To add to the seriousness of the situation, 25 per cent of Nova Scotia’s physicians plan to retire in the next five years.
Municipalities are pulling out all the stops when it comes to physician recruitment, but sometimes the best laid plans run awry. After municipal expenditure of considerable energy and funds, some physicians decide their new location just isn’t for them.
Dr. Ed Janke, chief of staff for South West Health, outlines some especially challenging conditions for recruiting physicians in this region.
“Physician recruitment has changed… the world has changed,” he said.
“Physicians can choose to practice anywhere in the world. There are great opportunities for them anywhere they want to practice. In our country many physicians choose to specialize, leaving smaller numbers of physicians who choose to practice as family physicians.”
In the last fiscal year 16 physicians were recruited and 21 site visits were hosted by South West Health.
Of those 16 – eight are specialists (both full time and locums). The other eight are family medicine physicians (both full time and locums) to open family practices or to support ER coverage.
There is also a commitment for two more physicians to start this fall.
One of the three, an opthaml One is a specialist, the other two are family physicians.
SWH recently recruited a “surgical” ophthalmologist who will start office practice within weeks, and surgery in August.
Physicians leave for many reasons, explains Dr.Janke, for example, the spouse cannot find work in the area, there may be cultural reasons or their family is located in an urban centre. Some physicians still stay in our communities for their entire career.
“For those who do leave, they do fulfill their obligation to us by providing service for four to five years or more. We do recruit international medical graduates that successfully complete the Clinical Assessment for Practice Program,” he said.
These graduates fill some of the demand for family physicians in the short term. There is always the long-term goal of hoping physicians choose to stay in the district for an extended time.
One of the greatest challenges to attracting new physicians is the lack of transportation.
South West Health relies on the community to provide reasonable access to transportation. Losing ferry service and regular airline service to major Canadian cities has made recruitment more difficult.
“It is extremely difficult to convince anyone that they can enjoy the benefits of an urban environment when our nearest city is 300 kilometres away and there is no public transportation,” said Dr.Janke.
The latest strategy for attracting doctors is to use various media channels for advertising. South West Health advertises in medical journals and medical websites and has contracts with several medical “head hunters”. It also has strong attendance and promotions at medical job-fairs, entertains prospective candidates with site visits, offers financial incentives, and does what it can to facilitate licensing, immigration, etc.
“Beyond that we are active in supporting foreign medical graduates to achieve medical knowledge and experience in rural Canada and to acquire the necessary credentials to practice here,” he said.
Communities have taken a very active role in promoting themselves to physicians who visit for inspection. Local municipalities have also provided financial support to help “sweeten the pot.”
The health authority is promoting medical careers to high school students, particularly family medicine, in the hopes to grow its own physicians. In addition it has made a greater effort to contact medical students from the area hoping to lure them home after graduation.
For those who have “lost” their family physician (and cannot find another) the only alternative is the ER. Nurse practitioners have been recruited and hired to provide some of the needed primary care. If funding becomes available more will be hired.
As for walk-in clinics, they also must be staffed and therein lies the same problem as finding family doctors.
“This is, to start with, a poor way of delivering medical care. There is virtually no follow-up and continuity of care is absent,” said Dr.Janke
Compared to the ER, diagnostic tools (radiology and lab) are not as accessible. Doctors who do decide to leave have a duty to notify their patients that they are closing their practice or if their patients will be transferred to another physician.
However, he added, “physicians are independent practitioners and they operate their practices separately from the district.” Physicians take this seriously, he says. In the case of the recent departure of two doctors (Salesh Budhoo and Nirvashni Rughuber), they issued a letter to each patient to notify them of their intent to close their practice and an ad was placed in the newspaper. Two to three months notice is considered appropriate.
“We are deeply saddened to lose these two family physicians. They have provided tremendous service to their patients and our communities. They have been active participants in the emergency department and the prenatal clinic, besides running very busy family medicine practices. We owe them a very large thank you for their contributions and wish them well in their new community,” said Dr.Janke.
