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Cited by 36Global Health Workforce IssuesGlobal Health and SurgeryHealthcare Policy and Management

Canada needs a national strategy for anesthesia services in rural and remote regions

Open access
Orser, Beverley A., Wilson, C. Ruth·2020·Canadian Medical Association Journal
DOI 10.1503/cmaj.200215PMC PMC7828913
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Abstract

KEY POINTS Rural and remote areas of Canada are at risk of losing surgical and obstetric services because of a shortage of anesthesia care providers. For more than a century, anesthesia, surgical and obstetric services were available in the remote community of Bella Coola, British Columbia.[1][1]

Integrity signals

Registry

Crossref · 10.1503/cmaj.200215

Cites

15 of 15 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

3 of 29 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured

  • Premisecitation
    § Why is there a shortage of anesthesia services in rural Canada?

    Low-risk procedures, including low-risk obstetric care, can be performed safely in smaller hospitals.

    “low-risk procedures -including low-risk obstetric care -can be performed safely in smaller hospitals.”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [6] 6. Iglesias S Kornelsen J, Woollard R, et al. Joint position paper on rural surgery and operative delivery. Can J Rural Med 2015;20:129-38.

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

    • cites [7] 7. Webb RJ, Kantor GSA. Obstetrical epidural anaesthesia in a rural Canadian hospital. Can J Anaesth 1992;39:390-3. source

      The Conclusion says obstetrical epidural anaesthesia can be performed safely and effectively in smaller Canadian hospitals. The study does not assess low-risk procedures generally or classify the obstetric care it studied as low-risk, so the citing sentence extends beyond its findings. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
    • cites [8] 8. Orser B. Obstetrical epidural anaesthesia in a Canadian outpost hospital. Can J Anaesth 1988;35:503-6.

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

  • Premisecitation
    § National research agenda

    Less than 1% of Canadian Institutes of Health Research funding has been awarded to rural research studies.

    “Less than 1% of Canadian Institutes of Health Research funding has been awarded to rural research studies.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [23] 23. Clinical coaching for excellence-rural surgical and obstetrical networks. Vancouver: University of British Columbia; 2020. Available: https://ubccpd.ca/rson-coaching (accessed 2020 July 8).

      Not checked in the free run.

  • Interpretationreasoning
    § KEY POINTS

    International medical graduates cannot be relied on to address specialist deficits in rural Canada.

    “Thus, we cannot rely on international medical graduates to address specialist deficits in rural Canada.”
    Quote in the paperSubstantial claim
  • Premisecitation
    § Why is there a shortage of anesthesia services in rural Canada?

    Increased urbanization of medical services has contributed to the loss of anesthesia, surgical, and obstetric care services in rural Canada.

    “Increased urbanization of medical services has contributed to the attrition of anesthesia, surgical and obstetric care services in rural Canada.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] 5. Rural road map for action: directions. Mississauga (ON): College of Family Phys- icians of Canada; 2017.

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

  • Premisecitation
    § Policy interventions

    During the COVID-19 pandemic, some jurisdictions rapidly enabled medical licensure of out-of-province or territory physicians to expedite locum emergency coverage.

    “during the current coronavirus disease 2019 (COVID-19) pandemic, some jurisdictions have rapidly enabled medical licensure of out-of-province or territory physicians, to expedite locum emergency coverage.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [21] 21. Rourke J, Wilson R. Research funding by the Canadian Institutes of Health Research: More rural needed! Can J Rural Med 2020;25:11-13. source
  • May combine two claims. 15
  • Classified as probably not a substantial claim. 4

  • May combine two claims.

    Premisecitation
    § What is the solution?

    Canada has been slow to invest in health human resource planning, and the most detailed forecasting for the anesthesia workforce is now 25 years old.

    “Canada has been slow to invest in health human resource planning 17 and the most detailed forecasting for the anesthesia workforce is now 25 years old.”
    Quote in the paperSubstantial claim1 of 4 sources checked
    • cites [17] 17. Yang H, Byrick R, Donen N. Analysis of anesthesia physician resources: projected Ontario deficit in 2005. Can J Anesth 2000;47:179-84. source

      Not checked in the free run.

    • cites [11] 11. Engen DA, Morewood GH, Ghazar NJ, et al. A demand-based assessment of the Canadian anesthesia workforce -2002 through 2007. Can J Anaesth 2005;52: 18-25. source

      The paper’s introductory discussion (indexed as Abstract; page unavailable) says Canadian physician resource planning historically relied on simple head counts and physician-to-population ratios. Its Non-OR activity section calls for a specialty-specific national human resources plan. These passages support a critique of planning, but do not establish that Canada was slow to invest in it. The citation is attached to that clause, not to the separate 25-year forecasting claim. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [18] 18. Soles TL, Wilson CR, Oandasan IF. Family medicine education in rural communities as a health service intervention supporting recruitment and retention of physi- cians: advancing rural family medicine: the Canadian Collaborative Taskforce. Can Fam Physician 2017;63:32-8.

