Working as a rural Northern physician, Dr. Nick Potvin saw how something as simple as sending a patient for a routine test in a tertiary care centre can be a fraught process for doctors in the North.  

So he returned to school to study the challenges facing Northern communities while pursuing a PhD in rural equity and distributive justice at Western University.  

In Southern Ontario, labs and testing facilities are often less than an hour away — they are typically located in the same hospital in larger urban centers. In rural Northern communities, testing facilities can be several hours away, meaning patients have to be transported by air ambulance. 
The time spent in flight can be risky for a very sick or injured patient, Dr. Potvin says. A nurse typically accompanies a patient on the lengthy journey, which can also exacerbate a hospital’s existing staff shortage. 

Results can come back in as little as 20 minutes in larger urban centres, so many physicians won’t hesitate to order a test. In the North, it can take hours to arrange transportation for tests –– even days for non-urgent cases.  

“In some cases, that results in us looking for reasons not to require that scan, where that likely would just happen as a matter of course in a larger centre,” says Dr. Potvin, who continues to work as a locum providing temporary emergency medical services in both Northern and Southern Ontario.  

Northern rural doctors are therefore forced to rely more heavily on their “clinical acumen,” Dr. Potvin says — their knowledge and experience to know when a test may be absolutely necessary or when it’s safe to do a bit of “watchful waiting” to see if a patient’s condition improves.  

That dependence on clinical acumen can be intimidating to clinicians not used to practicing in such an environment, especially new grads, he says. 

Dr. Potvin believes this is one of the reasons Northern communities struggle to attract and retain doctors. “It doesn’t take very many episodes like that to start to cause people to say ‘You know what? Maybe this isn’t the sort of career that I’m interested in,’” he says.  

And it’s just one more stressor for Northern doctors who lack the resources to provide the best care to their patients. “I honestly don’t think that money is the solution,” Dr. Potvin says. “A lot of cases, I think it comes down to having adequate supports.”