Physician and Locum Recruitment and Retention Event Mary Winspear Centre, Sidney B.C. March 29, 2012
Purpose of the Event The goal of the March 29 th physician and locum recruitment and retention event was twofold: (1) to facilitate a good understanding of how to develop a framework for recruiting and retaining physicians; and (2) to establish a framework for developing locum pool programs. Small group discussions were organized to enable the development of strategies to achieve the aforementioned goals. The event also served to identify key areas and opportunities for collaboration between the South Island and Victoria Divisions of Family Practice. VIHA Physician Recruitment Program: Brenda Warren, Manager of Physician Recruitment Program In 2008, VIHA established a physician recruitment program to address increasing vacancies. The key function of the program is to recruit family practitioners and specialists to Vancouver Island and facilitate matches between practitioner s needs and available opportunities. Once practitioners have been recruited, the program becomes a resource for them to assist with relocation, orientation and, for International Medical Graduate physicians, and support processes to obtain a work permit. The average recruitment cycle is 12 months. Physicians are sourced through a variety of methods. VIHA works in collaboration with HealthMatchBC, a Ministry of Health funded professional recruitment service for physicians (www.healthmatchbc.org). Job opportunities are posted on the HMBC and VIHA websites. Further marketing of physician opportunities is also done by placing journal 2
advertising, exhibits at conferences, by connecting with residents at hospitals, through contact with medical students and by word of mouth. Opportunities for Partnership between VIHA Physician Recruitment Program and SIDFP: Physician recruitment is a key deliverable in the portfolio of medical affairs Recruitment Program coordinators can be contacted to inform them of job vacancies and they will post the positions on the VIHA and HMBC websites and provide advice on other advertising sources The Program emphasizes building capacity, coordinating site visits, orientation, welcoming and acclimatizing new physicians Known job vacancies are advertised on HealthMatchBC and VIHA websites and in appropriate journals and other publications Candidates who contact Physician Recruitment Coordinators will be referred to practices that have registered an opportunity Perspectives of Residents: Carly Loomes and Alexandria Baxter, medical residents (Note: key points provided reflect a compilation of ideas from a number of medical residents) Carly Loomes and Alexandria Baxter presented the perspectives of residents and how they envision the transition into becoming a locum as a form of support to practicing FPs: 3
Key reflections of what locums are looking for: EMR with IT support Good staff (i.e., helpful, patient, friendly, welcoming, organized, responsible) Group practice (i.e., being able to speak with other FPs) Patient population that is suited to our specific interests (i.e., obstetrics) Efficiently run practice Clear patient profiles Clear prescribing processes especially around antibiotics, narcotics and benzodiazepines (etc.) Clear office policies (i.e., telephone prescriptions, uninsured services) List of preferred specialists What factors would influence where locums would work and live: Family (i.e., partners ability to work here) Climate, recreation, arts Ability to build the practice locums want (i.e., inner city medicine) Community (services, housing, recreation, physical environment etc.) Money (i.e., what are the incentives, esp. for locums with debt?) Tight knit and welcoming medical community (i.e., invitation to dinner by host physician, introduction to colleagues) How to attract locums: Be specific about the practice in the advertisement Offer home if available during locum placements Provide daily compensation minimums Have office set up locum hospital privileges before arrival 4
Cowichan Valley Division of Family Practice Locum Coordinator Program: Valerie Nichol, Cowichan Division of Family Practice Executive Lead A locum coordinator program was proposed to Cowichan Valley Division membership after FPs raised concerns regarding access to locums. A Locum Coordinator, who had the interest and expertise, was hired to develop and implement the program. After a six-month trial with the program, a survey was created for FPs and locums to determine if the daily minimum was sufficient. As a result of the survey, the minimum was adjusted. The Locum Coordinator Program has since become a key service to the Division members. Over the last year and a half, a number of initiatives including: (1) establishing program policies related to locum requests and responsibilities; (2) setting daily minimums in collaboration with membership; (3) creating a new locum package that is given to residents with a sample contract, locum billing form, overview of program and policies that have been developed and a check-list for basic resources; (4) developing a post-locum survey. Benefits of Locum Coordinator Single point of contact Coordinates all aspects of scheduling and communication between locums and hiring FPs Assists with accommodations Coordinates EMR training before locums start Provides fair and equitable access to locum program services 5
