A leader in rural medicine
MUN wins national award — again — for its record of producing rural doctors
Memorial University’s Dean of Medicine equates the school’s recent national award for excellence in producing rural doctors to winning a gold medal. However, Dean James Rourke says, the win is not his alone, rather one he shares with hundreds of physicians, particularly those practicing in rural areas of the province.
“This award gets at the core of what we do and confirms that what we are doing is actually working,” Rourke said during a recent interview in his office.
After graduating from medical school, doctors must complete a two-year residency program before they are eligible to practice.
The Society of Rural Physicians of Canada (SRPC) presents its annual Keith Award to the postgraduate medical program that produces the largest number of graduates who are practicing in rural areas a decade after graduation.
The family medicine residents were identified through the Canadian Post-MD Education Registry and the practice location was taken from the Canadian Medical Association database 10 years later.
This is the fourth time Memorial’s medical school has received the award since it was introduced in 2000.
Well above average
Rourke says encouraging medical students to practice in rural areas begins by targeting high school students to choose careers in medicine and continues with the school’s selection process.
Between 30-40 per cent of Memorial’s medical students are from rural communities. The Canadian average is about 12 per cent, he says.
If people come from a rural area they are more likely to go back there to practice, Rourke said.
Supported by a network of physicians throughout the province, the faculty of medicine also ensures that a large portion of the students’ learning takes place in rural areas. The dean said this also helps the student lean towards a practice in a rural area.
Rourke has received many accolades over the years for his commitment to rural medicine, including a Rural Leadership Award from the SRPC in 2009 which recognized his outstanding leadership in rural medicine and education.
In the House of Assembly on March 7, Health and Community Services Minister Susan Sullivan acknowledged the medical school’s most recent award.
“I congratulate Dr. James Rourk … and the faculty at Memorial’s medical school for their efforts in delivering exemplary training in the preparation of our rural doctors,” the minister said.
Sullivan noted that, of the 1,115 physicians currently practicing in this province, about 45 per cent are working outside the Northeast Avalon.
Full scope of practice
Second-year family medicine resident Ana Maleeva-Karaivanova is from Sofia, Bulgaria. She came to Canada with her husband and baby 12 years ago and settled in Goose Bay, where her husband works as a family physician.
“At first we were planning to move to a larger town but we liked it and decided to stay. He is still working there and I plan to start work too as soon as I finish my residency,” Maleeva-Karaivanova says.
The couple had a second child since moving to Goose Bay.
There are many reasons why she chose a rural area to practice, she says.
“You can have a full scope of practice. You can do obstetrics, surgical assist, work in the emergency department, be involved with aboriginal health … work in a large team involving other health professionals, and enjoy a close-knit community feeling.”
Second year family medicine resident Brandon Cross was born in St. John’s and raised in Paradise.
Cross will be working in a split emergency/family medicine practice based out of Gander and also covering surrounding communities.
The exposure he got to rural medicine as part of his medical school and residency training helped him decide on a rural practice, he says.
“Rural family medicine will give me the opportunity to set up a more diversified practice. Having limited resources makes practicing in a rural community more challenging and exciting than working in the city. Those limited resources will also allow me to develop a better professional relationship with the special- ists in the area.”
Practicing in a rural area will also allow him a better opportunity to become a part of the community, Cross says.
People more respectful
Jason Mackey is also a secondyear family medicine resident. A native of St. John’s, Mackey says, as a Newfoundlander, he feels a sense of responsibility to work in a rural area where physicians are often difficult to recruit and retain.
While he isn’t sure where he’ll be practicing, Mackey says the scope of practice in rural areas is much more varied and diverse. He feels the people are more respectful and that there is a much greater sense of community and family.
“They are less pretentious and general ly much more approachable and friendly. There are more opportunities for outdoor activities. There is no commute to work and the pace of work and life is generally more relaxed. There are usually no high strung executives working nearby to make things uncomfortab l e b y breathing down your neck.”
Living in a rural area is also an opportunity to l e av e your door unlocked at night and let your children play outside without worry, Mackey said.
“Almost everywhere you look is a beautiful natural landscape, unspoiled by pollution or development,” he says.
Second-year family medicine resident Chris King grew up in Grand Falls-Windsor. When he completes his residency this summer, he’ll be practicing in the Annapolis Valley in Nova Sco- tia.
King decided to practice in a rural setting about halfway through clerkship after being exposed to several large and small hospital settings.
Practicing in a rural area gives physicians an opportunity to manage their patients more closely, King says, compared to urban physicians.
“In the larger tertiary centres, the primary care phy s i c i a n i s rare l y involved with inpatient management. In my mind this affects the care of your patient population. Also, I noticed physicians in rural areas appeared to be more satisfied with their lifestyle outside of work. They appeared to work hard but yet enjoy time with friends and family when they could. I would like that as well.”
Rourke practiced rural medicine in Goderich, Ontario for 25 years with his wife and partner Dr. Leslie Rourke.
He made house calls, worked in an emergency room and delivered over 700 babies.
“As one of my colleagues said, ‘When you do rural practice, you get to do the whole textbook of medicine not just one chapter.’”
You can have a full scope of practice. You can do obstetrics, surgical assist, work in the emergency department, be involved with aboriginal health … work in a large team
involving other health professionals, and enjoy a close-knit community feeling.
— Ana Maleeva-Karaivanova, a medical resident from Sofia, Bulgaria
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Pictured here are second-year family resident doctors (from left) Chris King, Brandon Cross and Ana MaleevaKaraivanova at the Faculty of Medicine’s Family Medicine Clinic, Health Sciences Centre.