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

    • cites [19] 19. Frequently asked questions for physicians interested in locum opportunities in the Northwest Territories. Practice NWT; 2019. Available: www.practicenwt.ca/ sites/practicenwt/files/resources/locum_physician_faqs.pdf (accessed 2020 July 8).

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Why is there a shortage of anesthesia services in rural Canada?

    Vacancy rates are greatest in smaller hospitals, and facilities with fewer than five operating rooms have proportionally more unfilled positions.

    “Vacancy rates are greatest in smaller hospitals, and facilities with fewer than 5 operating rooms have a proportionally greater number of unfilled positions.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [11] 11. Engen DA, Morewood GH, Ghazar NJ, et al. A demand-based assessment of the Canadian anesthesia workforce -2002 through 2007. Can J Anaesth 2005;52: 18-25. source

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Findingnone given
    § KEY POINTS

    For the Toronto area alone, about 31 and 78 anesthesiologists will be needed in the next 1 and 5 years, respectively, but the city has only 21 first-year training positions.

    “area alone, about 31 and 78 anesthesiologists will be needed in the next 1 and 5 years, respectively, but the city has only 21 first-year training positions (personal experience of one of the authors).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationreasoning
    § Why is there a shortage of anesthesia services in rural Canada?

    Delivering low-risk procedures close to the patient's home is often preferable to avoid the difficulties and expenses of medical travel in a large country like Canada.

    “delivery of low-risk procedures close to the patient's home is often preferable, to avoid the difficulties and expenses of medical travel in a large country like Canada.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § KEY POINTS

    Most international medical graduates in postgraduate anesthesia training programs are visa trainees, who are granted temporary resident employment and will not remain in Canada.

    “Most international medical graduates in postgraduate anesthesia training programs are visa trainees.These visa trainees are granted temporary employment as residents and will not remain in Canada.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [15] 15. Bourgeault I, Simkin S, Chamberland-Rowe C. Poor health workforce planning is costly, risky and inequitable. CMAJ 2019;191:E1147-8. source

  • May combine two claims.

    Premisecitation
    § Conclusion

    Canada's medical schools and professional organizations have started working together to address the shortages, with the Collaborative Advisory Group for General and Family Practice Anesthesia as one initiative.

    “The good news is that Canada's medical schools and professional organizations have started working together to address the shortages.The Collaborative Advisory Group for General and Family Practice Anesthesia is one such initiative.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28]

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

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

    Premisecitation
    § Social accountability

    Recruiting physicians for rural practice requires educational strategies such as admitting medical students from rural areas, ensuring meaningful rural medical education with well-supported rural mentors, and providing training in competencies needed for rural practice.

    “Recruiting physicians for rural practice requires educational strategies such as admitting medical students from rural areas, ensuring meaningful experiences in rural medical education with well-supported rural mentors, and providing training in competencies needed for rural practice.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9] 9. Rourke J. Increasing the number of rural physicians. CMAJ 2008;178:322-5.

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

    • Rests on an assumption: Most rural and remote communities need doctors with broad skill sets to work in emergency departments, obstetrics units, family practice clinics, and anesthesia.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § Mentorship and continuing professional education

    The Australian program facilitates longer-term peer support and specialist mentorship.

    “The program facilitates longer-term peer support, and specialist mentorship.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27]

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

  • May combine two claims.

    Premisecitation
    § Why is there a shortage of anesthesia services in rural Canada?

    Canadians living in rural areas make up 18% of the population but are served by only 8% of physicians.

    “Canadians living in rural areas comprise 18% of the population but are served by only 8% of physicians.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] 5. Rural road map for action: directions. Mississauga (ON): College of Family Phys- icians of Canada; 2017.

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

  • May combine two claims.

    Premisecitation
    § Why is there a shortage of anesthesia services in rural Canada?

    The specialty anesthesiology workforce comprises about 3300 physicians, and more than 13% are older than 65 years.

    “The specialty anesthesiology workforce comprises about 3300 physicians, more than 13% of whom are older than 65 years.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [12] 12. Khan J, Gilbert J, Sharma A, et al. Perspectives of anesthesia residents training in Canada on fellowship training, research, and future practice location. Can J Anesth 2015;62:956-63.

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

  • May combine two claims.

    Premisecitation
    § R

    In Nova Scotia, a shortage of anesthesiologists has reduced elective surgeries and forced pregnant women in some communities to travel to Halifax for delivery.

    “in Nova Scotia, a shortage of anesthesiologists means that elective surgeries have been reduced and pregnant women in some communities have had to travel to Halifax for their deliveries.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [3] 3. Vibert J. Yarmouth hospital crippled by exodus of anesthesiologists. The Chronicle Herald [Halifax] 2019 Apr. 10 [updated].

