Dr Denise Jaworsky, Internal Medicine and Project Lead, and Alison Irvine, Project Coordinator, presented findings from a needs assessment and environmental scan on rural specialist care in BC, supported by the Specialist Services Committee (SSC) and Joint Standing Committee on Rural Issues (JSC). The research project stemmed from a recognition that expanding access to specialist care close to home, in rural BC, is crucial for addressing health care disparities and ensuring equitable access to medical services. Nationally, rural areas are home to nearly 20% of the population, while only 8% of physicians and 2% of specialists practice in these communities. This means rural residents, who often have the greatest health needs, experience longer wait times, travel burdens, and poorer health outcomes.
 

Guided by an oversight committee, the project team conducted interviews with program directors of specialty programs and specialist/primary care providers currently providing care or intending to provide care to rural BC populations. This portion of the project aimed to understand barriers and facilitators to providing specialist care to rural populations as well as map the current rural specialty training opportunities.
 

They highlighted key motivators for rural practice, including equity in health care access and lifestyle preferences. Enablers of rural specialist care included provincial programs, local support, virtual care, and team-based approaches. Major barriers identified were limited resources and infrastructure, challenges in patient transfer, and the need for formal support for allied health. The discussion also touched on specialist training improvements, with a consensus that rural electives are beneficial, but opinions were mixed on mandatory rural rotations. Patients' main challenges in accessing specialist care were travel-related burdens and connectivity issues for virtual care.
 

Next steps include sharing these findings back with the JSC and SSC and using the information to guide future project work aimed at improving rural access to specialist care.

The following information on provincial programs, policies, and resources were shared with all participants, followed by an opportunity to ask questions.

Northern & Isolation Travel Assistance Outreach Program (NITAOP):

• Purpose: Provides funding from for approved physicians who visit eligible rural and isolated communities to provide medical services.
• Funding: Reimbursement includes travel costs, travel time, and accommodations/meals to supplement outreach related costs
• Eligibility: Based on geography, population, service gaps, and alignment with regional rural service planning, communities must be pre-approved before outreach is scheduled
• Process: BC's regional health authorities submit yearly funding requests to Rural Practice Programs. Once approved, visiting physicians are contacted by the health authorities and outreach visits are organized.
• Contact: HLTH.RuralPrograms@gov.bc.ca

SSC/JSC Outreach Clinic Support Program

• Purpose: Provides funding and support for specialist physicians to establish new or expand existing rural outreach clinics
• Funding: Up to 15 hours of sessional support to cover time needed to support relationship-building, administrative set-up, quality improvement, etc. for outreach clinics
• Eligibility: Specialist physicians
• Process: Complete online program application and asynchronous 1-hour virtual program introduction/overview, evaluation
• Contact: RuralSpecialistProject@rccbc.ca

Facility Engagement (FE) Funding

• Purpose: Provides funding to local Medical Staff Associations (MSAs) to support medical staff priorities.
• Funding: Accessed through each local MSA and covers a variety of activities, see Examples Across FE – Supporting Specialist Rural Outreach.
• Eligibility: All facilities with acute care beds are eligible to receive FE funding to support improved engagement within and across MSAs and their Health Authority partners. See the FE funding guidelines for more information.
• Process: Medical staff interested in using FE funding to build relationships and improve the visiting specialist experience can reach out to their local MSA executives and/or Engagement Partner for more information.
• Contact: engagement@doctorsofbc.ca

Pathways

• Purpose: A province-wide, clinician-led platform used to support referrals, clinical decision-making, and access to up-to-date service information at the point of care.  It is designed to ensure clinicians have reliable, current information in one place, including specialist services, outreach clinics, referral requirements, as well as patient information and clinician tools.
• Contact: contact-us@pathwaysbc.ca to help set up or update outreach listings and ensure information aligns with real-world clinic workflows.

Through panel presentations and small group discussions, the event brought together specialists and rural healthcare providers to connect, build relationships, and identify practical ways to improve access to specialist care. Discussions focused on what works, where gaps exist, and how to move forward with scalable, sustainable solutions.

Participants heard from Drs Breanne Abbott and Tracy Morton, Family Physicians, Liza Hart, Clinic Manager, Kerry Laidlaw, Health Service Administrator, Dr Denise Jaworsky, Internal Medicine, and Dr Daisy Dulay, Cardiologist, who each shared their experiences organizing rural specialist outreach clinics. Attendees then had the opportunity to ask questions, share advice, and highlight lessons learned.

Key success factors included the importance of building relationships, having strong administrative support, and engaging residents in rural specialist care.

The main challenges highlighted were complicated logistics (e.g., travel, scheduling, EMR connectivity, reimbursement processes, etc.), lack of a centralized system to match specialists to communities in need, and compensation models.

To assess whether the event met its intended objectives, participants were asked multiple-choice questions at the end of the event. Options were provided on a 5-point Likert scale, from strongly disagree to strongly agree.

89% of respondents agreed "The virtual symposium was a valuable use of my time."

88% of respondents agreed "The virtual symposium helped me to understand barriers and enablers of providing rural specialist care."

85% of respondents agreed "The virtual symposium increased my knowledge of supports and resources available for developing specialist rural outreach clinics."

81% of respondents agreed "The virtual symposium supported connection and relationship-building between participants."

70% of respondents agreed "Attending the virtual symposium has increased the likelihood that I will support a specialist rural outreach clinic."

N=27

Quotes from participants included:

“Hearing the experiences of others who work with specialists in a rural context and feeling motivated by their care and passion for this work.”

“…It’s reassuring that everyone has the same challenges and similar experiences; particularly the importance of the relationship-building piece to support specialists in community. Glad to hear that FE supports activities that prioritize these relationships.”

“In terms of the information presented, the most valuable part was hearing that the sustainability of an outreach clinic seems less about funding alone and more about relationships – knowing who to call, having predictable touchpoints, and feeling mutually respected.”

As part of the event evaluation, participants were given the opportunity to be matched with communities and/or specialists interested in supporting rural outreach. Six specialist physicians indicated interest in providing outreach services, with three additional specialist physicians requesting more information prior to taking further steps, and six participants from rural, remote, and/or Indigenous communities/facilities indicated interest in hosting a specialist rural outreach clinic.