No community left behind: advancing rural anesthesia, surgery, and obstetric care in Canada.

It may state two separate claims as one.

Rural Canadians experience poorer health outcomes partly due to service shortages, with First Nations, Inuit, and Métis peoples affected disproportionately.

“Such shortages have contributed to poorer health outcomes for rural Canadians, with disproportionate effects on First Nations, Inuit, and Métis peoples.3–6”

• cites [3] Canadian Institute for Health Information. Supply, distribution and migration of physicians in Canada, 2020–data tables, 2021. Available from URL: https://www.cihi.ca/sites/default/files/document/supply-distribution-migration-physicians-in-canada-2020-data-tables-en.xlsx (accessed June 2022).Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [4] Rourke J. Increasing the number of rural physicians. CMAJ 2007; 178: 322–5. https://doi.org/10.1503/cmaj.070293 sourcePartly supported

  The opening passage documents a shortage of physicians in rural Canada, and the Medicine and society conclusion calls for a stronger rural health strategy. Neither passage states that the shortages have caused poorer health outcomes or that First Nations, Inuit, and Métis peoples are disproportionately affected; searches for those outcomes and populations found no supporting passage. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites [5] Bosco C, Oandasan I. Review of Family Medicine within Rural and Remote Canada: Education, Practice, and Policy. Mississauga: College of Family Physicians of Canada, 2016.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites [6] Canadian Post-M.D. Education Registry. 2019-2020 Specialty report, 2021. Available from URL: https://caper.ca/sites/default/files/pdf/province/2019-20_Individual_Specialty_Tables.pdf (accessed June 2022).Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

It may state two separate claims as one.

About 18% of Canadians reside in rural areas, but only 8% of the country's physicians practice there.

“Currently, approximately 18% of Canadians live in rural regions, whereas only 8% of the country’s physicians work in these areas.2”

• cites [2] McVicar JA, Poon A, Caron NR, et al. Postoperative outcomes for Indigenous Peoples in Canada: a systematic review. CMAJ 2021; 193: E713–22. https://doi.org/10.1503/cmaj.191682 sourceCould not verify

  The Background and Interpretation discuss challenges accessing care in rural and remote Canada, but give no rural population or physician-workforce percentages. Searches for the 18% and 8% figures and for rural physician distribution found no passage addressing those figures in our copy; page numbers were not available. (LLM, conf=0.76)

  Experimental — accuracy not yet measured

Probably not a substantial claim.

The consensus statement outlines a partnership model linking family physician generalists with anesthesia, surgical, and obstetrical specialists.

“This consensus statement presents a model for partnerships between family physician generalists and anesthesia, surgical and obstetrical specialists.”

• cites [7] Iglesias S, Carson G, Wilson CR, et al. Consensus statement on networks for high-quality rural anesthesia, surgery, and obstetric care in Canada. Can Fam Physicians 2022; 68: 258–62. https://doi.org/10.46747/cfp.6804258 sourceSupported

Probably not a substantial claim.

Explicit agreements between rural providers and urban specialists are helpful because they define the clinical activities of rural providers, including scope of practice, patient selection, triage criteria, escalation strategies, and transportation plans for transfer to regional hospitals.

“Explicit agreements between rural providers and urban specialists are helpful as they set out the nature of the clinical activities performed by the rural providers, specifically defining scope of practice, patient selection criteria, triage criteria, strategies to escalate care, and transportation plans for patients who require transfer from rural to regional hospitals.”

• cites [7] Iglesias S, Carson G, Wilson CR, et al. Consensus statement on networks for high-quality rural anesthesia, surgery, and obstetric care in Canada. Can Fam Physicians 2022; 68: 258–62. https://doi.org/10.46747/cfp.6804258 sourceSupported

It may state two separate claims as one.

The Canadian Anesthesiologists' Society has called for more anesthesiologist training positions, yet overall numbers have remained relatively stagnant.

“The CAS has called for increases in the number of anesthesiologist training positions, yet the overall numbers have remained relatively stagnant.15”

• cites [15] Orser BA, Wilson CR. Canada needs a national strategy for anesthesia services in rural and remote regions. CMAJ 2020; 192: E861–3. https://doi.org/10.1503/cmaj.200215 sourcePartly supported

  In “Why is there a shortage of anesthesia services in rural Canada?” (page unavailable), the paper reports that 121 specialty-training entry positions are available annually and that more are needed. Its References list a Canadian Anesthesiologists’ Society news release calling for more residency positions. The paper gives no comparison over time to establish that the number of positions has remained relatively stagnant. (LLM, conf=0.87)

  Experimental — accuracy not yet measured

Probably not a substantial claim.

A recent article in Canadian Family Physician presented a joint consensus statement on rural anesthesia, surgery, and obstetric care networks.