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

    • cites [4] 4. Gorman M. Disagreements lead to N.S. docs missing out on anesthesiology train- ing. CBC [Nova Scotia] 2019 Sept. 12. Available: www.cbc.ca/news/ canada/nova -scotia/health-care-doctors-family-practice-anaesthetists-surgery -1.5279835 (accessed 2020 July 8).

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § KEY POINTS

    Currently, about 500 family physician anesthetists work in rural Canada, but they are located almost exclusively in Ontario and the western provinces.

    “Currently, about 500 family physician anesthetists work in rural Canada, but they are located almost exclusively in Ontario and the western provinces.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] 4. Gorman M. Disagreements lead to N.S. docs missing out on anesthesiology train- ing. CBC [Nova Scotia] 2019 Sept. 12. Available: www.cbc.ca/news/ canada/nova -scotia/health-care-doctors-family-practice-anaesthetists-surgery -1.5279835 (accessed 2020 July 8).

      Not checked in the free run.

    • Rests on an assumption: Family physician anesthetists, who bring other generalist skills to rural communities, have been cost-effective care providers in rural Canada for decades.

  • May combine two claims.

    Premisecitation
    § KEY POINTS

    Of international students who graduated from any postgraduate program in 2016, only 26 (4.5%) were practising in rural towns and 39 (6.8%) in small towns two years later.

    “Of the international students who graduated from any postgraduate program in 2016, only 26 (4.5%) were practising in rural towns and 39 (6.8%) in small towns 2 years later.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [16] 16. Ryten E. A physician workforce planning model for the specialty of anesthesia: theoretical and practical considerations. Toronto: Canadian Anesthesiologists' Society; 1995. Available: www.cas.ca/CASAssets/Documents/Affiliates/93 _Ryten-Report.pdf (accessed 2020 July 8).

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § Why is there a shortage of anesthesia services in rural Canada?

    In 2019, the Canadian Anesthesiologists' Society reported a need for more anesthesiologists and predicted a shortfall in services.

    “In 2019, the Canadian Anesthesiologists' Society reported the need for more anesthesiologists and predicted a shortfall in services.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] 10. Shortage of anesthesiologists impacts delivery of surgical, acute and chronic pain services: more residency training positions needed [news release]. Toronto: Canadian Anesthesiologists' Society; 2019 May 23. Available: www.newswire.ca/ news-releases/shortage-of-anesthesiologists-impacts-delivery-of-surgical-acute -and-chronic-pain-services-872753250.html (accessed 2020 July 8).

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § KEY POINTS

    Many graduating residents seek one of 205 fellowship positions in Canada to prepare for academic positions in an urban centre, and rural Canada is not high on their list of motivators.

    “Many graduating residents seek out 1 of 205 fellowship positions that are available in Canada to prepare them for academic positions in an urban centre; an orientation to address the needs of rural Canada is not high on the list of motivators for these residents.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [14] 14. The National IMG Database report. Ottawa: Canadian Post MD Education Registry; 2019.

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

  • May combine two claims.

    Interpretationreasoning
    § Why is there a shortage of anesthesia services in rural Canada?

    The current lack of adequate anesthesia services in rural Canada occurs against a background of a general shortage of physicians in rural areas and chronic shortages of anesthesiologists across the country.

    “The current lack of adequate anesthesia services in rural Canada is playing out against a background of a general shortage of physicians in rural areas and chronic shortages of anesthesiologists countrywide.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation
    § Policy interventions

    Return of service policies may help recruit physicians to rural areas, but without a supportive community and practice environment, they generally do not succeed for long-term retention.

    “Return of service policies may be helpful in recruiting physicians to rural areas, but unless there is a supportive community and practice environment, such initiatives are generally not successful for long-term retention.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] 20. Ho B, Tepper J, Hinds R. Is it time to implement one national license for Canadian doctors? Healthy Debate; 2020 Mar. 18. Available: https://healthydebate. ca/2020/03/topic/is-it-time-to-implement-one-national-license-for-canadian -doctors (accessed 2020 July 8).

      Not checked in the free run.

17 of 17

  • The paper relies on this without support.

    Remote Indigenous populations often have poorer health outcomes than non-Indigenous populations.

    “This lack of services disproportionally affects remote Indigenous populations, which often have poorer health outcomes than non-Indigenous populations.”

  • The paper relies on this without support.

    Problems of unfilled advertised positions and urgent requests for locum coverage are widespread.

    “Problems of unfilled advertised positions and urgent requests for locum coverage are widespread.”

  • The paper relies on this without support.

    Most rural and remote communities need doctors with broad skill sets to work in emergency departments, obstetrics units, family practice clinics, and anesthesia.