Thoughts on the Shifting Landscape of Family Practice in Victoria: Ambrose Marsh, FP, Chief of Staff at Saanich Peninsula Hospital Ambrose Marsh identified some of the key differences between older FP practices and current trends facing new FPs and residents: FP Practices in 1980s Current and New FP Practices 200 FPs 350 FPs Many Single Practices Pair or groups Pairs Without hospital privileges Few Clinics OB hard call (approx 40 physicians) Rounding Daily in 1 or 2 Hospitals Sessional opportunities Many FPs/FPs doing Obstetrics While 40% of recent UVic graduates are going into family practice, it is unclear how many will continue their practices in an office based practice model that will offer patients care on an on-going basis. It is important to consider whether medical schools are encouraging residents to consider family practice professions. It is important to ensure that new graduates going into family practice have business management skills necessary for running practices. New graduates face increasing financial pressures, which may lead them to migrate to rural areas to relieve debt before returning to urban centres. This presents challenges for recruiting new graduates to urban areas. These graduates are also attempting to balance work and personal life and have expectations regarding models of care that are considerably different from older FPs. It is necessary to understand what these new models of care might be and how they will meet the seemingly conflicting expectations of 6
new graduates. Moreover, it is important to consider how and with whom these models will be created and managed and ensure that they will not unfairly compete with or undermine existing practices. Managing the Physician Partnership Strategy for VIHA, Alix Adams, Medical Affairs Project Lead, VIHA VIHA developed a partnership strategy in acknowledgement of the need to build relationships with physicians throughout the region. This strategy is a multi-year project and the relationship that VIHA is developing has been an on-going endeavour. The partnership strategy can help identify root causes of relationship challenges and offer solutions. There is interest in continuing to improve practices in the way physicians are engaged. As part of the structure of the South Island Collaborative Services Committee, VIHA representation from the senior management level ensures continued relations with the Division. Question and Answer Period The questions asked after presentations focus on two pressing concerns: 1. Recruiting new FPs and the challenge of changing expectations and practices; and 2. Collaboration between VIHA and the Division to recruit new FPs. Recruitment and Changing Expectations: What is the pool of FPs from which VIHA and HealthMatchBC are recruiting? How many physicians have been recruited this past year and how many vacancies? VIHA reported: o FPs: 33 new; Vacancies: 13; South Island vacancies: 7 7
How do we facilitate a shift in the way FPs currently practice and market themselves to accommodate the expectations of new graduates? o Consider new models of care (e.g. larger group practices; multi-disciplinary care models) o Develop good Practice Profiles to share with new physicians/locums o Keep practices modern and up-to-date with technologies etc. What is prohibiting new FPs from working in B.C.? o Practice models are different o Want more control over their lives o Other provinces are competitive o Need to speed up the process of credentials for locums How many FPs are in office-based general practices and when are they planning to exit their jobs? How many will be needed to meet population needs in next 5-10 years?] o VIHA needs to increase efforts to develop a better demographic profile of the physician community to determine short and long term needs Practicing physicians need to be aware that new graduates are aware of issues fullservice FPs face. New graduates are looking for greater work/life balance. Collaboration More collaboration is needed between VIHA s recruitment program and the South Island Division and VIHA needs to liaise more closely with Divisions An action plan is needed to improve communications between VIHA and Divisions VIHA recruitment service needs to be better marketed to FPs as many of whom do not know it is available VIHA needs to communicate more clearly about how it can help FPs with support for their practices? 8
Small Group Discussion Small group discussions were organized as a way of addressing key issues related to recruiting and retaining physicians and locums. Three main areas were discussed: 1. Attracting and retaining physicians; 2. Recruitment strategies and tactics; and 3. Developing a locum pool. 1. Attracting/Retaining Physicians Key questions: What are the key attributes that will attract doctors to our community? A. Characteristics of New FPs: Want their time and work-life balance protected Location is the biggest deciding factor Want to work collaboratively Disconnect between what students are learning (or not learning) in school and the realties of running a family practice clinic o Training needs to be more reflective of realities of the working life of a FP B. Successfully Retaining Physicians Requires: Community welcome to prospective FPs o Holistic welcoming process o Better preplanned action and support from groups of FPs who are willing to work with the new FP in the community adopt a mentoring approach o Offer accommodation to a visiting doctor (and family) where possible Providing efficient, up-to-date computer technology 9
