RE: Surgical and obstetrical services for rural and Indigenous Canadians
References
Jason A. McVicar, Alana Poon, Nadine R. Caron, et al. Postoperative outcomes for Indigenous Peoples in Canada: a systematic review. CMAJ 2021;193:E713-E722.
Smylie J, O’Brien K, Beaudoin E, et al. Long-distance travel for birthing among Indigenous and non-Indigenous pregnant people in Canada. CMAJ 2021;193:E948-55.
Orser BA, Wilson CR. Canada needs a national strategy for anesthesia services in rural and remote regions. CMAJ 2020;192:E861-3.
Orser BA, Wilson CR, co-chairs. Symposium on anesthesia care and pain medicine in rural and remote regions of Canada; 2020 Nov 20–21. Toronto: University of Toronto, Temerty Faculty of Medicine, Department of Anesthesiology and Pain Medicine; 2021. Availa
Two recent articles highlight health care inequities for Indigenous Peoples in Canada. Relative to the non-Indigenous population, these groups had a 30% higher rate of death after surgery, limited access to certain surgeries and higher complication rates.(1) They also experienced reduced access to birth care close to home.(2) Anesthesia care represents an essential foundation for both surgical and obstetric services, and limited availability of anesthesia care providers may have contributed to these inequities.
Provincial governments need to respond to the national shortage of anesthesiologists by expanding the number of training positions for specialist anesthesiologists, as well as for family practice anesthetists, who serve rural communities.(3) A recent report on rural anesthesia care identified additional strategies.(4) These include addressing the maldistribution of physicians, by providing access to suitable training, continuing professional education and mentorship for generalist family physicians with anesthesia skills. Medical schools must become more socially accountable, training anesthesiologists to meet population needs. Health policies must support small rural hospitals, recognizing the interdependence of surgery, obstetrics and anesthesia and promoting the networks of care with tertiary centres on which these hospitals rely.
The impact of the shortage of anesthesia care providers in rural Canada is unknown because relevant human workforce data are sorely lacking. However, strategies that propose quick fixes based on anecdotal evidence are ill-advised. A reliance on foreign-trained physicians or the creation of new classes of care providers will not address the needs of those living in rural Canada. Our current models of anesthesia training and care delivery work exceptionally well but are markedly under-resourced.
Expanding training programs and developing collaborative relationships with Indigenous and rural communities, policy-makers and academic departments will help to address some of the inequities identified in the CMAJ articles.(1,2)