Small, remote rural communities, even in developed countries, find it hard to attract and retain physicians. Around the world, experts agree that medical training needs to be located in these areas to achieve a long-term solution.
Twenty-seven hours by train from the nearest town, James Cook University's medical school in Northern Queensland, Australia, is in a large region with a scattered population that has suffered from physician shortages.
Its one-year-old clinical programme has attracted between 700 and 800 applicants for 64 places - now increased to 80 - and dean Richard Hays says he expects 70 or 80 per cent of students to stay after graduation to work long-term in rural areas.
Canada has now decided to establish a medical school in Northern Ontario in an effort to supply one of its most remote areas with enough doctors.
Principal medical training will take place at Laurentian University in Sudbury, Ontario, with the first students admitted in 2004. The school will have a satellite campus at Lakehead University in Thunder Bay and a network of small medical facilities across Northern Ontario. It will be the first Canadian programme with a dedicated focus on rural and remote medicine, training 55 students a year.
Locating a medical school outside the metropolitan regions will help to change the uneven distribution of physicians, according to Robert McKendry, professor of medicine at the University of Ottawa, who examined the shortages for Ontario. He found at least 8.5 physicians per 10,000 residents in regions served by a medical school, while more remote areas averaged 7 to 7.5.
"This is a huge step for rural and northern medicine," said James Rourke, a small-town family doctor and director of the Southwestern Ontario Rural Medicine Unit. In cities, different doctors delivered babies, administered anaesthesia or dealt with emergency medicine, he said, but in remote areas a single doctor "with little back-up and relative isolation" did it.
"But you see joys and challenges that you would not normally see in an urban setting," he added.
Facts and figures
Across Canada the number of physicians per 100,000 population fell from 190 in 1995 to 185 in 1998. In Ontario the number of physicians retiring will exceed the number of new graduates by 2009 unless enrolments are increased.