Training an adequate number of rural family physicians.

A ll measures indicate a shortage of rural family physicians (FPs) in ever y province in Canada. In 1999, the College of Family Physicians of Canada (CFPC) approved, and the Society of Rural Physicians of Canada (SRPC) endorsed, a national plan to train doctors for rural family practice. 1-4 Substantial progress is being made in training doctors for rural family practice, but we are only halfway there. Educating an adequate number of appropriately trained rural FPs will require doubling the number of rural-regional family medicine training positions. In this editorial, we summarize the rationale for that action and consider the number of physicians needed. A common definition of " rural " communities in Canada includes those with populations of up to 10 000 people. By this definition, 8 740 847 Canadians (30.3%) are rural. 1,2,5 Rural people can also be defined as those living outside census metropolitan areas and census agglomerations. By this definition, 6 396 906 Canadians (22.2%) are rural. 1,2,5 A census agglomeration is defined as " a large urban area (known as an urban core) together with adjacent urban and rural areas (known as urban and rural fringes) that have a high degree of social and economic integration with the urban core. " A census agglomeration has an urban core population of at least 10 000, based on the previous census. Rural practice can then be defined as practice outside census metropolitan and census agglomeration areas. By that definition, only 9.9% of Canada's doctors—4775 FPs/GPs (16.5% of Canada's FPs/GPs) and 756 specialists (2.8% of Canada's specialists)—can be considered rural (numbers as of Januar y 1998). 6 In the CFPC's Janus Project, 4179 FPs/GPs identified themselves as primarily serving rural or remote populations. 2 A useful functional definition of rural practice is " practice in non-urban areas, where most medical care is provided by a few GPs or family doctors with limited or distant access to specialist resources and high technology health care facilities. " 7 Too much work; too few doctors Compared with doctors in urban areas, r ural physicians are older and more likely to be male. 6 In addition to office-based practice, housecalls, and nursing home visits, many rural physicians are actively involved in direct hospital management of patients, including obstetric deliveries, emergency department shifts, and anesthesia, to a far greater extent than their urban counterparts. 2 Those " second jobs " are often done …