2014

PRAIRIE MOUNTAIN HEALTH PHYSICIAN RECRUITMENT STRATEGY

In 2012, Brandon, Parkland and Assiniboine Regional Health Authorities amalgamated to form Prairie Mountain Health (PMH). • PMH is located in the Southwest corner

of Manitoba • Covers over 67,000 km² • 164,000 residents

INTRODUCTION

• Outside of Brandon, there are 27 primary care practices/clinics and 7 satellite clinics

• Brandon has 10 primary care practices

• Of the 27 communities in PMH, 18 continue to offer acute and Emergency Room care

• The majority of the rural communities are being served by 4 or less family physicians

• Physician turnover is significantly impacting continuity of care

• Recruitment and retention of physicians is an ongoing struggle

RURAL MEDICINE IN PMH

METHODS

• In a partnership program with the Office of Rural and Northern Health (ORNH), Prairie Mountain Health hired nine Home for the Summer students to work with rural physicians throughout PMH from May-August 2014.

• As part of this program, the students worked with Michelle McKay, Director of Medical Services Administration on the development the Physician Recruitment Strategy via tree one hour focus groups o Students had discussions with practicing rural physicians & other health

care providers prior to focus group meetings o Students also drew upon their own ideas, beliefs and life experiences. o Reviewed websites and advertising, as well as researching papers on rural

recruitment and retention

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 Pinawa , MB. Danielle Paradis Med I Dunrea, MB. Katelyn Sinclair Med I Winnipeg, MB. Kelsey Uminiski Med I Winnipeg, MB.

FINDINGS

1. Medical Students from rural areas are much more likely to return to a rural community to practice medicine

Primary reasons for choosing rural practice:

• Family and personal “roots” in an RHA • The background of a physician’s spouse is also important: rural family

physicians are three times more likely to have a rural spouse than urban counterparts

• Broad variety and scope of practice 2. Early Active Engagement With Medical Students is Important for Recruitment

• Rural Week • Rural Interest Group trips • Home for the Summer employment program • Early Exposure opportunities • Clerkship/Elective opportunities in Med III and IV

FINDINGS II

3. Promote Rural Manitoba Lifestyle: Noted positives of working in rural sites:

• Lower cost of living • Short commute times = more personal time in one’s day • Can go home for lunch if one desires • Abundance of outdoor activities (in PMH specifically: Riding Mountain

National Park, Assessippi Ski Resort, Spruce Woods Provincial Park, as well as the abundance of hunting, fishing, ski-dooing, biking, etc.)

• Small town feeling of safety and comfort • Sense of community

3. Rural Lifestyle Continued Important factors in promoting/encouraging rural physicians to move to a c community include:

• Land to build a home or opportunities to purchase a home • Flexible daycare hours • Educational opportunities for their children • Integration of all family members into the community, including

spousal employment (vital factor!) • Good recreational facilities • Reasonable proximity to a larger center with many amenities • Work-life balance: maximum of 1 in 4 call, but preferably 1 in 6 call • Flexibility in hours of work • Access to Continuing Medical Education (CME) • Locum support to reduce risk of burnout

FINDINGS III

4. Broad Scope of Practice Utilize as a key feature for rural recruitment strategies: • Full spectrum of patients: infants, children adult, geriatrics etc. • Continuity of care and strong relationships with patients • Ability to do one’s work in one setting • Opportunity to practice subspecialties

o Advantages of rural subspecialty (example: increased OR time for surgeons) 5. Overhead/Turnkey/Electronic Medical Record system (EMR) When choosing a practice location, physicians are looking for: • Modern medical clinic • Electronic medical record system (EMR) and utilization of up to date technology • Access to necessary medical equipment and support services • Reasonable and competitive overhead costs

o Staff, equipment, rental space and day to day operations handled by management is desirable

FINDINGS IV

FINDINGS V

6. Collegial Support New physicians need to feel supported by: • Senior physicians willing to act as a mentor • Colleagues who completed similar medical training/similar practice style • Colleagues willing to discuss opinions, best practices, explain rationale for

treatment, etc. • Support from clinical, managerial and allied health care staff • Strong physician social group

7. Return of Service Agreements/Signing Bonuses • Viewed as a positive bonus to receive, but not sole criteria for practice location

decision • Makes students feel welcomed/desired in a community or RHA • Medical students do NOT like a location directed agreement or grant

o Appreciate the ROS agreements that offer some choices of locations

FINDINGS VI

Rural medicine challenges were also discussed and included: • Risk of medical isolation • Fewer opportunities to participate in CME • Limited opportunity for some sub-specialties depending on the size of the rural

community • Limited resources such as ultrasound, CT, MRI, blood products, etc. • Risk of medical errors being remembered by community of practice indefinitely • Blurring of work life and personal life as physicians are well known in a rural

community • Potential cultural differences may exist between physicians and their families and

the community the physician is practicing within RHA is encouraged to create strategies to help address these issues and concerns. Rural communities also encouraged to strive to connect with physicians and families, especially if there is a cultural difference. Furthermore, it is a joint effort between physicians and residents of rural communities to respect and support one another.

THE SITE VISIT

Meeting clinic staff Meeting physicians in a clinical and social setting Community organized event Food and cocktails/beverages Having candidates complete a needs assessment to

ensure the expectations of the visit are met Have a well developed check-list in order to assist

community organizers when arranging the site visit

Focus group participants felt that a site visit if important when considering a community in which to establish a medical practice. Though each visit should be tailored to the individual applicant, general important components include:

ACTION PLAN

1. Develop a recruitment database of students entering medical school in Manitoba with rural roots or interest in rural medicine. 2. Maintain the database with additional information being added throughout the students medical training and ensure regular engagement with students throughout their training and residency. 3. Ensure a consistent RHA contact person for students to be able to direct enquiries, questions, comments, etc. 4. Provide as many opportunities for rural exposures as possible

ACTION PLAN II

5. Work with communities to ensure: • Modern clinic facilities with turnkey operations as well as EMR • Spousal employment • Family integration • Valuable Site Visit

6. Ensure an effective and well organized Site Visit utilizing the needs assessment and Site Visit Checklist

Physicians most likely to practice in a rural location favor : - A broad and varied scope of practice - Attracted to a rural lifestyle - Have rural roots/origins

Students expressed that they would most likely remain in rural communities if: - They could continue to experience a broad scope of practice - Felt appreciated by their patients/community - If physician’s family is happy and integrated within the community

CONCLUSION

QUESTIONS?