    “Most rural and remote communities need doctors with broad skill sets to work in emergency departments, obstetrics units and family practice clinics, as well as anesthesia.”

  • The paper relies on this without support.

    The physicians who meet these needs are usually family physicians, some of whom also provide anesthetic care.

    “The phys icians who meet these needs are usually family physicians, some of whom also provide anesthetic care.”

  • The paper relies on this without support.

    The College of Family Physicians of Canada accredits a one-year training program for family physician anesthetists, using nationally developed priority topics and key features for competence assessment.

    “The College of Family Physicians of Canada accredits a 1-year training program for family physician anesthetists, using a set of priority topics and key features developed nationally for assessment of competence.”

  • The paper relies on this without support.

    After completing the family physician anesthesia program, a Certificate of Added Competence in Family Practice Anesthesia may be awarded, with continuing professional development requirements.

    “After completion of this program, a Certificate of Added Competence in Family Practice Anesthesia may be awarded, which has continuing professional development requirements for maintenance of competence.”

  • The paper relies on this without support.

    Family physician anesthesia training programs are offered at only 7 of 17 Canadian medical schools, with 22 positions total.

    “However, training programs are offered at only 7 of 17 Canadian medical schools, with a total of 22 positions available.”

  • The paper relies on this without support.

    Quebec and the Atlantic provinces have no family physician anesthesia programs.

    “Quebec and the Atlantic provinces have no family physician anesthesia programs.”

  • The paper relies on this without support.

    Discussions regarding national licensure are currently under way.

    “Discussions regarding national licensure are currently under way.”

  • The paper relies on this without support.

    Anesthesia services are essential for the provision of surgical, obstetric, and emergency services in rural Canada.

    “Anesthesia services are essential for the provision of surgical, obstetric and emergency services in rural Canada.”

  • The paper relies on this without support.

    Family physician anesthetists, who bring other generalist skills to rural communities, have been cost-effective care providers in rural Canada for decades.

    “Family physician anesthetists, who bring other generalist skills to rural communities, have been cost-effective care providers in rural Canada for decades.”
11 of 11

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • 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”

    From No community left behind: advancing rural anesthesia, surgery, and obstetric care in Canada. (2022) · cites this paper as [15]

    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

  • 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”

    From No community left behind: advancing rural anesthesia, surgery, and obstetric care in Canada. (2022) · cites this paper as [15]

  • The anesthesiologist shortage in Canada is most serious in rural and remote communities.

    “This shortage is most serious in rural and remote communities.”

    From The anesthesia human resources crisis in Canada (2024) · cites this paper as [7]

  • Only 8% of physicians serve the rural population, who comprise 18% of all Canadians.

    “Only 8% of physicians serve the rural population, who comprise 18% of all Canadians.7”

    From The anesthesia human resources crisis in Canada (2024) · cites this paper as [7]

  • Operative anesthesia care in Canada is currently almost entirely delivered by specialist physician anesthesiologists or family practice anesthetists.

    “Operative anesthesia care in Canada is currently almost entirely delivered by specialist physician anesthesiologists or FPAs 7 (with a very small number of dentists with additional training in anesthesia and physicians with other specialty designations).”

    From The anesthesia human resources crisis in Canada (2024) · cites this paper as [7]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • British Columbia coaching example cites an Australian handbook

    Minor

    The citation attached to the British Columbia program is reference 25, but that entry is an Australian continuing professional development handbook. The bibliography lists the British Columbia coaching program as reference 23.

  • Rural research funding statistic points to an unrelated reference

    Minor

    The funding statistic cites reference 23, which is a description of a clinical coaching program. The bibliography instead lists a paper on rural research funding as reference 21.

2 of 2

Cites

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1 of the 16 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Orser, B. A., & Wilson, C. R.
Affiliations
Sunnybrook Health Science Centre (CA)
ORCID
Venue
Canadian Medical Association Journal
Publisher
CMA Joule Inc.
Published
2020-07-26
Volume
192
Issue
30
Pages
E861-E863
ISSN
  • 0820-3946 (ISSN-L)
  • 1488-2329
DOI
10.1503/cmaj.200215
PMC
PMC7828913
OpenAlex
W3043922159
Cited by
35
References
16
Citations by year
2025: 4 · 2024: 10 · 2023: 7 · 2022: 3 · 2021: 7 · 2020: 4
FWCI
4.90
Type
journal article
Language
en
Open access
Locations
  • Canadian Medical Association Journal (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Surgery
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
anesthesia services, rural health care, remote care, national health strategy, surgical services, obstetric care, Bella Coola
MeSH terms
Anesthesia, Cardiac Procedures, Canada, Health Services Accessibility, Health Services Needs and Demand, Humans, Quality of Health Care, Referral and Consultation, Rural Population, Socioeconomic Factors, Surgical Procedures, Operative, Rural Health Services

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