Centralizing surgeries in regional hospitals and continued use of locum doctors in small towns is the new normal in B.C. health care, says Health Minister Margaret MacDiarmid.

The physician turned politician, who once practised in Trail, said there won't be a return to the way rural hospitals and communities functioned in the past.

With physician recruitment a national and even global issue, MacDiarmid said communities may have to adjust to the idea of locum physicians, who rotate in and out of communities.

Many of those communities set aside special housing for visiting doctors. In Nakusp, the municipality purchased a home that it uses to house locum physicians.

"I do value continuity of care — I'm biased," said MacDiarmid, who is familiar with rural practice. "I had four generations of the same family in my practice and that enriched it."

But MacDiarmid said there is a "cultural shift" in the way new physicians view their hours as well as the way they want to work.

"Students are different and have different ideas. We have to adapt to that."

When she was in Trail helping recruit other doctors or locums, a typical response was: " 'I'll work with you for a few months. But I don't want to work in summer or over Christmas.'

"We'd look at each other: In a small group one of us always had to be available. You couldn't opt out."

While many residents recall receiving minor surgeries in Ashcroft or Clearwater, for example, MacDiarmid said there won't be a return to those days. Research has shown that patient outcomes are better when physicians do more surgeries in their specialization, which requires frequency of procedures not available in rural hospitals.

In its most recent agreement with physicians, B.C.'s Liberal government committed $10 million to enhance services in rural and remote areas.

It also offers a generous loan-forgiveness program that pays off debts in three years as well as a $20,000 grant on top of that for rural practice.

Those efforts are paying off, MacDiarmid said.

The government points to its efforts in doubling the number of medical school seats and attracting more doctors. According to the ministry, the province has increased the number of doctors practising in rural B.C. to 2,240, up from 1,770 almost a decade ago — a 26 per cent increase at a time when rural populations are largely stagnant.

MacDiarmid acknowledged many of those physicians may be locums. Clearwater, for example, is heavily reliant on use of locum physicians.

In May, the province announced an initiative to boost the number of nurse-practitioners graduating each year to 190 by 2014-15.

MacDiarmid said the province is also looking at physician assistants, used in the U.S. and the military.

"I believe we can go forward and have things get incrementally better," she said.

cfortems@kamloopsnews.ca