Dr. Tobias Gelber comes from a long line of physicians—three of my four grandparents were physicians, and my extended family includes at least 20 physicians. My paternal grandmother, a family doctor in our community, inspired me the most. Today, I work shifts in the same Grand Forks emergency department where she once practiced.
Life as a rural doctor
Living and working in a rural community means I can walk to my clinic, run into my patients at the grocery store, and feel deeply connected to the place I serve. It creates a sense of belonging—for me and my patients. When people see me outside the clinic, they see me as a person, not just a doctor.
Raising a family in a rural setting is special. It really does take a village, and in a small town, people look out for each other’s kids. While urban centres can be more anonymous, rural life fosters community.
Challenges in rural medicine
One of the biggest challenges is access to specialty care. Almost everyone in rural communities has to travel to see specialists, which adds costs in time and money. I call this the “rural tax.” Even in a mid-sized referral centre like Trail, we still don’t have the same access as urban centres.
Another challenge is the need for broad skills. In a rural setting, family doctors often manage everything—obstetrics, emergency medicine, hospital care, surgery, MAiD, long-term care and anesthesia. That level of responsibility can be daunting, especially for new doctors who may not feel prepared.
Fixing the system
The biggest change needed in primary care—rural and urban—is team-based care. It’s proven to improve patient outcomes, increase doctor and patient satisfaction and reduce healthcare costs. But our current system puts the cost of running a team onto individual doctors, which discourages it.
Hospitals don’t ask surgeons to pay for their own OR nurses. We need to apply that model to primary care. I propose “primary care hospitals”—community-led clinics where overhead costs are covered by per-capita government funding, separate from physician pay.
These clinics wouldn’t be government-run or health authority-controlled. Instead, they would be operated by non-profit boards, ensuring community-focused care that isn’t dependent on individual doctors. This model would provide stable funding for nurses, dietitians, physiotherapists, counselors, and other key team members, so care doesn’t fall apart when a doctor retires or leaves.
Another project I’m working on is a rheumatology telehealth program. The nearest rheumatologist accepting patients is four hours away. Through this program, rural family doctors would receive advanced training in rheumatological exams, allowing them to collaborate with specialists via video. This model improves access, builds local expertise, and ensures patients receive better ongoing care close to home.
Making change happen
I’m working on multiple levels to improve primary care, from local initiatives to provincial system reform. My goal is simple: build a better, more sustainable system.
Change is never easy, but it starts with a vision and the drive to make things better. I believe in a future where every patient, no matter where they live, has access to high-quality, team-based care. We can create a system that works for both doctors and patients—one that is resilient, forward-thinking and built on collaboration.
We don’t have to accept the status quo. We can do better. And together, we will.