“To address the attrition of medical services in rural Canada, a joint consensus statement on networks for high-quality rural anesthesia, surgery, and obstetric care in Canada was recently published in Canadian Family Physician.7”

• cites [7] Iglesias S, Carson G, Wilson CR, et al. Consensus statement on networks for high-quality rural anesthesia, surgery, and obstetric care in Canada. Can Fam Physicians 2022; 68: 258–62. https://doi.org/10.46747/cfp.6804258 sourceSupported

Probably not a substantial claim.

The most important feature of successful generalist-specialist networks is trusting relationships among stakeholders in rural and urban centres.

“The most important characteristic is trusting relationships among the various stakeholders working in rural and urban centres.”

• cites [7] Iglesias S, Carson G, Wilson CR, et al. Consensus statement on networks for high-quality rural anesthesia, surgery, and obstetric care in Canada. Can Fam Physicians 2022; 68: 258–62. https://doi.org/10.46747/cfp.6804258 sourcePartly supported

  The Report lists trusting relationships between rural and urban stakeholders as a component of successful networks, and the Conclusion calls those relationships foundational. Neither passage ranks them as the most important characteristic; the Report identifies several other important components. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

The consensus statement is a bottom-up, grassroots declaration led by physicians living and working in rural and remote communities.

“Overall, the consensus statement is a bottom-up, grassroots declaration that was led by physicians who live and work in rural and remote communities.22”

• cites [22] Orser BA, Wilson CR, Bainbridge D. Improving anesthesia care and pain medicine in rural Canada: nothing about us without us. Can J Anesth 2021; 68: 1731–7. https://doi.org/10.1007/s12630-021-02098-9 sourcePartly supported

  The paper (section labelled Abstract; page unavailable) says a consensus-based call to action emerged from a symposium with contributions from people living in rural and remote communities. It does not say rural physicians led the statement or describe it as a grassroots declaration; it says the symposium was organized by the University of Toronto’s Department of Anesthesiology and Pain Medicine. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim.

The proposed CRNA program is envisioned to resemble the Certified Nurse Anesthetist model in the USA.

“This program is envisioned to be like the Certified Nurse Anesthetist model that exists in the USA.”

• cites [18] Orser BA, Wilson CR. The authors respond to “Nurse anesthesiologists”. CMAJ 2020; 192: E1215. https://doi.org/10.1503/cmaj.76648 sourcePartly supported

  The main text (p. E1215) says commenters proposed using certified registered nurse anesthetists in rural Canada and describes their role in the United States. It does not describe a proposed Canadian CRNA program or say that such a program is envisioned to follow the US model; the authors argue against introducing that class of provider. (LLM, conf=0.79)

  Experimental — accuracy not yet measured
• cites [19] Smylie J, O’Brien K, Beaudoin E, et al. Long-distance travel for birthing among Indigenous and non-Indigenous pregnant people in Canada. CMAJ 2021; 193: E948–55. https://doi.org/10.1503/cmaj.201903 sourceCould not verify

  The Interpretation discusses geographic access to birthing services in rural Canada, not a proposed CRNA program. Searches for “Certified Nurse Anesthetist model USA CRNA program” and “nurse anesthetist anesthesia program United States” found no passage addressing the claimed program or US model; page numbers were not available in our copy. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

Probably not a substantial claim.

The consensus report identifies several essential features of successful generalist-specialist networks.

“The consensus report identifies several essential characteristics of successful generalist–specialist networks.”

• cites [7] Iglesias S, Carson G, Wilson CR, et al. Consensus statement on networks for high-quality rural anesthesia, surgery, and obstetric care in Canada. Can Fam Physicians 2022; 68: 258–62. https://doi.org/10.46747/cfp.6804258 sourceSupported

Probably not a substantial claim. The paper’s conclusions may not depend on it.

There have been calls for a national anesthesia services strategy focusing on rural and remote regions.

“Calls have been made for a national strategy for anesthesia services with an emphasis on rural and remote regions.15,20”

• cites [15] Orser BA, Wilson CR. Canada needs a national strategy for anesthesia services in rural and remote regions. CMAJ 2020; 192: E861–3. https://doi.org/10.1503/cmaj.200215 sourceSupported
• cites [20] University of Toronto. Symposium on anesthesia care in rural and remote regions of Canada 2021. Available from URL: https://www.anesthesia.utoronto.ca/sites/default/files/anesthesia_symposium_report_2020_final_report_posted_on_website.pdf (accessed June 2022).Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

It may state two separate claims as one.

Inadequate workforce planning has led to limited local medical care and obstacles to diagnostic services and treatments.

“Poor workforce planning has contributed to a scarcity of “closer to home” medical care and has created barriers to diagnostic services and treatments.”

It may state two separate claims as one.

