DrCaleb DrCaleb:
That assumes Doctors are only in it for the money. Most who are, move to the US. The rest are more concerned about patient care. Fund the rural hospitals like the big city ones, and I bet you attract more doctors than by raising pay.
At the risk of boring everybody, this is the way I look at it and I should say that as a retired rural physician (from the other end of the country) I’m obviously biased on this. Unless you’re jumping out of a fire, few human actions are rarely motivated by one cause. Essentially, they are like resultant vectors with a fair few vectors going off in all directions summed together. I see medicine as something like a better paid version of the military. Although perhaps on average a bit tougher and more altruistic (myself excepted), doctors are basically like the rest of us and are motivated by much the same things. Money, location and conditions of work are key factors although Canadian trainees have been educated not to bring these up too much. Before I retired I used to interview medical graduates for a specialty training program and I much preferred foreigners like me because they would bluntly say refreshing things like, “I couldn’t get into the surgical residency program so I applied for this” instead of sweet nothings along these lines: “I’ve always admired this specialty and wish to practice eventually in the remotest location possible”.
Young people love the city - there’s lots to do and their friends are there. There’s a class factor too, especially for females, as cities offer more potential mates of the same status or higher than small towns do. Enough said on the psychosexual front. On conditions of work, the contrast is obvious in one crucial area - call. Large urban medical centres
generally protect doctors better from excessive call which is the one thing that grinds even the most enthusiastic doctors down. What you see is
call flight to such centres - ideally, getting into a one in four or better call schedule where you have residents and experts around you and are only responsible for a very specialized area that doesn’t require you to get up very often during the night. (I deliberately chose a specialty with very light call duties.) Contrast that with being an internist in outback Canada, sometimes doing 1 in 2 or even 1 in 1 call with no residents - often working all night and then doing your regular job all day, for days. These guys are physically wrecked after a week of that, and if anything goes wrong you’re judged by the same standards as your colleagues downtown. It’s no wonder we so often leave such jobs to the foreigners, sometimes with little experience.
The successful rural centres are those that retain a critical mass of doctors, keeping call tolerable and avoiding a churn of new people coming through. So given that location and conditions of work usually favour the city, we’ve got a decision to make. We can either fund rural hospital posts properly or centralize care and spend money on better patient transport. As medical budgets are going to to be tight for the foreseeable future, the money to keep rural doctors in place should come from the city. Just my two cents.