Prairie Mountain Health Physician Recruitment Strategy

Transcription

1 Prairie Mountain Health Physician Recruitment Strategy 2014

2 Table of Contents Recruitment Committee Members Introduction Methods

3 Recruitment Committee Members Tanja Borchers Med I Winnipeg, MB. Jordan Cram Med II Souris, MB. Alise Gaiser Med II Brandon, MB. Adam Hoffman Med I Winnipeg, MB. Katlin Mallette Med I Brandon, MB. Aaron Martin Med I Neepawa, MB. Kilmeny Melnick Med I Beausejour, MB. Danielle Paradis Med I Boissevain, MB. Katelyn Sinclair Med I Winnipeg, MB. Kelsey Uminiski Med I Winnipeg, MB.

4 Introduction In 2012, Brandon, Parkland and Assiniboine Regional Health Authorities amalgamated to form Prairie Mountain Health (PMH). Prairie Mountain Health is located in the southwestern corner of Manitoba, covers over 67,000 square kms, and has a population of approximately164,000 residents. Approximately 53,000 of this population reside in the City of Brandon, with over 100,000 residents living in small rural communities throughout a vast geography. The aboriginal population comprises almost 10% of the total population. Within Prairie Mountain Health s rural communities, there are 27 family physician/primary care clinics and 7 satellite clinics. This excludes the city of Brandon which has multiple primary care practices. With the exception of Dauphin, all primary care clinics are served by less than ten family physicians, with the majority of clinics being served by four or less family physicians. Of the 27 communities, 18 continue to offer acute care, emergency room care, in addition to primary care and long term care services. Recruitment and retention of physicians is an ongoing struggle in the majority of these communities, with physician turnover significantly impacting continuity of care. In addition, emergency room and acute care services are often temporarily suspended due to lack of physician support. This further impacts quality of care for rural residents, often creating confusion and in some instances long travel distances for elderly patients. The City of Brandon also struggles with physician recruitment, relying predominately on International Medical Graduates to fill both specialty and family physician vacancies. The one area of the region that has seen significant success with the recruitment and retention of Manitoba Medical Graduates is the City of Dauphin, which has ran a family medicine residency program for the last two decades. These struggles are not unique to rural Manitoba. The shortage of physicians in rural areas is a global phenomenon in both developing and developed nations. A great amount of research has been done on this topic throughout most provinces and territories throughout Canada. Some of this information gathered through these various studies will be referenced throughout the report.

5 Methods For the 2014 summer, Prairie Mountain Health took nine Home for the Summer students, all having recently completed their first or second year of medical school at the University of Manitoba. These nine medical students were placed in communities throughout the Region. Home for the Summer requires all students to complete a written project to be presented at a Project Presentation Evening on September 10, As part of this summer project, they worked with Michelle McKay, Director of Medical Services Administration on the development of the following Physician Recruitment Strategy. Three one hour focus groups were planned as part of the project, and questions and answers from these meetings form the basis of the information contained within this report. Students were also encouraged to review websites and advertising, such as utube videos used in other areas of the country as physician recruitment tools. Some students also researched papers and materials on rural physician recruitment and retention. See Appendix I for all questions and responses.

6 Findings Medical Students from rural areas are much more likely to return to a rural community to practice medicine. Many literature studies suggest a correlation between rural background and probabiliyty to subsequently practice in a rural location. The background of a physician s spouse is also important. The focus group findings continued to support this literature. The top reason given for considering rural practice, in particular in Prairie Mountain Health is that their family and roots are in the region. Students felt that the Home for the Summer Program provides a great opportunity for local students to return home for the summer months, get a taste of rural practice and provides an opportunity for Prairie Mountain Health staff the opportunity to develop a meaningful relationship with local students. Winnipeg students, however, did stress that not only students from rural communities may be interested in rural practice but city students as well, for different reasons, primarily scope of practice. Action: Development of a recruitment database is maintained of all local students entering medical school. Student information can be obtained through Rural Interest Group trips, Home for the Summer, word of mouth, community contacts, etc. Early Engagement Medical students praised Prairie Mountain Health for their involvement in Rural Week, Rural Interest Group Trips and the Home for the Summer Program. They feel that the region goes out of their way to engage with students and they see that as a key in recruitment. They stressed the importance to maintain relationships throughout medical school and to have one contact if possible for students to enquire through. Action: Maintenance of the regional database with additional information being added throughout medical training. Use the database as a tool to ensure regular engagement with students throughout their training and residency. Promote rural Manitoba lifestyle Students cited many positives about making your home in rural Manitoba. They encourage all advertising, promotion and communication to focus on such things as: Lower cost of living Limited/no commuting time resulting in added time in your day

