Guest lots of thinking Posted March 12, 2003 Report Share Posted March 12, 2003 Heres a question that was just asked on a friends interview and I wanted to get others opinions on: How would you promote rural medicine, ie how would you recruit doctors to work in rural areas? Link to comment Share on other sites More sharing options...
Guest Emila Posted March 12, 2003 Report Share Posted March 12, 2003 There are a lot of people who grew up in rural areas and would probably like to practice there. I think accepting people from these areas into medical schools (if they were interested in working there) would help increase the number of rural doctors. I might be a little biased on this question. As a child I lived on a farm where the nearest neighbours were a few kilometres away. As a teenager, I lived in a small village (~50 houses) where most of the houses were built in the early 1800s. It had a general store and a saw mill. Everyone knew each other. It was surrounded by farms. We had a well for water and an aerial for tv (cable wasn't available). While we didn't have all the luxuries of city life, it was a much more warm and caring community. I'm at university in Waterloo now and I've also had the opportunity to live and work in Toronto for 2 years. I really don't enjoy city life that much. I found it so hard to adjust. Not knowing the other people in a huge apartment building is so strange to me. When I lived in the country, I never even thought of locking the car or the house. In Toronto I had an apartment that had three different locks on the door! And there is soooo much traffic. If I get accepted to medical school, I definitely want to work in a small community and not a city. Also, a lot people from the area where I grew up didn't finish high school or go on to university. There really needs to be more public education in this respect. People from universities need to travel to rural high schools and get kids interested. When I came to university, I knew absolutely nothing about medical school. Having medical school representatives come to these areas could get more applicants from them in the future. It definitely would have gotten my interest a lot earlier. Well, this is just my opinion. What do other people think? Link to comment Share on other sites More sharing options...
Guest MayFlower1 Posted March 12, 2003 Report Share Posted March 12, 2003 ...hmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm.... I think there are a few things that might be worthwhile exploring: 1) Consider providing government-funded education (i.e., read "Free") for people from these communities to go through medicine. The people who live in the remote communities are most likely those who have a vested interest. Also, make it really easy for those from these communities with acceptable qualifications (i.e., GPA, etc) to get into medical schools. 2) Provide financial incentives to docs willing to sign long-term contracts to practice in remote areas. Provide them with free housing...potentially, a "remote practice" bonus. 3) Integrate rural medicine more formally in medical education. The more people who have exposure to it, the greater the number that may find they enjoy and want to pursue it (idea directly stolen from Romanow) Just a few ideas. I'm sure there are a ton more. Peter Edited a bunch of m's out because they were screwing up the table formatting. -Ian Link to comment Share on other sites More sharing options...
Guest Koggetsu Posted March 12, 2003 Report Share Posted March 12, 2003 another thing I think that needs to be looked at is increasing the equipment, facilities and other trained medical personnel (like nurses) available in rural areas cause I heard that there is a shortage of all these things there. And even if u have 100 more doctors and u lack all these other things it would still make their job very difficult. I know for myself, even if u offered me a lot of money, but i didn't have the proper personnel or equipment to work with, I wouldn't want to go there and work. Also what about an idea where u rotate doctors up there for certain clinics? let say u go up there for 4mths a year or something like that? cause I wouldn't mind doing something like that although I doubt I would enjoy living in that environment for tthe whole year. can anyone give me some insight on something like this? Link to comment Share on other sites More sharing options...
Guest lots of thinking Posted March 12, 2003 Report Share Posted March 12, 2003 What do you guys think about telemedicine. Instead of necessarily increasing the number of doctors in rural areas, what if instead, the technology was put in place in rural areas so that many health concerns (even surgery) can be done by specialists from another city?? just a thought. I personally don't think this is the answer although I do think the possibilities of telemedicine are pretty amazing!! M Link to comment Share on other sites More sharing options...
