Healing hands

Convincing new doctors to call Kawartha Lakes home

“I grew up on a farm in Huron County and I know the importance of rural medicine,” says Sam Murray, a second-year University of Toronto School of Medicine student, and one of the senior student executive organizers of ‘Rural Medicine Experience Day,’ held at Ross Memorial Hospital recently.

Murray was one of 42 first- and second-year University of Toronto (U. of T.) Faculty of Medicine students who came to Lindsay to be exposed to and learn about the opportunities within rural medicine. The event was the result of an organized partnership between the Kawartha Lakes Health Care Initiative (KLHCI), the Ross Memorial Hospital (RMH) and the Rural Medicine Interest Group at the Faculty of Medicine at U. of T.

“Exposing medical students to a rural lifestyle and practice early in their medical school training encourages them to explore rural training opportunities throughout medical school and residency,” explains Cindy Snider, recruitment and retention coordinator at KLHCI.

Events like these are just one part of KLCHI’s effort to recruit and retain doctors in the Kawartha Lakes. The non-profit, charitable organization’s mission is to create a healthier community by recruiting, supporting and retaining family doctors in the area. Since its establishment in 2004, the organization has recruited 41 doctors to the community.

Most local residents, either through personal or community experience, are aware of local doctor shortages, at least anecdotally. But according to Ontario’s Minister of Health, the Hon. Sylvia Jones, the retention and recruitment of doctors in the province is “not a major concern.” Her comments were made recently at the ongoing arbitration case with the province and the Ontario Medical Association (OMA) which represents over 43,000 physicians and medical students in the province.

The data from every source would seem to contradict the minister’s assertion. The Ontario College of Family Physicians estimates that by 2026 more than four million people, or one out of every four Ontarians, will be without a family physician. More than 2,500 physicians are needed right now in Ontario (according to HealthForceOntario) and population growth, retirement rates among doctors and other systemic funding issues will only increase the strain on the healthcare system.

And for those living in a rural area like Kawartha Lakes, the news may be even more dire. While 22 per cent of Canadians live in a rural area, fewer than 10 per cent of physicians and two per cent of specialists work in these areas, according to the Canadian Health Workforce Network. Furthermore, only 11 per cent of medical students come from rural or remote areas, making future doctors like Phillips in the minority. This all results in what experts in the field refer to as maldistribution of physicians, with rural areas having substantially less access to medical care than urban areas.

Now, KLHCI is actively recruiting for an additional 15-18 positions and forecasts a future need, because of retirement and population growth, of an additional 15 positions. Ross Memorial Hospital is currently recruiting for five specialist positions and has constant openings for emergency room and specialist positions. Therefore KLHCI, RMH and its partners must find a way, in a very competitive recruitment environment, to recruit almost as many doctors as the KLCHI has recruited in the last 20 years. This reality makes events like the ‘Rural Medicine Experience Day’ all the more crucial from a future recruitment perspective.

The RMH clearly supports these efforts as evidenced by the participation of several staff members at the recent event. The students got well-received hands-on instruction in suturing, dermatology and wound care by Doctors Dawn Reid and Naomi Nicholson and 40-year RMH veteran and Infection Prevention and Control consultant Leanne Harding, RN, respectively.

Second year med student Mahnoor Malik commended the workshops, noting that, “It was great to get hands-on practice for these skills as they are very prevalent in all specialties. It was also really helpful when the workshop leads would provide anecdotes on how the skills are used differently in rural/urban settings.”

The difference between rural and urban medicine, both in terms of the skills doctors must employ and the difference in quality of life as a rural doctor were some of the key highlights of both the hands-on sessions and a lunchtime panel discussion with the students by Doctors Stuart Bothwell, Sara-Lynn Francis and Bruno Helt.

All of the doctors on the panel spoke to the possibilities of a better work-life balance and the collegial sense of community that comes with living and working in a smaller community.

These discussions clearly resonated with students like Malik who commented that, “These are things I am definitely considering. Medicine is a challenging field that has a lot of uncertainty, and it is important to me that I pursue a specialty where physicians help to support each other and manage the challenges that come with the profession. It is also important for me to have a good work-life balance as that ensures my own well-being is maintained as well as that of my patients.”

Co-senior student executive organizer of the event Jeremy Penn agreed that work-life balance is an important consideration when mapping out a career. “I had not considered it or weighed (rural medicine) as seriously as working in an urban setting. I’ve spent time in rural communities so (the idea of rural medicine) was never a stretch for me, but I did grow up in downtown Toronto,” he says.

“Medicine is infinitely stressful. Balancing that with a more relaxed way of living is definitely something to consider,” he adds.

Beyond the quality of life discussions throughout the day, several participating doctors spoke to the inherent differences between practicing rural and urban medicine.

Dr. Dawn Reid, for example, spoke to how a certain type of serious injury might require an amputation in a rural setting, where access to specialists is more time-delayed than in an urban setting.

Those challenges, however, are ones to be embraced according to Doctors Francis and Helt and provide exciting on-the-job learning opportunities that one might not get in an urban setting with immediate access to specialists. Francis spoke to the unique learning opportunities from practicing in remote Labrador.

Helt summed up these opportunities by telling the students “you use your brains more in a rural hospital. You’ve got brains, use them.”

Some of the panel discussion veered into the more systemic challenges of the current doctor shortage. Telemedicine was discussed both as a useful team tool in certain medical situations and as an inferior option to in-person primary care.

Available modes of practice (the arrangement of how a doctor is employed and gets paid, from solo fee-for service, family health teams, hospitalists, etc.) in the area were raised by the students.

While not specifically discussed at the event, the lack of coverage by the province for administration and operating expenses in fee-for-service models is one of the key reasons many family doctors are leaving their practice, according to the OMA. A recent fee increase by the province to private practitioners will result, after taxes and administration costs, to an additional $12 a day for doctors, according to a recent press release by the OMA.

So, while some challenges of doctor recruitment and retention lie with higher levels of government and funding/policy, it’s clear that events like the ‘Rural Medicine Experience Day’ are crucial to future doctor recruitment and retention strategies.

As Murray commented, “I think through our initial conversations with students following the event it definitely helped give students a new perspective on what the world of rural medicine looks like and how their future careers (can) integrate rural practice. A few students commented to me that they were certainly more interested in rural medicine after the event. I think if nothing else we got the wheels turning in student’s heads about the opportunities available to practice rural medicine.”