Health committee  One of the things that was mentioned earlier was that we need a mechanism to bring all the stakeholders together, from the community level up through the various professions, to generate the recommendations that have the broadest consensus possible that we can bring to whatever level of government is the appropriate one for the recommendation.

Health committee  As far as the definition of rural goes, I would strongly encourage you to steer away from trying to completely understand it, because it's a moving target. If you are a researcher, you need sort of a Statistics Canada definition. If you're a health planner, you need more a style of practice definition.

Health committee  The quick answer to that is that there is more appetite for a global capitation-type system, because one of the characteristics of rural areas is that volumes are unpredictable. Emergency rooms, for instance, may be quiet or may be overwhelmed from one day to the other. Just to add a point about the distributed education point, we're in the middle of a Canadian experiment.

Health committee  With reference to the locum licence, the Society of Rural Physicians has long lobbied for a mechanism for locum licence. A rural physician's best replacement is another rural physician, and it's not true that every community is in crisis across the country at the same time. For physicians a change is often as good as a holiday, and many are very interested in seeing other parts of the country, but when it involves buying a licence for an entire year....

Health committee  I can speak from the experience in Quebec. The incentive structure that works best, in my mind, is one that is tied to the characteristics of the practice. In other words, the major thing that distinguishes a rural physician from his urban colleague is—and the word is best in French—la polyvalence de la pratique: the fact that the physician is responsible for patients who are sick in hospital and who may be in the intensive care unit, or they may be obstetrical patients; the physician will also have an office practice and may be on duty in the emergency room and have to deal with trauma.

Health committee  I'll just make a first comment. Roger is working in a more northern area than I am, but I have worked in Sioux Lookout in his area. Fundamentally, from a health human resources perspective, I think there's a great deal of similarity. There are a lot of physicians and nurses who move from isolated communities in the north to rural communities farther south.

Health committee  Thank you very much. I appreciate this opportunity. I will give my presentation mostly in English, but I can answer your questions in French if you wish me to. I practice in the Outaouais region, on the Quebec side, about an hour from here. So I am the closest from Ottawa. The Society of Rural Physicians is a national organization that brings together physicians who share a common style of practice and common challenges across rural Canada and northern Canada.

Health committee  Mostly we're trying to pull all the retired nurses back into the fray. Already in rural Canada, when we have residents and students, we give them a lot of responsibility, so they certainly take some of the load that is appropriate to their level of training. The Society of Rural Physicians really tries to take the long view on all of this.

Health committee  I don't think it's an issue of supplies; it's mostly an issue of manpower. In most rural communities the essential services are covered by people who are working flat out already. If 30% of them are sick, then there will be difficulty covering emergency departments. I had one note from Golden, which is in the Rockies and gets a lot of accidents off the highway.

Health committee  Thank you, Madam Chair. I appreciate the opportunity of appearing before you. I have Cecelia Li with me, whom I dragged into this. She's a medical student who's currently doing a rural rotation in Shawville, just down the road. She's part of the group that is the relief, the cavalry coming over the horizon, and we hope to interest her in rural practice.

Human Resources committee  The most crucial part is to counter the tendencies in our society toward centralization and specialization. We should privilege versatile human resources, something which is the opposite of specialization. That is why people were much more versatile fifty years ago. Even the demands in our society are more for specialists than for generalists.

Human Resources committee  Mr. Romanow's recommendations were not implemented, and there was no investment. When I was with Health Canada's rural health office, some investments were made. There was a $50 million investment in programs, and it was distributed according to a provincial formula. But it was used mainly for pilot projects.

Human Resources committee  We consider the programs that are implemented by the provinces to deal with these problems. Provinces are quite capable of making decisions at a certain level, more particularly in their own fields of jurisdiction, as concerns the financing of the system and the distribution of resources.