................. i Authors’ Affiliations...................................................................................................... ii Acknowledgments........................................................................................................ iii About ICES ................................................................................................................... iv Executive Summary ...................................................................................................... 1 Issue .........................................................................................................................................1 Study.........................................................................................................................................1 Key findings ..............................................................................................................................1 Implications ...............................................................................................................................2 Overview ........................................................................................................................4 Introduction ...............................................................................................................................4 Background...............................................................................................................................4 Levels of analysis......................................................................................................................5 Geographic framework..............................................................................................................5 New approaches .......................................................................................................................8 Chapter 1. Characteristics of Rural and Northern Communities in Ontario .......... 10 Introduction .............................................................................................................................10 List of Exhibits.........................................................................................................................10 Exhibits—Findings ..................................................................................................................11 Discussion...............................................................................................................................24 Chapter 2. Government-funded Policy Initiatives to Address Rural and Northern Physician Issues........................................................................ 25 Introduction .............................................................................................................................25 List of Exhibits.........................................................................................................................25 Exhibit—Findings ....................................................................................................................26 Discussion...............................................................................................................................33 Chapter 3. Physician Supply ...................................................................................... 34 Introduction .............................................................................................................................34 List of Exhibits.........................................................................................................................34 Exhibits—Findings ..................................................................................................................35 Discussion...............................................................................................................................39 Institute for Clinical Evaluative