Strategies to overcome physician shortages in northern Ontario: A study of policy implementation over 35 years

<p>Abstract</p> <p>Background</p> <p>Shortages and maldistibution of physicians in northern Ontario, Canada, have been a long-standing issue. This study seeks to document, in a chronological manner, the introduction of programmes intended to help solve the problem by the provincial government over a 35-year period and to examine several aspects of policy implementation, using these programmes as a case study.</p> <p>Methods</p> <p>A programme analysis approach was adopted to examine each of a broad range of programmes to determine its year of introduction, strategic category, complexity, time frame, and expected outcome. A chronology of programme initiation was constructed, on the basis of which an analysis was done to examine changes in strategies used by the provincial government from 1969 to 2004.</p> <p>Results</p> <p>Many programmes were introduced during the study period, which could be grouped into nine strategic categories. The range of policy instruments used became broader in later years. But conspicuous by their absence were programmes of a directive nature. Programmes introduced in more recent years tended to be more complex and were more likely to have a longer time perspective and pay more attention to physician retention. The study also discusses the choice of policy instruments and use of multiple strategies.</p> <p>Conclusion</p> <p>The findings suggest that an examination of a policy is incomplete if implementation has not been taken into consideration. The study has revealed a process of trial-and-error experimentation and an accumulation of past experience. The study sheds light on the intricate relationships between policy, policy implementation and use of policy instruments and programmes.</p

Exploring the effects of telehealth on medical human resources supply: a qualitative case study in remote regions

BACKGROUND: The availability of medical human resource supply is a growing concern for rural and remote communities in many countries. In the last decade, various telehealth experiences in Canada have highlighted the potential impact of this technology on professional practice. The purpose of this study was to explore physicians' and managers' perceptions regarding the potential of telehealth to support recruitment and retention of physicians in remote and rural regions. METHODS: A case study in Eastern Quebec was performed to explore this complex phenomenon. The analytical framework was based on two literature reviews and a Delphi study. Data were collected from semi-structured interviews with 41 physicians and 22 managers. Transcripts were produced and interview content was coded independently by two judges and validated by an expert panel. RESULTS: Interviews have highlighted the potential impact of telehealth on several factors influencing the recruitment and retention of physicians in rural and remote regions. The potential effects of telehealth on physicians' choice of practice location could be seen at the professional, organizational, educational and individual levels. For instance, telehealth could improve work satisfaction by allowing a regional on-call duty system and a better follow-up of patients. However, there are also certain limits related to telehealth, such as the fear that it would eventually replace all continuing medical education activities and onsite specialists in remoteregions. CONCLUSION: Telehealth is likely to have an impact on several factors related to medical workforce supply in remote and rural regions. However, the expected benefits will materialize if and only if this technology is properly integrated into organizations as a support to professional practice

Life-History Responses to the Altitudinal Gradient

We review life-history variation along elevation in animals and plants and illustrate its drivers, mechanisms and constraints. Elevation shapes life histories into suites of correlated traits that are often remarkably convergent among organisms facing the same environmental challenges. Much of the variation observed along elevation is the result of direct physiological sensitivity to temperature and nutrient supply. As a general rule, alpine populations adopt ‘slow’ life cycles, involving long lifespan, delayed maturity, slow reproductive rates and strong inversions in parental care to enhance the chance of recruitment. Exceptions in both animals and plants are often rooted in evolutionary legacies (e.g. constraints to prolonging cycles in obligatory univoltine taxa) or biogeographic history (e.g. location near trailing or leading edges). Predicting evolutionary trajectories into the future must take into account genetic variability, gene flow and selection strength, which define the potential for local adaptation, as well as the rate of anthropogenic environmental change and species’ idiosyncratic reaction norms. Shifts up and down elevation in the past helped maintain genetic differentiation in alpine populations, with slow life cycles contributing to the accumulation of genetic diversity during upward migrations. Gene flow is facilitated by the proximity of neighbouring populations, and global warming is likely to move fast genotypes upwards and reduce some of those constraints dominating alpine life. Demographic buffering or compensation may protect local alpine populations against trends in environmental conditions, but such mechanisms may not last indefinitely if evolutionary trajectories cannot keep pace with rapid changes.Peer reviewe