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

danette@nl.rogers.com Web/link: www.med.mun.ca

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.

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