7 Ability to go home for lunch if you want Abundance of outdoor activities Small town feeling of safety and comfort Focus on the many outdoor attractions in PMH such as Riding Mountain National Park, Assessippi Ski Resort, Spruce Woods Provincial Park, as well as the abundance of hunting, fishing, skidooing, biking, etc. Things students noted as being important when deciding on a specific rural community would be: Good recreational facilities Land for physicians to build a home Good schooling for their children Flexibel daycare hours Spouse/Family All students discussed the importance of not only a fit for them as a physician, but also for a spouse and children. Integration by all family members into the community is critical. Included in this theme is the physician s spouse finding employment. In some instances, this can be difficult, but working with the physician and their family and presenting possible employment opportunities was seen as a good first step. However, it is recognized that some professionals are difficult to practice in rural communities. Work Life Balance The Annual National Physician Survey asks medical students each year to respond to factors that would be most important to having a satisfying and successful medical practice. The number one answer historically has been the ability to achieve a work life balance. Students surveyed felt that the flexibility often available in rural practice could be helpful in achieving work life balance. The ability to allow for part time work would be important, in particular for female physicians. Availability of locum support, access to continuing medical education, and reasonable on-call schedules were critical elements discussed. Broad Scope of Practice Students discussed the variety of practice opportunities and full scope of family practice as a huge recruitment tool. Students more interested in specialty training such as surgery, also cited the variety of procedures/practice vs. vary narrow subspecialties that exist in larger urban centres as a big draw. Students also discussed the flexibility of practice and the ability to create a practice niche that works for you. A full spectrum of patients from kids, young adults, families, adults, elders, and geriatrics was seen to be interesting and rewarding. All students felt this was a huge plus to practice in Prairie Mountain Health. As noted earlier, this was seen as the largest draw for students who

8 didn t have roots in rural Manitoba. In addition to the variety of work and large of scope of practice, the ability to do all of your work in one setting was seen as a positive. Many students commented on the great set up of rural health centres, with clinic, hospital, lab and x-ray, ER, and long term care all under one roof. Students liked the idea of being able to refer to Winnipeg for specialty services vs. to Winnipeg. Another huge asset noted in smaller rural practices was the continuity of care provided and the ability to develop strong relationships with your patients, therefore resulting in better quality of care and better job satisfaction. In a recent Saskatchewan survey a rural physician remarked the enduring relationships with patients and the strong sense of community in a rural centre are what continue to attract me to rural practice. Another noted working in a rural setting enable one to better understand illness in light of the cultural and social context. For instance, even in the emergency room we know a great deal about our patients the moment they walk in the door; more than you could ever possibly know in the city. Action: Ensure recruitment tools focus on the broad scope of practice Provide as many opportunities as possible for students to fully engage in rural exposures (Rural Week, Home for the Summer, Rural Manitoba Health Mentorship Program, Clerkships, electives) Overhead/Turnkey/Electronic Medical Records (EMR) Medical students that participated in the focus groups confirmed that when presented with several opportunities, with all other factors being equal, a modern clinic with electronic medical records becomes the decisive factor. The new medical student is looking for a centre that is equipped with the necessary medical equipment, has access to support services, has implemented full utilization of the technologies available and uses modern and efficient processes. They often do not want to be business owners or practice managers, and therefore joining a turnkey practice is very appealing. Similar comments were made about the hospital facilities that they would be admitting to or working Emergency Room on-call shifts in. Students would prefer to work in a setting that is relatively new, bright and has up to date features. Old, time expired facilities were not seen as appealing. Action: Work with communities to ensure modern clinic facilities are available. Integrate EMR to the greatest extent possible Return of Service Agreements/Signing Bonuses

9 While incentives and financial supports play a role in creating an environment that will attract physicians, medical students expressed that supports alone will not address all of the recruitment and retention issues. Students described them as nice to have but certainly not the sole criteria to determine a practice location. Some students commented on the fact that they make you feel wanted and needed which is nice. Students also expressed that location directed grants were very worrisome and not something they would sign up for. Students did mention that all things being equal a Return of Service Agreement or Signing Bonus could be the deciding factor however it wouldn t outweigh such things as collegial support, scope of practice, access to certain amenities, etc. Collegial Support As a new grad in any community and/or practice, students communicated the need to feel supported and mentored by colleagues. One of the critical factors in determining a practice location would be senior physicians their willingness to act as a mentor and support new grads. Students talked about support from nursing staff, allied health staff and clinic staff as also critical when establishing a new practice. Students felt a strong social group among physicians would be important. They also felt that in a smaller practice this may be easier as in very large groups this is often difficult to achieve. Conclusion Although the following report was developed based on a relatively small number of medical students, valuable information was gathered and most importantly, verified. What the exercise revealed, is that those most likely to practice in a rural location favour a broad and varied scope of practice, are attracted to a rural lifestyle, and have rural roots. Students expressed that they would most likely remain in these rural communities if they could continue the broad scope of practice they came there for, if they felt appreciated by their patients, and if there family is happy in the community.