Practice Experiences of Rural GP Surgeons in British Columbia

To explore the potential for enhancing the obstetrical skills of GP surgeons as a strategy for maintaining safe and cost-effective maternity care services in small, rural BC communities.

To explore the potential for enhancing the obstetrical skills of GP surgeons as a strategy for maintaining safe and cost-effective maternity care services in small, rural BC communities.

Research Summary

BC currently lacks comprehensive information about the safety, cost effectiveness, and overall sustainability of small rural maternity services, and the resulting impact of closing these services on the psycho-social and health outcomes of pregnant women and their families. Research suggests that the viability of maintaining rural maternity services hinges in part on a whether a community can offer cesarean section services. However, the number of Obstetricians and General Surgeons practicing in rural communities across Canada and elsewhere in the world is diminishing for a variety of reasons, including difficulty with recruitment and retention as well as increasing subspecialization in training programs that generates fewer general surgeons. The result is a rapid erosion of rural maternity services across Canada.

As a response to this health service delivery challenges, General practitioners with enhanced obstetrical skills have maintained a presence in underpinning cesarean section services in a number of small rural communities in western Canada. However, little is known about their training or practice experiences or the effects of the lack of an educational and regulatory framework for the profession. This research project explored the training and practice experiences and requirements of GP Surgeons in British Columbia and Alberta into to develop an evidence base to inform sustainable rural maternity care planning in BC and across Canada. Specifically, the research team used an exploratory, qualitative research design to investigate:

• The Experiences of GP surgeons providing obstetrical care to rural communities including motivation, support received and barriers to practice;
• The relationships between rural GP surgeons and specialists located in their local communities and in regional or provincial referral and tertiary facilities; and
• The effectiveness of mechanisms through which GP surgeons secure training, mentoring and continuing medical education.

Research Results

In-depth, comprehensive interviews were conducted with 58 GP Surgeons (GPS), obstetricians and administrators in 24 communities in BC and Alberta.

Participants identified several key themes in their narratives that were organized into attributes and barriers to practice and training. Practice experiences were characterized by recognition of the importance of GP Surgery to local care, the impact of GPS on increasing the capacity for local care, lack of support from tertiary specialists, and difficulties accessing continuing medical education (CME). Participants’ training experiences were characterized by access to resources including financial reimbursement for training through the Rural Education Action Plan (REAP) program in BC, positive mentorship by specialists in mixed models of service who understood family practice (primarily in Alberta) and the fact that there was a training program. Perceived barriers included non-supportive training environments, competition from General Surgical residents, lack of mentorship from established GPS, limited access to training positions and the lack of a defined career path.

This research provides a foundation for understanding current practice and training experiences of GPS within the context of recognizing the role they play in sustaining services in many isolated, rural communities. However, GP Surgery is on the decline and requires a supportive professional framework to continue attracting and retaining practitioners. Findings from this study indicate the need for a rational approach to service and educational planning for rural GPS including the need for the development of a structured, evidence-based a College of Family Physicians of Canada (CFPC) -accredited educational program administered within a professionally-supportive context including mandatory training in obstetrical case management and underscored by an evaluation framework.

We hope that results from this study will inform a rational approach to rural surgical planning based on population need in conjunction with geographic isolation. Research findings have already contributed to the development of a curriculum for GPS training at UBC through the Departments of Family Practice and Surgery, as well as the curriculum at the first Canadian CME day for GP Surgery (Banff Jan 2008).