C/O Luis Melendez

Medical students from rural backgrounds can help resolve the inequities of the Canadian healthcare system 

While the Canada Health Act has always maintained that all Canadians should have equal access to healthcare, the unfortunate reality is that this ideal is far from the truth. Although many Canadian cities have sufficient doctors for their population, the same cannot be said for rural communities.  

Comparatively studying the doctor-per-capita ratios between urban and rural communities exposes a harsh inequity. In fact, the country’s overall value for doctor-per-capita is one in 450 while rural areas average one doctor for every 3000 residents.  

Clearly, there is a severe problem in our current healthcare system that needs to be resolved. Unfortunately, this statistic cannot be taken at face value and the snowball effect that is a result of this inequity must be studied as well. 

Due to limited access to healthcare, individuals living in rural areas are more likely to have a significant disease burden. What this means is by the time someone in a rural community can see a doctor, their disease has progressed even further leading to higher rates of chronic disease and poorer mental health.  

If you take a step back and really look at the problem, you notice that by allowing this population to go underserved, the Canadian healthcare system is essentially shooting itself in the foot. They are manifesting a sicker and more expensive population, in concordance with their healthcare needs.  

By now, I’ve hopefully illustrated the dire need for a solution. My proposition? Increase medical school admissions for students with a rural background.  

Studies have shown that when students who come from rural communities are admitted into medical schools and ultimately become physicians, they are more likely to practice in rural areas. Unsurprisingly, medical schools that have noticed and applied this phenomenon in their admissions strategies have seen benefits. 

The Oregon Health & Science University School of Medicine visits undergraduate students in rural areas who have an interest in healthcare and guides them through the admissions and financial aid processes. By providing guidance to students from a rural background and linking them to residencies in rural areas, OHSU has proven successful in filling the gap. 

This is especially impactful when you consider that over 50% of medical residents in the United States end up practicing in the state they trained in.  

It’s undeniable that one possesses an innate connection to the community that they grow up in. This connection to serving rural communities is one that is best understood by students who have lived there and have the drive to give back to those exact areas.  

The medical community should look to advance the practice of culturally competent care — care that meets the cultural and social needs of diverse communities. Where better to start than the medical schools themselves?  

Other plans, such as incentivizing doctors to practice in rural areas with higher salaries have proven expensive. Rather, medical schools should commit to leveraging the passion that already exists in so many students that have a better understanding and connection with Canada’s rural areas.  

Students volunteering on the frontlines speak on their experiences during these difficult days

This article is a part of the Sil Time Capsule, a series that reflects on 2020 with the aim to draw attention to the ways in which it has affected our community as well as the wider world.

The COVID-19 pandemic has been at the forefront for much of this year, even before it was officially declared as such in early March. It has affected every one of us in some way and has rightly dominated our news headlines. The pervasive nature of the pandemic has also drawn our attention to the indispensable but often unrecognized work of those who have been on the frontlines of this crisis.

Hospital staff are, of course, among this group, having been involved with the pandemic since the beginning. However, the crisis has drawn attention to essential work done by not just the nurses and physicians, but also the administrators, janitors, paramedics, screeners, security workers, social workers and x-ray technicians among many others.

The pandemic has also drawn attention to the essential services and workers beyond the hospital, including construction workers, firefighters, gas station and grocery store clerks, long-term care home workers, social services workers, teachers, transit operators, truck drivers and utility services workers. This list does not even begin to scratch the surface of how many frontline workers still go to their job each and every day in order to make our lives easier.

Prior to the pandemic, arguably many people took these services for granted and those working in these industries received little recognition for their work. Now, these individuals are at the forefront of the crisis, keeping our communities going during these difficult days. It has never been more apparent just how essential they are.

Before the pandemic, many students already occupied jobs that are now considered essential. In 2007, 61% of working full-time students were employed in the retail and foodservice industries. Heading into the pandemic, individuals aged 15 to 24 were more likely than other age groups to hold jobs in industries hit hard by the pandemic, such as accommodation and foodservice.

