Rural hospitals: We can't do without them!
John Wootton, MD, CM, CCFP, FCFP
Shawville, Que.
Can J Rural Med vol 2 (2):59
© 1997 Society of Rural Physicians of Canada
In Alberta, Saskatchewan and Manitoba rural hospitals have been closed by the dozens. Ontario's Health Services Restructuring Commission has been blitzing communities, leaving confusion in its wake and the future of many rural hospitals in doubt.
Much of this activity is purportedly driven by economics, but closing rural hospitals for economic reasons can be short-sighted. There are persuasive clinical and demographic arguments that must be considered to understand fully the role of a rural hospital.
People should have access to emergency services within a minimum length of time, regardless of where they live. For example, in cases of myocardial infarction for which thrombolysis is necessary, 1 hour appears to be the maximum tolerable delay in treatment, although some might argue that it should be half this. As an indicator condition, myocardial infarction highlights the need for services and the concern that people living in rural areas feel when their local hospital is threatened.
The demographic argument, made recently in a popular management text,[1] is no less persuasive. As the effect of the baby boomer generation moves though the economy, hospitals will become increasingly important to rural communities competing to supply services to this group. As Foot1 explains,
"Over the next two decades, as 9.8 million baby boomers turn 50, we will witness a significant exodus from big-city Canada to small-town Canada. The participants in this exodus are going to need the same hospitals that provincial governments want to close in the mid-1990s. . . . A region that loses its local hospital may be losing its best chance for economic rebirth."
How best, then, to safeguard this precious resource? If our rural hospitals are to continue to play a central role in rural health care, they must play their trump card -- service -- effectively. They must be accessible to their communities and dispense essential, high-quality services. Existing services should act as magnets for the development of new ones: our rural hospitals must develop to the maximum those services that human resources and infrastructure will allow. They must lobby government to create conditions that favour recruitment and pressure our universities to provide graduates with the appropriate training. They must pester their administrators to provide properly equipped facilities and encourage their physicians to share their expertise and to support each other. Although resources in urban centres must be planned to accommodate any necessary transfers from the field, rural hospitals must act to minimize the number of cases in which transfer is required. Scoop and run, and you're done!
As daunting as this task is to rural hospitals already stretched to provide 24-hour emergency care, the alternative is that if services are not provided they will be deemed not to be needed and will be lost.
The role of the rural hospital in our communities must become better understood by all players if changes are to be equitable and respectful of the right of rural residents to high-quality, accessible medical care. Otherwise, rural residents will find themselves inheriting a patchwork system, full of hazards.
Reference
- Foot DK, with Stoffman D. Boom bust and echo. How to profit from the coming demographic shift. Toronto: Macfarlane Walter & Ross; 1996.