Guest shutterbug Posted March 12, 2003 Report Share Posted March 12, 2003 I actually did a small project on telemedicine last term. Telemedicine covers everything from Telehealth Ontario to remote surgery. Then there are sub categories like telephsychiatry, tele/remotesurgery, or tele_____, etc.. In other words, there really isn't a fixed definition of telemedicine. Telesurgery With remote surgery you have an effector or robot end that interacts with the patient. The doctor then controls the robot end via manipulators. Advances in telecommunications allows the two ends to communicate. I think that remote surgery is being driven from engineering/research...it's still cheaper to fly a specialist to wherever you may need them. If that place is very remote then what are the chances that you'll have the support structure in place to support the robot/effector end. That is, you'll still need an operating room, nurses, anethesiologists, etc. Some company in the US has gotten FDA approval for a laproscopic remote surgery machine. I think it's called DaVinci. Anyways, it's only approved if the surgeon using the remote is in the SAME room as the robot end. Not very remote right now. It's kinda cool with its 3D needle camera thing and force feedback controls. Sounds like something the Nintendo generation would pick up really fast. Video Conference Appointment Michigan has been using video conferencing to connect doctors with immates for a while. For some reason they can't seem to recruit doctors to work in prisons. Anyways, a nurse is present with the imate so the doctor can instruct the nurse to perform physical examinations if necessary. Supposedly, the visual aspect is meant to increase the degree of 'connectiveness' (Peter maybe you can elaborate). But, if anyone has ever video conferenced before you know that its only remotely better than the telephone. In the end, this saves the prison system money since they only use this for routine care. I guess this is better than no doctor...but, I would prefer to see a flesh and blood doc. Online Patient Management One step up is the secure online patient management system (or something to that effect). This grew out of increased use of email/computers for communication. But, email is not good for patient-doctor communications since it is largely unsecure, one-way, etc. Some company in California (I believe) has created a secure system that is meant to 'complement' the way people see family docs now. The patient logs onto the network and works through a wizard (like when you install a new program). Somewhere, somehow a doctor is monitoring this?.? Legal and Licensing Issues One of the more interesting and down to earth issues with telemedicine concerns licensing and compensation. With the advances in the internet geographical borders are essentially gone. So, how are you going to work all that out. So, if I'm licensed in Ontarion can I examine someone in the US; what if I mess up; how will I be compensated for my time. Remote Monitoring Remote monitoring can also be beneficical for home care. You would have a base station set up in you house. At set times you would hook yourself up to it to take meaurements of whatever. Then that info is processed and sent to (maybe) a doctor...or computer! This saves money by not requiring the patient to drop by the hospital/clinic for routine tests and it may pick things up at an earlier time isnce you have a historical reading which can be assessed for wierd trends. Remote monitoring will be (is actually) used to monitor icu patients. All those leads coming from the patient will be fed into a central computer. Now, you can design a system to set off alarms, warn doctors, etc... Electronic Health Record I think this is definitely coming in the next 10 to 15 years....maybe sooner. Basically, a record is created as soon as you are born (maybe before) and stays with you forever (maybe this record could even cross national boundaries). Everytime you go to an ER, your family doc, get a prescription filled etc your record is then updated. The information does not have to be stored on a computer somewhere; it could be stored on a smart card similar to the health card we all have now. Of course there would be layers and layers of security installed. This information store would be a huge asset for whomever is treating you. It could also be tapped for population based studies. There are other pros and cons as well. Link to comment Share on other sites More sharing options...
