Millions of Canadians need a family doctor. Here's how one B.C. recruiter attracts them

Fourth-year medical stu‐ dent Nicole Costanzo is in‐ tensely focused on the chil‐ dren's board game Opera‐ tion, as she tries to scoop out one of the plastic pieces without the buzzer going off.

"That's hard," she says. The stakes are low for stu‐ dents, residents, and physi‐ cians as they stopped by Cheryl Gnyp's booth at the recent Rural and Remote Medicine Conference in Ed‐ monton. But for the physici‐ an liaison for Castlegar, B.C., the pressure to find four family doctors and backfill for summer is high.

Each visit to her booth could be a potential recruit.

But Gnyp is recruiting at a time when hundreds of other recruiters across the country are also looking for physi‐ cians.

Demand for primary care providers is high; an esti‐ mated 6.5 million Canadians don't have a family doctor or nurse practitioner they can see regularly.

Recruitment has become "increasingly more competi‐ tive" in the last decade, Gnyp says. Fewer students are choosing family medicine as a specialty and Canada isn't producing enough primary care doctors to keep up with demand.

For those who do choose the specialty, Gnyp says sev‐ eral recruiters may be speak‐ ing to them at the same time.

"Now it's just more people vying for their time," she told Dr. Brian Goldman, host ofWhite Coat, Black Art.

The recruitment process can take years, as emails, phone calls, and site visits happen as part of the pro‐ cess.

Many people don't realize the effort that's needed to get a physician and that the engagement doesn't stop once they're working, says Bryan MacLean, the physici‐ an and recruitment coordina‐ tor for Northern Medical Ser‐ vices in Saskatchewan.

What successful recruit‐ ment looks like can depend on several factors, like how long a physician sticks around, or what position was filled.

"It's really hard to have one definitive answer be‐ cause every community and every practitioner is different. What does success mean to you and how do you go about achieving that success will look very different in downtown Toronto than in

North Bay," said Ivy Bourgeault, a University of Ottawa professor and lead of the Canadian Health Work‐ force Network.

It starts with a conver‐ sation

Conferences like the one held recently in Edmonton are good ways for recruiters to meet doctors or soon-tobe physicians interested in working in rural areas, said MacLean.

At many of the recruiter booths, pens, mugs, and oth‐ er community-branded free‐ bies are handed out in hopes of getting people's attention. Some of the booths have

draws for gift baskets, or in the case of Yarmouth, N.S., a draw for five pounds of fresh lobster.

"It's a good way to bring them in," said Nancy Ellis, community navigator for physician recruitment and re‐ tention for the town.

Dr. Dannika Bakker, who works in Upper Tantallon, N.S., and was at the confer‐ ence, says free swag would get her to a booth. But it wouldn't be enough to get her to relocate.

"It's going to be what's the support, how do I get there, what do I do when there. Those are the things that are going to influence whether or not I do the locum," she said, although she isn't consider‐ ing a temporary stint at this time.

There's no free swag at Gnyp's conference table. In‐ stead, she relies on the Oper‐ ation game to reel potential recruits in to make an im‐ pression.

"You have to have cama‐ raderie, you have to build trust. You have to do all those things in a time span of about 10 minutes," she said.

She needs to build trust, as she's looking to fill vacan‐ cies in Castlegar, B.C., a city of almost 10,000 people. Of those, an estimated 3,500 people aren't attached to a family doctor, according to provincial health statistics from last year.

Castlegar is one of many communities in B.C. dealing with a doctor shortage. Roughly 895,000 people need family doctors in that province.

Candice Karas is one of them. For the last three years, the Castlegar resident, her husband, and six-yearold son have been without a family doctor.

"I'm at a point of despera‐ tion here," she said.

She tries to get regular blood work and pre-screen‐ ing for certain cancers after losing both of her parents to cancer when they were in their 40s. Without a consis‐ tent primary care provider, regular screening has been difficult to get.

"For years, every time you go to do your routine physi‐ cal once a year, you speak about your history and they say 'Yeah, that's something we need to screen for but not until your 40s.' Well, now I'm there and I have no way to deal with this," she said.

Gnyp feels the pressure to find a doctor for people like Karas.

"I feel it not only for our community, but I feel it mostly for our physicians who I know are just swamped."

The long game

In some cases, Gnyp will start speaking with a potenti‐ al recruit when they're in medical school, and will check-in several times a year.

When a doctor is inter‐ ested, then comes the tour of the community, dinners, ac‐ tivities in the area like kayak‐ ing or hiking, all while fielding specific questions.

"It can take years for that to happen ... you're trying to remain positive … and you're trying to tick all those boxes and ensure that you are the solution to their next move," she added.

In her 10 years as a physi‐ cian recruiter, Gynp has re‐ cruited - alongside colleagues in neighbouring areas - 13 physicians. Some of those doctors have left.

"It doesn't sound like a huge number, but when you're talking sometimes years to recruit a physician, I may never see the outcome of some of my recruits," she said, adding that recruiting one physician a year means a recruiter is "doing very well."

Are recruitment efforts enough?

It's a high-pressure job that doesn't end once a doc‐ tor lands in the community, Gnyp says.

Recruiters say that a big part of their role is making sure a physician feels sup‐ ported in the community and by other physicians in town, according to MacLean.

WATCH | Ottawa's ef‐ forts won't solve family doctor shortage, experts say:

Gnyp caters to her re‐ cruits. She even went as far as putting up a Christmas tree and lights outside of the home of an Australian physi‐ cian and his family arriving in Castlegar.

"I tried to make it feel very much like home."

A large part of the job is also making sure a doctor's partner and kids -if they have them- are supported. It can involve helping find work for a doctor's spouse or setting up play dates for their kids.

This effort is just part of the job, Gnyp adds, and it could mean the difference between a doctor temporar‐ ily working in the community versus staying for five years or more.

Many union representa‐ tives and officials have said that retaining physicians is key to improving primary care in Canada, and that fi‐ nancial incentives offered by some communities are often not enough to keep them around long-term.

Bourgeault agrees, adding that recruiting and retention need to be constant efforts.

"You need to measure outcomes, not just 'I just re‐ cruited a doctor to this com‐ munity' but we lost three be‐ cause no one has focused on retention efforts," she said, adding that communities should also be recruiting oth‐ er health workers to create a strong team setting.

For Gnyp, she walked away from the recent confer‐ ence with 37 contacts, two of which will help with vacation coverage this summer.

"While I didn't sign a doc‐ tor on the dotted line, I'm still thrilled with the results sim‐ ply because those locums will actually get us through our ER summer gap," she said.

"Mission accomplished."