'Rural' doesn't mean 'uniform': northern vs southern rural family physicians' workload and practice structures in Ontario

Introduction: There is a tendency in health policy in Ontario, Canada, to conflate 'northern' with 'rural' and to equate northern rural settings with southern ones. Although previous research has identified some differences between rural and urban practitioners, these studies have not acknowledged the subtle nuances that make rural practice different in the north than in the south. This study looks more closely at practice patterns and compares number of hours worked per week, patient volume and practice type for rural northern, rural southern, urban northern and urban southern physicians. Methods: This study utilized data from Ontario's medical regulatory authority's 2007 annual membership renewal survey. Descriptive statistics and chi(2) analyses were used to examine practice type (eg solo, clinical group), hours worked per week and number of patient visits per week for 10 968 primary care physicians in Ontario's rural north, rural south, urban north and urban south. Results: Three key results emerged from the analyses: (1) physicians in rural northern Ontario worked more hours per week than their counterparts in other regions of the province, yet (2) they saw fewer patients per week, and (3) worked more frequently in clinical group-based practices. Conclusions: Rural northern physicians with different practice structures, different patient types, broader scope of services, and different encounter lengths indicate variations specific to locations and populations and communities. The interaction between the rural and northern context is unique and as such a blanket 'rural' or 'northern' approach to policy development is likely to be ineffective.