Giving residents tours of practices that incorporate a balanced atmosphere and supportive work environment Providing new graduates with information about business models, so they don t feel overwhelmed when going into practice including exposing residents to business management issues/needs Linking people in locum practices with residents so it s less intimidating for new practitioners 2. Recruitment Strategies and Tactics Key Questions: How can we best get information about our community out to new doctors? A. Getting Information about the Community to New Doctors: Develop community recruitment committee to formulate initiative: o Needs to be a shared responsibility to find new doctors committee can help develop/direct strategies o Improve links with HealthMatchBC and VIHA o Identify opportunities for local graduates o Highlight the progressive aspects of family practice and the strengths of the region (i.e., natural beauty, recreation, community amenities, lifestyle) for doctors and families o Coordinate actions with range of local community agencies, services, organizations and municipal governments o Ensure a community-wide approach Move to multi-disciplinary primary care centre models (assess different practice models) 10
Identify better incentives to bring doctors to urban and semi-urban centres by employing a recruiter and developing community engagement opportunities Facilitate networking between new doctors and those with established practices Work with medical students to improve relationships with doctors, provide career planning skills and promote the satisfaction that can be realized through family medicine Identify resources so that new FPs know what s available Utilize the Community Health and Resource Directory (CHARD) Create initiatives in physician-partnership strategies to make the prospect of working here enjoyable Develop a dialogue with patients through the ImpactBC Patient Voices Network Develop a good practice profile for each family practice office so that new physicians have a full understanding of a practice both from a business and clinical perspective so they can make a fully informed decision before joining or accepting a locum with a practice 3. Developing Locum Pool Key Questions: What should be included in a locum pool? How can we get doctors to participate in a locum pool? A. Requirements of a Locum Pool Contracts to hold locums to an agreed set of responsibilities Coordination of locum pool necessary from the Division by a central contact person Specify needed skill set of locums needed for particular practices (rural vs. urban) Keep an up-to-date locum list Keep track of residents to know who is available/interested in a locum pool Determine what can be offered to locums 11
Provide an easy way for physicians to identify availability of locums and locums to identify placement opportunities with physician practices or provide coordination of this type of matching service B. Recruiting Doctors to Participate in Locum Pool Be more welcoming to locums Provide information about practices in the need (opportunity) for locums Utilize retiring doctors as a resource; they may have an updated list of who might be available to take on locum placements Encourage semi-retired doctors to be part of a locum pool (and to act in mentoring capacity) Practices need to make sure that appropriate equipment and technology is available to locums Provide coaching for physicians to help them make their practice look appealing o Division led and include the locum s perspective Having a majority of physicians on the same EMR would make it easier to attract locums Develop and maintain engagement opportunities for conversations with older established FPs and new doctors to find common ground Next Steps for the Division Compile and distribute workshop summary notes to participants. South Island and Victoria physicians will need to collaborate to develop a strategic plan. Identify staff and resources needed to strategize around achieving the goals discussed during the small group discussions. Establish a working committee to help spearhead initiatives. 12
Identify, plan, organize future physician engagement events involving multiple community partners to collaborate and strategize around action plans. Division to take the lead on designing a template to help FPs develop their practice profile so that locums and new doctors are fully familiar with the practices they are considering joining or providing locum services to. Develop a community profile to help promote the broader community to prospective physicians. For information contact: Andrew Hume, Executive Director South Island Division of Family Practice P.O. Box 205 Saanichton, B.C. V8M 2C3 Ph: 250-652-2025 Email: ahume@telus.net Web: https://www.divisionsbc.ca/south-island 13