Guest MayFlower1 Posted March 12, 2003 Report Share Posted March 12, 2003 shutterbug, VERY cool project. When I was first employed by Nortel (actually, back then I was part of Bell-Northern Research...the R&D arm of Northern Telecom, which was later amalgamated with the manufacturing & sales arm...together now known at Nortel Networks) our group did much research in Telemedicine, with the aim of trying to figure out "what the heck are we going to do with all this bandwidth? Anyway, our group...known as "the wacky behavioural guys living in the country club"...did a bunch of really cool telemedicine simulations and research. Although I wasn't directly involved in all of it...I am familiar with the outcomes of most of it. It's been about 7 years...however, the results are still extremelyl valid (we were projecting 20 years out at the time) and...if I'm not too old already, I believe I can remember a fair bit of the detail as well... Telesurgery ========= A very cool idea...I have a lot of opinions about this, however, we didn't do any experiements in this area. The one comment I have is your comment about the Ninetendo generation (of which I am a pioneer 8o ) "picking up on it fast"...the comment I have is...WHAT ON EARTH HAPPENS WHEN YOU PRESS 'B' REPEATEDLY, WHILE HOLDING DOWN THE 'L' KEY IN COMBINATION WITH THE 'DOWN ARROW' AND WHILST TAPPING THE JUMP KEY? OR, IS THERE A 'RUN FAST' OPTION? IF SO, WHAT HAPPENS? :rollin Video Conference Appointment ======================= The video conference appointment was one experiement we simulated to an amazing level. We brought our demos to several large telecommunication/broadband tradeshows. Believe me when I say the video equipment, etc., we modelled was state of the art fibre-optic equipment still extremely advanced for today. Although docs really enjoyed the idea, it was actually quite amazing what stopped it from being widely adopted...connectiveness...this caused many issues for both the doc and the patient: 1) Delay Like video conferencing...there is inevitably still some delay at a distance. We were using an end-to-end fibre solution...so it was possible to eliminate this variable, however, we were forced to simulate delay under various conditions as it wasn't (and still isn't to the best of my knowledge) possible to have end-to-end fibre to most places. On a typical telephone or data call...the signal can pass over copper, fibre, wireless connections, satellite, etc...each with its own delay issues at various distances. The problems with delay are quite obvious...in a good condition it's kinda like watching a bad martial arts movie translated into english where the speach finishes and the lips keep moving afterwards. Connectedness is affected by this and, believe it or not, affects effective communication. At its worst...movement is brought to a screeching halt...and nothing other than voice is really contributing to the communication. 2) Quality...again, assuming that point-to-point fibre is either not currently available, or at best, is cost prohibitive in most cases...one would be forced to use current mechanisms to transport data and voice. There is only so much you can stuff over a copper wire without compression...the more you compress...the worse the quality. Current digital methods of transporting data across the internet uses "packets" of information...your data are litterally busted up into little electronic "pills"...each with a code for reassembly...when the data get to a point just before you see it...the packets are reassembled. Unfortunately, packets get lost, there are delays (i.e., the packets don't necessarily arrive in the correct order and the computers/switches have to wait for the correct packet before continuing the assembly (very simplistic explanation...it's not actually as bad as it sounds...it's much more parallel than that)...then there's jitter, blah blah. The short of it is...all these factors affect the quality of the images and sound you receive. Try watching a video on the internet as it's downloading...that's what I'm talking about. The end effect is that very subtle parts of human communication are lost. While gross facial/body movements greatly contribute to communication...it's actually amazing how much information is transmitted through tiny musculature in the face, etc....through very subtle variations in sound for voice...current state of the art typically doesn't preserve these...this is one of the very large factors affecting good "connectiveness" between humans at a distance. At some point in time the equipment will be cheap enough/readily available to deploy effectively...but I'm not convinced we're here yet still on this one. 3) the last major thing we found on connectiveness was about the relative position of people at a distance. Have you ever communicated with someone over the net using net cams? If so, you'll probably have experienced the fact that it doesn't really look like you're looking at one another...it's totally different that communicating with someone face-to-face. This is due to several factors, including size of the image and relative positions of one to the other. We created a "life-sized" image using a rear projection screen. So the image of the person you were talking with was the same size as if he/she were right in front of you. We also developed methods to align equipment at both ends to get you and the image you were looking at to be looking directly at one another. As best as we tried, we could NEVER get the experience to be like the face-to-face meeting. It was actually quite amazing...while all of the "physics" were aligned...you never still got the sense you were looking directly at the person. Wierd...but one of the factors we isolated as being highly responsible for the feeling of connectiveness. So, what does this have to do with medicine? Well...we found that through a combination of these issues, we were never able to truly simulate face-to-face human communication...several things were missing...some which we knew about...smells, subtle muscular movements, glances, warmth of a touch, etc...and some which I'm sure we still didn't know about. The lack of these characteristics left a coldness in the communication that made