If all goes according to plan, Lieutenant Bradley Martire, MD, a member of the Canadian Armed Forces and a second-year medical resident at Â鶹AV, will either be practising family medicine in a remote military base in Canada, or providing humanitarian relief in an overseas war zone.
Today, he is laying the groundwork in a family medicine residency program, completing a rural rotation in Shawville, a small town northwest of Gatineau that is an accredited training site for Â鶹AV family medicine residents and part of its Distributed Medical Education Program Rural Stream. “My pathway is unique in that the family medicine program requires residents to do two months of rural medicine, but I chose to extend it to four,” says Dr. Martire, who studied medicine at UniversitĂ© Laval.Ěý
Part of why he chose to do a rotation in Shawville was to increase his exposure to emergency medicine in an environment where there are fewer specialists, and the responsibility to acutely manage patients, some of whom can sometimes be severely ill. This would emulate routine practice in a military setting.
In addition to his responsibilities in Shawville, Dr. Martire has about 200 patients assigned to him at a CLSC in downtown Montreal. “I act as a family doctor under the supervision of attending doctors. I’m responsible for lab follow-up and if anything happens to those patients I ensure continuity of care,” he explains. “While I’m in Shawville, I ensure follow-up under a different attending for patients in that region. I also do off-service rotations, meaning I rotate through many emergency rooms and walk-in clinics. I see patients of all ages, across many specialties to get a better understanding of different fields of medicine.”
Providing healthcare in a rural location comes with unique challenges, Dr. Martire says. For example, in an urban hospital environment it’s relatively easy to consult with a specialist who is often on-site to assess the patient. “But in a rural environment, you have to take on more responsibility and sometimes go beyond what you would normally do, to manage that patient on your own,” he explains. “The specialist will be there over the phone if you have questions for them. But it’s you doing the exam and the investigations. In that sense, it can be a little bit uncomfortable at first to not have someone who’s there to independently manage the patient, but then it gives me an opportunity to advance my learning and try to bridge that knowledge gap myself for the betterment of the patient.”
Some of the other challenges are common within the health system as a whole. Dr. Martire points to access to care, and how the number of patients to see far exceeds service availability. “That means that sometimes patients will consult healthcare in environments that we wouldn’t expect them to, like in the emergency room when that patient could be better served in a clinic. And even if they are seen in a clinic there may be limited availability to schedule follow-up appointments simply due to demand.”
For Dr. Martire, family medicine is a specialty that best allows a single practitioner to investigate multi-system medical issues, often even social issues that a patient might have, and bring them together and create a complete treatment plan that will provide the best health yield.
“Sometimes the management plans for all these different problems overlap, and by doing one thing, for example, reducing alcohol consumption or quitting smoking, you’re in a great position to motivate patients on how to act on multiple problems at once. And that’s something that I think is unique to family medicine. I think we can have a big impact.”
About the Shawville Rural Stream training site for family medicine
- Population: 20,300 (Pontiac region)ĚýĚý
- Language: 60% English, 40% FrenchĚýĚý
- Hospital: 31 acute care beds, 165 deliveries and 1200 surgical interventions per yearĚýĚý
- Residents are assigned to a team to Family Medicine PhysiciansĚýĚýĚý
Learn more about the Shawville training siteĚý
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