WHAT’S BEING DONE, OR NEEDS TO HAPPEN, TO RECRUIT MORE DOCTORS
Sheila MacLean is one of the most experienced health recruiters in Atlantic Canada.
Shortly before her retirement P.E.I.’s department of Health and Wellness, the Canadian Association of Staff Physicians Recruiters (CASPR) gave her a lifetime achievement award.
During her career, she recruited nearly 300 doctors. She is currently a recruiting consultant and remains active with the communications committee of CASPR.
Her answer is blunt when asked why medical school graduates are increasingly choosing not to specialize in family medicine in rural communities.
“Nobody in their right mind wants to work 60-80 hours a week. So why should we be expecting physicians to do that?” MacLean said.
She said the health system, which has often relied on a generation of family doctors who brought their work home with them, often lacks flexibility to provide local medical grads with a reasonable work-life balance.
“Our system says, if you want to be a family doctor here, you've got to take on 2,400-2,700 patients, and you've got to participate in the on-call schedule for family medicine in the hospital,” she said.
MacLean added many residents — often saddled with debt in the hundreds of thousands of dollars — do not see rural family practice as offering competitive pay compared to other specialties in urban areas.
Last spring, only 20.4 per cent of Dalhousie medical residents listed family practice as their first choice of specialty, down from 41.7 per cent in 2014.
At Memorial University, 36.3 per cent of medical residents listed family practice as their first choice, down from 43.9 per cent in 2014.
If national trends are followed, most who choose family practice will remain in urban areas.
According to the Canadian Post-M.D. Education Registry, only 6.2 per cent of Canadian medical school graduates were practising in rural communities in 2017, two years after graduating.
So where does that leave the region’s health-care recruiters?
Many have focused upon drawing physicians from countries whose training is comparable to Canada’s.
Rebecca Gill, manager of Health P.E.I.’s recruitment and retention secretariat, said there are many steps involved in ensuring physicians are a good fit for specific communities.
P.E.I., she noted, has had success in recruiting physicians from South Africa, the U.K. and Ireland.
"There's a lot of work that goes into recruiting the internationally-educated medical graduates," Gill said.
"There's an immigration piece to get them to be eligible to work in Canada, but also the (medical) licensing piece, to get them to be eligible to work in Canada."
Gill’s team of five also focuses on helping spouses of potential recruits find employment.
She said P.E.I.’s small size can be advantageous for physicians. Young graduates, who have access to policymakers, can be change-makers in the healthcare system.
“You can come here and effect change very quickly in our health system," she said.
Despite its advantages, P.E.I. appears to be barely keeping up with retirements and resignation of family physicians. Over the last two years, the number of family physicians hired by the province has equalled the number of physicians who have departed or retired.
In an “educated guess,” Gill estimated as much as half of the time of staff members is spent on filling locums, in order to allow for personal leaves or vacations.
Some recruiters refer to this as “reactive recruitment.” Tracey Bridger, president of the Newfoundland and Labrador Medical Association, believes recruitment should be driven more by the current and future health needs of the population.
“A lot of time and effort is spent on filling critical and immediate gaps as opposed to planning for the long-term. They're just trying to fill a position or just get locum after locum,” Bridger said.
A report released by the NLMA last spring called for the Newfoundland and Labrador government to complete a physician human resource plan that could guide recruitment and retention over a 10-year period.
Cindy Snider, CASPR’s chairperson, believes this should be national priority.
"Having a plan like that in every province would be wonderful. It helps everybody and it helps the medical schools," Snider said.
Some provinces have already begun this work. Gill said P.E.I. is developing a five-year human resource plan. Nova Scotia currently has projections of the number of physicians needed over the next 10 years and has a recruitment strategy in place.
But tracking of basic recruiting data has occurred only relatively recently.
"A lot of provinces don't even record that data," MacLean said, referring to tracking of departures and arrivals of family physicians.
Still, MacLean believes that the recruitment and retention practices of all four Atlantic Canadian provinces are sound. Recruiters often follow up with physicians repeatedly once they have been hired within a community.
"Everybody, I believe, is doing all the right things," she said.
Other regions in Canada have placed a more long-term focus on healthcare staffing issues.
Peter Strasser, founding dean of the Northern Ontario School of Medicine in Thunder Bay, said health authorities in his region have focused efforts on local high schools. "It's recruiting our own students,” Strasser said.
“We encourage high school students in the Indigenous communities, elementary school students to see a future for themselves which might include healthcare."
An action plan developed by NOSM also urged rural communities to “collaborate rather than compete” on recruitment and retention efforts.