To achieve sustainability, remote and rural communities require health service models that are designed in and for these settings and are responsive to local population health needs. This paper draws on a panel discussion at the Rural and Indigenous Health Symposium held in Toronto, ON, on September 21, 2017. Active community participation is an important contributor to success in rural health system transformation, as well as health workforce recruitment and retention. Increasingly, communication technology is contributing to the quality and effectiveness of healthcare in remote rural community settings, particularly by ensuring that specialist expertise is accessible to and supportive of the local providers of care. Recent medical graduates bring life experiences and work expectations to rural primary care that are different from their senior colleagues. Successful recruitment and retention of the rural primary care workforce depend increasingly on offering a "turnkey" clinic work supported by a functioning electronic medical record. Rural health system sustainability occurs most frequently through ongoing collaboration and partnerships, partnerships, partnerships. It is through partnerships with communities, health services and healthcare providers that the Northern Ontario School of Medicine (NOSM) has been successful in producing medical graduates who provide care responsive to population health needs in previously underserved communities of northern Ontario. Sustainable healthcare in remote and rural communities is enhanced by active community participation and clustering these communities in local networks. An important key to success is shifting from hospital-centric to community-centric care.
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