Department of Sociology, University of New Brunswick, Fredericton, Canada
New Brunswick Institute for Research, Data and Training (NB IRDT), University of New Brunswick, Fredericton, Canada
Rural Remote Health. 2023 Jun;23(2):7882. doi: 10.22605/RRH7882. Epub 2023 Jun 2.
Health workforces around the world are characterized with geographic maldistribution, often leading to inequalities in rural health outcomes. Monetary incentives are frequently raised as a policy option to bolster recruitment of healthcare practitioners to rural and underserved communities; however, few rural health workforce studies focus on allied health professionals (AHPs), include urban comparators, integrate gender considerations, or measure rural diversity. This population-based observational study examines trends in the geographic and gender distribution and earnings of AHPs in Canada across the rural-urban continuum.
Nationally representative data from the 2006 and 2016 Canadian population censuses were pooled and linked with the geocoded Index of Remoteness for all inhabited communities. Five groups of university-educated AHPs providing prevention, diagnostic evaluation, therapy, and rehabilitation services were identified by occupation. Multiple linear regression models were used to estimate the associations between relative remoteness and annual earnings of AHPs aged 25-54 years, controlling for gender and other personal and professional characteristics.
The density of AHPs was found to be 15 times higher in more urbanized and accessible parts of the country (23.6-25.6 per 10 000 population in 2016) compared to the most rural and remote areas (1.6 per 10 000 population), a pattern that changed little over the previous decade. A positive correlation was seen across occupations in terms of the degree of feminization and their geographic dispersion by relative remoteness. While pharmacists residing in more rural and remote communities earned 9% (95% confidence interval 4-15%) more than those in core urban centers, relative remoteness contributed little to wage differentials among dentists, physiotherapists and occupational therapists, or other AHPs in therapy and assessment (no significant difference at p<0.05). Women earned significantly less than men in dentistry, pharmacy, and physical or occupational therapy, after adjusting for remoteness and other characteristics.
This study did not find consistent wage disparities by relative remoteness as characterizing allied health professions in Canada. The evidence base to support financial incentives to AHPs to reduce perceived opportunity costs associated with working and living in rural and underserved areas remains limited. More research is needed on the intersections of rurality, gender, and wage differentials among AHPs in different national contexts.
全球医疗工作者的分布存在地理分布不均的问题，这往往导致农村地区的健康结果存在差异。货币激励措施常被作为一种政策选择提出，以鼓励医疗保健从业者到农村和服务不足的社区工作；然而，很少有农村卫生人力研究关注辅助卫生专业人员 (AHPs)，包括城市比较，综合性别考虑因素，或衡量农村多样性。这项基于人群的观察性研究考察了加拿大农村-城市连续体中 AHPs 的地理和性别分布以及收入的趋势。
对 2006 年和 2016 年加拿大人口普查的全国代表性数据进行了汇总，并与所有有人居住的社区的地理编码偏远程度指数进行了链接。通过职业确定了五组提供预防、诊断评估、治疗和康复服务的接受过大学教育的 AHPs。使用多元线性回归模型，控制性别和其他个人及专业特征，估计相对偏远程度与 25-54 岁 AHPs 年收入之间的关联。
与最偏远和最偏远地区（2016 年每 10000 人 1.6 人）相比，在城市化程度较高和交通便利的地区，AHPs 的密度高 15 倍（2016 年每 10000 人 23.6-25.6 人），这一模式在过去十年中变化不大。在相对偏远程度方面，各种职业的女性化程度和地理分布呈正相关。虽然居住在较偏远和偏远社区的药剂师比核心城市中心的药剂师多挣 9%（95%置信区间 4-15%），但相对偏远程度对牙医、物理治疗师和职业治疗师或其他治疗和评估中的 AHPs 的工资差异贡献不大（p<0.05 无显著差异）。在调整偏远程度和其他特征后，女性在牙科、药学和物理或职业治疗方面的收入明显低于男性。
本研究未发现相对偏远程度作为加拿大辅助卫生职业的特征，存在一致的工资差距。支持向辅助卫生专业人员提供财政激励，以减少与在农村和服务不足地区工作和生活相关的感知机会成本的证据基础仍然有限。需要在不同的国家背景下对农村、性别和 AHPs 工资差距的交叉问题进行更多研究。