it, according to docs and patients, ineffective for many types of interactions. Could it be used for some types of applications...sure...assuming cost was a reasonable factor. ...sorry, I'm going to post this so I don't lose it...then I'll continue through edit... Remote Monitoring ============== Now, this is a very cool and viable tool...which, I believe is still being used by the Heart Institute in Ottawa. We were involved with a trial they were doing...essentially, a radio chip was "installed" on the patient at the time of, for example, heart surgery. The chip was designed to collect data on various metrics the doc would monitor at a visit...bp, pulse, whatever...as long as the patient was in range of a cellular basestation...their data could be monitored, like the signals from a cell phone...by the doc. A simplified version of this, telemetry, is commonly used in hospitals as shutterbug has correctly pointed out. The primary value of this one was on the patient side although it also has obvious benefits for the healthcare system as well. Patients loved it because it mean a few things...one...they didn't have to be bothered coming for an appointment if these vitals were the only things in question and, of course, assuming all was normal. The patients also enjoyed the idea because it gave them a sense of security..."someone is always taking care of me...monitoring my health to ensure I'm ok". I believe there is a lot more in this area we could exploit in the most positive sense imaginable. One potential problem...cellular systems are still not "five nines reliable" (i.e., the level of reliability associated with standard telephony...you know...when was the last time you lost standard telephone service? Can you actually ever remember a time?) If, for some reason, a patient was out of range of a basestation or there was a network problem...obviously, this could have grave consequences. Also, those the system would be designed to serve most (i.e., people in remote locations) are also the least likely to be in range of a cellular system...satellite could be used...still very expensive...a home wireless device could be used...then you have issues of range, mobility etc. Possible? Absolutely...lots of potential...a few bugs and logistics to work out still for rural medicine in my opinion. Anyway, great discussion shutterbug...you're lucky to have been involved in this research...it's fascinating, isn't it? To end my complete bandwidth hogging post...I personally believe that the current telehealth service offered in many parts of Canada is a joke...it's actually costing us tons of money...causing duplication...without much (I would bet but I have no data) reduction in ER/walk-in clinic/after hours clinic saturation...I would even bet...that there have been many cases where someone should have gone to the doctor and didn't because of this (but, again, I have absolutely no evidence of this). Anyway...some more food for thought...probably most of you will think..."ya, actually, a meal fit for friar tuck, Peter!) Sorry about the long post...I'm tired...and this area excites me... ....ok, ok, I'll stop. Peter Link to comment Share on other sites More sharing options...
Guest Biochem10 Posted March 12, 2003 Report Share Posted March 12, 2003 Mayflower, I just wanted to add a thought to your first post on this thread. I really do think we need to get students from rural areas to get interested in medicine so that they can go back to their communities and practice. My problem is with "making it really easy" for them to get into med school. I don't think it would be fair to the northern communities to have a lower quality of doctors than in the urban centers, this is assuming that GPA is correlated with success in medical school. So, I personally don't think that lowering GPA or other criteria for students from remote communities is a good idea. First of all, I think we have to improve the elementary and secondary education in the north, so that these kids have the same chances from a young age that those from the city do. I think it's a great idea that they're putting in place a Northern medical school because just it's presence will promote medicine as a career, but what about further north? That seems to me where the big problem is. Someone on this thread was also suggesting rotations of urban doctors in the north, I think that 4 months is really short and could potentially interrupt continuity of care. Anyway, I'm not putting down any ideas, actually I think most of the ideas on this thread are great. I personally think that there should be a restructuring of education in general in the north, which would then result in more students getting interested in medicine. Link to comment Share on other sites More sharing options...
Guest MayFlower1 Posted March 12, 2003 Report Share Posted March 12, 2003 Biochem, I agree with you...however, I didn't say we should make it easier with respect to entrance criteria...I think they should have to meet the same level of standard all other med school applicants have to meet (hence the importance of what you said with respect to education)...I think what I meant to say was don't make it as competitive for people from these communities to get a spot in a medical school, once of course, they have attained the minimum criteria. Peter Link to comment Share on other sites More sharing options...
Guest strider2004 Posted March 12, 2003 Report Share Posted March 12, 2003 Solution: Send SINGLE med students up north for rotations and arrange parties for them where they meet other SINGLE residents in those rural areas. They'll get hitched and stay. It's a gamble but I think the odds aren't bad. Link to comment Share on other sites More sharing options...
Guest UWOMED2005 Posted March 12, 2003 Report Share Posted March 12, 2003 Or why not just marry them to one of the locals? But seriously. . . did anyone read that commentary by the graduating med student on in the facts & arguments section of the globe & mail on why he wouldn't go into rural medicine? It came out in the summer of 2001 - argued his reasons for not choosing rural medicine were in fact based on life partners. Link to comment Share on other sites More sharing options...