Fourth-year student Alyssa Taylor has been working at her café job for 2 years. When the pandemic hit, she continued to work.

“Working during the pandemic has been a strange time. Every shift I came into, especially near the beginning, there were new rules and protocols that were never really explained thoroughly. Everyone really got thrown into it and we had to figure things out for ourselves, much like the rest of the world during this time and it was difficult. Although there were many challenges, it was good for me personally because I began to get more hours, responsibility and seniority at work,” said Taylor.

"Every shift I came into, especially near the beginning, there were new rules and protocols that were never really explained thoroughly. Everyone really got thrown into it and we had to figure things out for ourselves, much like the rest of the world during this time and it was difficult," said fourth-year student Alyssa Taylor.

Many other students were prompted to help out in any way they could. Senior nursing students have continued to do clinical placements and many have also worked with community organizations in Hamilton on an initiative to provide homeless individuals and those at risk of homelessness with necessary personal protective equipment, such as masks.

Students have been involved in a number of other capacities as well. Some students have decided to make masks and other PPE for healthcare workers. Others volunteered in food services and healthcare settings. Shalom Joseph and Emma Timewell were among these students volunteering on the frontlines.

“We were like: “we need to do something, we need a job, we need to keep ourselves occupied” and then we noticed a lot of other students are doing the same thing. They were doing their thesis or they were just taking a semester off and they were working at the hospital. [There were also] a lot of [University of Toronto and Ryerson University] students, like nursing students even just generally working [at hospitals], giving their time back. And it was really nice to see that,” said Joseph.

Joseph volunteered as a COVID screener at a Toronto hospital emergency room. He was one of the first points of contact for patients arriving at the hospital and would ask them what has now become standard questions regarding symptoms and travel history.

Joseph volunteered as a COVID screener at a Toronto hospital emergency room. He was one of the first points of contact for patients arriving at the hospital and would ask them what has now become standard questions regarding symptoms and travel history.

Joseph felt that it was important to give back to his community which had supported him during his own difficult days. However, watching the pandemic unfold in this way has been extremely difficult and emotionally draining work.

“It's a role that's mentally daunting . . . it's really hard to stop thinking about the occurrences of an ER and the events of an ER when you don’t want to. You process these events and memories later on when you're ready to process them and that's not something that everybody understands. Not everybody understands that when you work a job in the hospital, or even anywhere that could have that sort of effect on you, that you need some time afterwards to relax and to form a community while doing that — it's very difficult because you have to focus on one thing at a time,” explained Joseph.

"Not everybody understands that when you work a job in the hospital, or even anywhere that could have that sort of effect on you, that you need some time afterwards to relax and to form a community while doing that — it's very difficult because you have to focus on one thing at a time,” explained Joseph.

Additionally, Joseph mentioned that while he is grateful that he is able to do this for his community, he has found that it has made it more difficult for him to connect with other parts of his community, such as friends from McMaster. In part, because he has spent so much time on the frontlines, Joseph is well acquainted with the risks of coronavirus and has been very strict with regard to following social distancing guidelines and other pandemic protocols. However, this is something that many of his friends did not understand or agree with.

“So me and my friend groups [have not been] as close as we were. Some people in my life did take offence to that. They did say, “oh, you're being too worried about it" or, "you're taking it too far, we haven't seen each other in six months”,” said Joseph.

Timewell was on exchange in the United Kingdom when the pandemic was declared and chose to remain there rather than return to Canada. Over the summer months, she volunteered with a local food delivery program, packaging groceries and delivering them to members of the community who were self-isolating.

Timewell was on exchange in the United Kingdom when the pandemic was declared and chose to remain there rather than return to Canada. Over the summer months, she volunteered with a local food delivery program, packaging groceries and delivering them to members of the community who were self-isolating.

Though it was often difficult and demanding work, both mentally and physically, Timewell felt that her volunteer work had not only given her something to do during the lockdown but also, as someone new to the community, it gave her the opportunity to connect with people.