Quebec and the Atlantic provinces have few FPAs, and specialists provide nearly all anesthesia care in both urban and rural areas there.

“In Quebec and the Atlantic provinces, there are few FPAs, and specialists provide nearly all care in both urban and rural areas.”

It may state two separate claims as one.

The FPA model is highly effective because these physicians bring additional needed medical skills to rural communities, also providing primary, surgical, obstetric, and emergency care.

“This model has proven highly effective because these physicians bring additional much-needed medical skills to rural communities as FPAs also provide primary, surgical, obstetric, and emergency medicine care in rural settings.”

It may state two separate claims as one.

Canada currently has about 4,300 anesthesia care providers, or 11 per 100,000 people, which is lower than Australia (23 per 100,000), the USA (21 per 100,000), and the UK (18 per 100,000).

“Currently there are approximately 4,300 anesthesia care providers, which equates to 11 per 100,000 people, which is below other high-income countries such as Australia (23 per 100,000) the USA (21 per 100,000) and the UK (18 per 100,000).11,12”

• cites [11] Royal College of Physicians and Surgeons of Canada. Royal College medical workforce knowledgebase 2022. Available from URL: https://www.royalcollege.ca/rcsite/health-policy/medical-workforce-knowledgebase-e (accessed June 2022).Not checked yet
• cites [12] World Federation of Societies of Anesthesiologists. World anesthesiology workforce map 2022. Available from URL: https://wfsahq.org/resources/workforce-map/ (accessed June 2022).Not checked yet

It may state two separate claims as one.

After initial family medicine certification, family practice anesthetists typically complete a year of focused enhanced anesthesia training and receive a Certificate of Added Competency from the College of Family Physicians of Canada.

“Family practice anesthetists typically undertake one year of focused, enhanced anesthesia skills training after their initial certification in family medicine that leads to a Certificate of Added Competency issued by the College of Family Physicians of Canada.9”

• cites [9] College of Family Physicians of Canada. Certificates of Added competence in family medicine 2022. Available from URL: https://www.cfpc.ca/en/education-professional-development/examinations-and-certification/certificates-of-added-competence-in-family-medicin (accessed June 2022).Not checked yet

Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

Self-regulating colleges of respiratory therapists regulate respiratory therapy practice and govern their members in the public interest.

“The role of these colleges, such as the one in Ontario, is to regulate the practice of respiratory therapy and to govern the members of the college in the public interest.17”

• cites [17] College of Respiratory Therapists of Ontario. What is a respiratory therapist? 2022 Available from URL: https://www.crto.on.ca/public/what-is-respiratory-therapy/ (accessed June 2022).Not checked yet

It may state two separate claims as one.

Canada has a national shortage of anesthesiologists, involving both unequal distribution of providers and low overall numbers.

“There is a national shortage of anesthesiologists in Canada, which encompasses both an unequal distribution of care providers across the country and low overall numbers.10”

• cites [10] Cision. Shortage of anesthesiologists impacts delivery of surgical, acute and chronic pain services 2019. Available from URL: https://www.newswire.ca/news-releases/shortage-of-anesthesiologists-impacts-delivery-of-surgical-acute-and-chronic-pain-services-872753250.html (accessed June 2022).Not checked yet

It may state two separate claims as one.

The estimated shortfall of specialist anesthesiologists is 100-150, even though about 120 newly certified FRCPC specialists are added annually.

“The current estimated shortfall of specialist anesthesiologists is 100–150, despite the addition of about 120 newly certified Fellow of the Royal College of Physicians of Canada (FRCPC) specialists each year (personal communication, Mateen Raazi [President, Association of Canadian University Departments of Anesthesia], June 2022).”

It may state two separate claims as one.

In rural Canadian communities, family practice anesthetists deliver most anesthesia care, and internationally trained anesthesiologists provide another one third.

“In rural communities, FPAs provide most of the anesthesia care whereas another one third of care is provided by internationally trained anesthesiologists.14”

• cites [14] Orser B, Wilson R, Simkin S, Bourgeault I. Canada's rural anesthesia workforce: trends 1996-2018. Anesth Analg 2022; 5.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

It may state two separate claims as one.

This generalist-specialist network approach draws on models from other countries, including Australia, and has already been used in Canada for cancer care, HIV management, and chronic pain.

“This generalist-specialist network approach is patterned after models adopted in other countries, including Australia, and has been already used in Canada to address a variety of medical needs, including cancer care, HIV management, and the treatment of chronic pain.8”

• cites [8] Department of Family and Community Medicine. Enhanced skills program: OHTN HIV residency in primary care, 2022. Available from: https://www.dfcm.utoronto.ca/enhanced-skills-program-ohtn-hiv-residency-primary-care#:~:text=To%20promote%20the%20development%20of,skills%20program%20in%20HIV%2FAIDS (accessed June 2022).Not checked yet