Médecins sans Frontières seeks for more Canadian physicians · Shanks, medical director for...

Medical relief projects arefacing a “human resourcescrisis,” as Canadian doctors

become increasingly difficult to recruitto humanitarian work, says LeslieShanks, medical director for MédecinsSans Frontières (MSF).

Whether it’s the time commitment,“disaster fatigue” or a lack of infrastruc-ture to support doctors leaving the coun-try for relief work stints, Shanks says it’sbecoming tougher to attract Canadiandoctors to humanitarian projects in far-flung parts of the world. “It’s alwaysbeen a challenge and we’ve alwaysworked hard to find Canadian doctorsthat meet our criteria, but this last yearhas been particularly difficult and it’sabsolutely clear that our major limitationin terms of being able to respond to disas-ters is our shortage in human resources.”

While many doctors are willing tocontribute a week or two of time to keyinitiatives, MSF’s requirement that first-timers commit to a minimum of sixmonths in the field is “a real barrier,”Shanks says. “A lot of people find thatit’s too much. But you need to be therelonger than a few weeks if you’re goingto adjust to the culture, provide decentfollow up to your patients, get the train-ing we require and be a support for ournational teams.”

Six months of training becomes essen-tial when a fast response is needed to adisaster, she says. “In the early days of anemergency, we need people who can hitthe ground running and can train others.”

MSF has already cut the commitmentfor first time volunteers from nine to sixmonths. But the change “hasn’t made amassive difference by any means” torecruitment, Shanks says.

Faced with increased debt loads andlonger residencies coming out of med-ical school, young doctors — onceready recruits — now are putting travelplans on hold. “In the meantime, theydevelop more ties in Canada. They getmortgages, they get married and theystart families. The longer you wait, theharder it is to leave,” says Shanks.

On the other hand, experienced physi-cians are working later in life and thushave fewer retirement years to donate.

MSF exceeded its recruitment goalsin 2010, sending 39 Canadian doctorsto the field by August. But that successbelies the fact that demands at the fieldlevel were much higher than expected,in part because of ongoing emergenciesin Haiti, says Simona Powell, directorof human resources. With MSF’s exist-ing physician pool spread thin, she saysthe organization needs 45 new applica-tions from Canadian doctors in order tomeet operational needs for 2011.

Adding to recruitment difficulties isthe changing nature of the work itself.Medical relief is becoming more com-plex and demanding, requiring a higherlevel of training, coordination and spe-cialization from volunteers, says Shanks.“It used to be very simple. You had ahandful of diseases and a handful ofdrugs. You didn’t have to think aboutantibiotic resistance, for example. Youdidn’t have to do complicated labs.There’s a demand for medical coordina-tors that’s not being met because it goes

beyond being a good doctor and entersinto the strategic planning arena. Peoplearen’t interested in those kinds of jobs,and it’s tough to tear away physicians inCanada who are already in those leader-ship roles.”

Leadership is particularly necessaryfollowing major disasters, such as theearthquake in Haiti, when organizationsare overwhelmed with micromanagingunskilled volunteers.

In those cases, it’s best to “politely”turn away volunteers when there’s noone to coordinate, so as to avoid wastingtime and resources, Dr. John Yates, inter-national director of International ChildCare, told delegates to the CanadianConference on Global Health 2010 onNov. 3 in Ottawa, Ontario. “We don’thave the time to find something to keepthem busy.”

Yates also said that North Americanindividualism is eroding teamwork inthe field.

Shanks concurs, saying “we’re see-ing more and more tourists, people whoare interested in cross-cultural experi-ences, in doing a couple missions for

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Médecins sans Frontières seeks for more Canadian physicians

© 2011 Canadian Medical Association or its licensors CMAJ, January 11, 2011, 183(1) E35

Doctors from Médecins sans Frontières perform surgery on a young boy in a field hospitalin the Democratic Republic of Congo.

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their resume. But their primary motiva-tions are not the humanitarian objectivesof our organization.”

Volunteers who come with caveatslimit how organizations can respond tocrises, she says. “You have people say-ing ‘I will go here but not here,’ whenreally the attitude should be to go whereyou’re needed.”

That shift in attitude has led some toquestion whether people are no longeras motivated by altruism, she says,adding that even when doctors are wellintentioned, they may not get propersupport from the institutions wherethey now work. Few workplaces areable to accommodate the extendedleave and short notice required by relieforganizations, particularly when hospi-tals and practices are facing their ownpersonnel shortages.

Some countries, such as the Nether-lands, have also imposed licensingrestrictions that prevent physiciansfrom leaving the country for extendedstretches.

“I had a couple of my colleagueswho had to quit and go home, or elselose their license,” Shanks says. “Thank-fully, there’s nothing like that in Canadayet, but that’s why we depend on Cana-dian doctors so much: they have mobil-ity others do not.”

While hospitals and practices weremore supportive of doctors taking leaveto help following the earthquake in Haiti,the disaster drained MSF’s volunteerpool, says Shanks. “We wanted our goodpeople there but it took a huge number ofour resources away from other projects.We’re still feeling the gaps.”

As a result of human resources short-ages, MSF has been unable to respondto less publicized disasters, she says. “Incentral Africa, we wanted to work withpopulations affected by the conflict withthe Lord’s Resistance Army. Weneeded to send in people who are expe-rienced with security, who speakFrench, but we just didn’t have enoughpeople to send. So we couldn’t start thatproject. We know their needs aren’tbeing met by other actors. We know wehave the other resources to respond. Butwe just don’t have the bodies.”

Relief work often walks a “fineline” between working with a limitednumber of personnel and higher risklevels, Shanks says. But MSF willnever start a project that’s too danger-ous or that can’t provide quality care.

The organization has turned itsfocus to creative recruitment strategies,she says. Among those efforts is anappeal to the self-interest of physicians.“Some people may not realize that

working internationally can reallyimprove, I don’t like to say their career,but skills that can be transferrable tomany different specialties in Canada.”

MSF is also emphasizing researchopportunities that are available to physi-cians in the field, Shanks adds. “Wework with a lot of doctors doing theirMasters of Public Health. They can cap-italize on our experience in a way theycan continue in their work afterward.There are a lot more opportunities thatintersect with professional life in Canadathan people are aware of.”

Getting hospitals involved in provid-ing better support and incentives fordoctors who participate in relief workhas also worked well in other countries,Shanks says. “We really have to get cre-ative here in Canada in terms of makingarrangements with hospitals. In Amster-dam, we’re now working with hospitalsthat are using the partnership to attracttheir own staff. They are supportingnurses, and we’re trying to get supportfor doctors, to go and do six months oftraining. The hospitals keep the nurses’jobs open and they retain their benefits.It’s a real perk for nurses to work at thathospital rather than the one down thestreet.” — Lauren Vogel, CMAJ

CMAJ 2011.DOI:10.1503/CMAJ.109-3737

E36 CMAJ, January 11, 2011, 183(1)