“Especially during the heart of the first lockdown, it really helped me feel a part of a community that I didn't even live in before the pandemic started. Because we're doing all these deliveries and stuff, I got to know the actual physical location really well. I've been to every square inch of this borough that I never lived in before and then also, I got to know a lot of people that I would never have met and not just young people [either]. There were a lot of people who had lost their jobs and so they were volunteering because they couldn't find a job at the time, or [people] who were retired who would come and talk. Or even on our deliveries, we got to have short conversations [with people in the community],” said Timewell.

Connections and community are so important during trying times and in many ways, frontline workers have been a rallying point for communities. People have come together to support these essential services workers, offering their help in a variety of ways from childcare to therapy.

Additionally, as Timewell mentioned, volunteering or working in these services can facilitate the formation of new connections, especially for students who are not able to connect with their usual community in the same way.

“I think it's been really difficult not being able to be on campus. I think it takes away a lot of the community . . . I think [volunteering] can be a great opportunity for a lot of people to have a little bit of social interaction at a time that isn't really built for that,” added Timewell.

“I think it's been really difficult not being able to be on campus. I think it takes away a lot of the community . . . I think [volunteering] can be a great opportunity for a lot of people to have a little bit of social interaction at a time that isn't really built for that,” added Timewell.

As we move forward into the winter months, our frontline workers are going to be increasingly more important and it is imperative that we continue to support them and each other now, but also after this crisis has passed.

Sarah Yuan
The Silhouette

The topic of two-tier healthcare systems has been a frequent subject of discussion since Dr. Jacques Chaoulli’s win against the Attorney General of Quebec and the Attorney General of Canada. Though the arguments for the privatization of healthcare are sensible, there are many underlining factors that must also be considered. Canada has the second most expensive health system in the world in terms of GDP, but we don’t have the second-best health outcomes in the world. Our beyond-expensive system offers us just mediocre outcomes. It is true that our capabilities should be much higher but moving towards the establishment of a two-tier healthcare system is not the answer.

Contrary to belief, having more private funding will not improve the sustainability of our healthcare system. Countries in which private spending is high actually spend more in total on healthcare. The U.S., for example, spends more public dollars per person than Canada does and yet 48 million Americans remain uninsured. It seems that Americans are not getting much more after paying all these extra expenses, but they do pay much higher prices for what we as Canadians take for granted.

On top of that, private clinics often “cherry-pick” the healthiest patients with minor or acute care needs (people who are the most profitable). More complicated and chronic patients are often denied services because they require more time and care, resulting in a decline of the clinic’s profit.

If Canadian physicians were permitted to give private care to patients, an equitable portion of people who make a reasonable living will be able to choose to spend a few hundred dollars to see a good physician or maybe even a couple thousand to have some cataract surgery done immediately. Sounds like a good plan, right?

Although a loan might be required for surgery, your medical expenses should be deductible from your taxes in April. This would satisfy almost everyone who is employed except the millions of poor people, pensioners, immigrants, people with disabilities, and people with large families who don’t have sufficient resources to experience such luxury.

Moreover in countries that have two-tier systems, typically only the wealthiest can afford such service. In the U.K. for example, only 11.4 per cent of the population holds a subscription to private health insurance. In other words, a majority of Canadians would not actually benefit from being able to purchase private health insurance as they will either not qualify for it, or they won’t be able to afford the premiums.

Ultimately it’s no secret that there isn’t really an equality of access in the Canadian medical system, as those with better education and better connections can more effectively find a way to receiving prompt treatment. A study that appeared in the Canadian Medical Association Journal found that wealthier patients were 50 percent more likely to be taken on as new patients by doctors than welfare recipients.

It is worrisome to find a conspicuous bias against poor patients within our healthcare system. Not only do they have fewer resources than wealthier patients, but they also face many more barriers to good health and are the ones who will benefit the most from the access to a physician.

Allowing the establishment of a two-tiered healthcare system is to allow the drawing of a thick and definitive border between the rich and the poor. Access to healthcare should be based on an individual’s need and not their ability to pay. If available resources are restricted we should revisit what is and is not essential. Healthcare should never turn into a competition for those earning the greatest profit.  Is this what you would want for the country we’ve all lived in and loved?

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