Small system dynamics model for alleviating the general practitioners rural care gap in Ontario, Canada

The disproportionate concentration of healthcare professionals in urban areas is a concern in many countries, including Canada. A need to address this rural care gap has driven a large number of government led initiatives worldwide over the years. This paper presents a model that can be used as a tool to examine the efficacy of such policies on the workforce distribution in the long term. A small system dynamics model is employed to simulate the current and future distribution of general physicians at a jurisdictional level. The model represents the transition of general practitioners to provide insight into the dynamics of care provision over time. The movement, and competition, between rural and urban areas is modeled to enable detailed exploration of the ability for proposed measures to alleviate the care gap in the future. Among the tested policies are such commonly used initiatives as financial incentives to rural professionals, promotion of medical education in rural areas, expansion of rural education programs and the engagement of international medical graduates etc. We demonstrate how the model can be used as a tool to determine an efficient and well-chosen combination of policies which can help alleviate the rural care gap in the future, given that some policies are more effective than others alone but also combined with other initiatives. The presented small system dynamics model is tested on Canada's reality, but its simple nature lends itself to easy application to other countries that experience a similar problem.