Closed emergency facilities, hard-to-find family doctors, an absence of medical support services – each is a reality through much of rural Ontario, and inadequate funding makes solutions just as scarce.
Some say greater investment in the health care sector is ideal. However, supportive policies targeted to rural communities, as well as more long-term thinking toward community development, are required, according to Kelly Elliot, deputy mayor of Thames Centre and Middlesex County.
Why it matters: Rural healthcare systems were struggling before the pandemic. Strain and lack of resources suitable for growing populations exacerbated the problem.
“Emergency room closures, doctor shortages, etc. are all huge concerns and only exasperate the issues in our larger centres. There’s a huge inequity in terms of health access, even just in southwestern Ontario,” says Elliot.
Her municipality sees the same challenges as many rural communities even though it has resources nearby in major urban centres.
Thames Centre has no hospital, although residents can travel to Stratford, St. Mary’s, London, Woodstock, Ingersoll or further afield if they chose, provided the emergency facilities are open in light of ongoing, rotating closures.
Even when open, it’s sometimes recommended patients visit larger, better-resourced urban centres. Elliot attests to this, having previously been told by colleagues working at the St. Mary’s hospital that her time would be better spent driving to London from her home in north Thames Centre.
“Before COVID, access was an issue just from a geographical standpoint. A rural area equals a drive, always. Smaller hospitals have comparatively few resources. But because rural residents can’t go to their local hospitals, and are being pushed to urban hospitals, there’s more pressure on urban hospitals too.”
Hospital resources aside, lack of family doctors is also endemic in rural areas like Thames Centre. Those that do manage to find a family doctor often find themselves joining patient lists in the thousands, says Elliot. Her own family physician has a client list 10,000 names long.
While there is provincial funding to help attract doctors to rural regions, the programming does not cover every non-metropolitan area.
“It only applies to 30 municipalities. That’s where a lot of small municipalities get caught. We’re too big for these programs but too small to do it on our own.”
The problem also extends to other forms of medical support.
“These things are not just a rural issue, but they’re certainly exacerbated in rural areas,” Elliot says. “Support was a huge issue during the pandemic, especially for middle-aged women caring for kids as well as aging parents. Even before that, getting access to programming, bringing [the elderly] to programming, to the appointments – then when everything moved online, rural internet isn’t great so it was even more of a hindrance.”
Jackie Kelly-Pemberton, Ontario Federation of Agriculture zone director for Dundas, Frontenac, Leeds and Grenville, expresses many similar concerns. She and her husband have had to navigate a string of health crises in the recent years, and, although they have a family doctor, many in the community do not. Those practicing in the community also have patient lists with thousands of names. New doctors sometimes take only a portion of the patients on their predecessor’s patient lists. Even her daughter, who has been living in Kitchener-Waterloo for 14 years, has been unable to find a doctor in the metropolitan region and continues to trek back to eastern Ontario for appointments.
Having undergone treatment for breast cancer in 2021, Kelly-Pemberton highlights the lack of investment in modern equipment in rural hospitals as a critical part of the problem. Having to travel to major urban centres for daily chemotherapy, for example, does nothing to reduce pressure on the health care infrastructure and professionals in urban areas.
She reiterates how lucky she and her husband are to have a family doctor with which they share a long-standing relationship. Not only did it help her navigate three years of cancer diagnosis and treatment – she believes it has also kept her husband alive after a rapid series of health issues.
“If he had not had a family physician, and a hospital so close, I truly think my husband would be dead,” Kelly-Pemberton says.
Development worsens problems
These issues are complicated by other factors. One pertains to rural residents having statistically higher rates of heart disease, lung cancer and other illnesses. Another is housing development, in that many municipalities face increasing pressure as more people move to small and mid-sized communities without the health care or education system resources to accommodate them.
With health care capacity not keeping pace with growth, the situation poses a paradox for communities like Thames Centre. How can someone encourage and attract others to rural communities in the face of limited resources?
Elliot says things have become so tight locally that the hospital in St. Mary’s asked her municipality to contribute financially.
“I don’t believe property tax should be funding hospitals,” she says, explaining why she supported denial of the request.
“Our rural areas are experiencing more health issues than our urban areas. Why? How do we stop it? I would absolutely believe that poor access is a part of that.
“If [residents] don’t have a family doctor, if they’re not going in for regular checkups…if that’s not a priority, issues are not getting caught early.”
Elliot says she believes Ontario’s health care system requires better resources as a whole, but smaller hospitals are in particular need of more investment. A lack of family doctors is similarly a top issue, and one that could be alleviated, at least partially, by expanding the rural and northern attraction program for doctors and nurse practitioners.
“Healthcare isn’t in the municipalities wheelhouse…if there’s a way municipalities and the province can work together to attract people to open clinics, I think that would be a phenomenal start.
Kelly-Pemberton adds more health care professionals might be enticed to settle in rural communities if governments make much-needed investments in pay equity, plus wider infrastructure investments in school capacity, public transportation, and even municipal water and waste systems – not to mention health care facilities themselves.
“It would help entice doctors to come if they knew they were not working with antiquated equipment…They don’t want to come to an area with no high-speed internet if their partner works from home.”