Guest UOMeds05 Posted March 12, 2003 Report Share Posted March 12, 2003 It is a very legitimate concern. One that recruiters for rural and Northern communities are very aware of. Doctors are employable anywhere but what if your partner is a chemical engineer, architect, or one of many other examples. Another interesting concern is social isolation: what if you are the only or one of few docs in a community... you hold everyone's most personal confidences... not necessarily a person that everyone wants at a social gathering. This point was an interesting point brought up at a rural medicine conference... Link to comment Share on other sites More sharing options...
Guest shutterbug Posted March 13, 2003 Report Share Posted March 13, 2003 Thanks for the input Peter. Yeah we both kinda got off topic, but, ...., anyhoo. It sounds like you were involved in some interesting stuff. Actually, I've taken a number of course in cognitive ergonomics, systems design engineering, psychomotor behaviour, etc... Most of my undergraduate research is in that area as well. Back to the original topic: rural docs! What do you guys think about the Northern med school...I think it is a good start/idea. Train the students in a rural place, expose them to the way of life, and of course cut off all ties to the outside world :lol . Then, maybe a small percentage will buy into the idea of rural medicine and decide to train and stick around. Although, I think there will have to be residency openings in rural settings to have a complete rural medicine education...there's no point in going there for 4 years then finding out that there are no rural residency positions. I've heard arguments for and against this concept. Some say that it's a acomplete waste of time because it doesn't address the underlying issues; most of which have been discussed already. Others say that only the last two years of medschool is needed - you can learn the basic science at say TO then go to the new school for rotations. Supposedly, the new school would also take fourth year students on an elective basis. Would any of you guys be willing to go to med school at this new school? Link to comment Share on other sites More sharing options...
Guest UOMeds05 Posted March 13, 2003 Report Share Posted March 13, 2003 Of course i would attend. However, i think that the first few years may be a bumpy ride. There are going to be a lot of areas that will need some fine-tuning... one can only imagine the undertaking of opening a new medical school. Another hurdle will be the fact that it is the newest medical school. The Boards and Admin is really an "old boys club" and don't accept the "new guy on the block" with opening arms. With all that said, i think that when it gets up and running it is going to be an excellent medical school. The physicians in the north are very excited about teaching and are very good at it. Medicine up there is quite different from a university hospital and i think that the perspective the students will get will be a very interesting one. As for addressing the problem of recruitment and retention, i think that this is the best effort yet. I do agree, however, that it does not address a lot of the existing hurdles... Residency programs already exist there through the University of Ottawa. The currently have a number of family med positions, a couple internal med, gen surg, anasthesia, and a whole bunch of PGY-3 opportunities. I am certain that as the first class from NOMS graduates a number of new spots will be granted to that university. Thus, like all other med schools, elective opportunity in the fourth year there would only make sense. I think that the idea of training for the first 2 years at one instution and than completing the last 2 at NOMS would be silly. Although i probably would not be picky in the application process, to have to uproot your life after 2 years and essentially start over in a new city doesn't seem as attractive as being able to complete the 4 years at one institution. Link to comment Share on other sites More sharing options...
Guest lots of thinking Posted March 13, 2003 Report Share Posted March 13, 2003 Sorry- I have to apologize for this question, but I have never heard of this northern med school. Where is it, what is it and when did it open (or has it)???? thanks M Link to comment Share on other sites More sharing options...
Guest UOMeds05 Posted March 13, 2003 Report Share Posted March 13, 2003 It is the newest medical school in Canada... but has yet to open. So far it is called "Northern Ontario Medical School" (NOMS). It is slated to open with its first class of 55 students in September of 2004 and is based primarily in Sudbury and Thunder Bay as part of Laurentian and Lakehead University (ironically both LU). there has been a bit of discussion about it in these threads... it's website is http://www.normed.ca Link to comment Share on other sites More sharing options...
Guest Ian Wong Posted March 14, 2003 Report Share Posted March 14, 2003 Go to the OMSAS forum and there's at least three different threads regarding it on the first page. Ian Link to comment Share on other sites More sharing options...
Recommended Posts
Archived
This topic is now archived and is closed to further replies.