Doctor retention is one of the main problems plaguing rural communities across Saskatchewan. This is one of the issues those in southeastern Saskatchewan are struggling with currently. Sun Country Health Region explains they have done quite well with recruitment when looking at the numbers; but, the doctor shortage is still prevalent, which is heavily due to the overall retention of physicians.
Retention is something that begins with recruitment. As described last week recruitment focuses on finding physicians for the health region. Physicians though ultimately have the choice of where they want to go. Whether their choice is within the region or within the province depends on who is doing the recruiting; but, overall doctors make the decision as to where they want to go.
Sun Country encourages this because this is a way of retention. Instead of telling doctors where they will be going, whether their lifestyle matches up or not with the community, the physicians have the freedom to decide for themselves. If they are choosing the lifestyle they want they are therefore more likely to remain.
The health region has thusly developed a questionnaire for prospective physicians to fill out in order to match special skills or interests with a community in Sun Country.
"There are going to be physicians that are going to enjoy the rural life that may want to be skidooing and hiking in the mountains and hunting moose. And you know, I don't want to do it, but that's why I'm not a physician in Arcola, I'm a physician in Weyburn, but why am I not a physician in Regina? Because I prefer the independence of my practice, that I can do a little bit more, that I can look after this patient in the hospital, that I can do an anesthetic, that I can do a procedure. If I was in Regina I'd have to be referring all that stuff so physicians need to match up where they want to practice and that's what we try to do on the recruitment level," Dr. Alain Lenferna, VP Medical with Sun Country, explained.
Ultimately they are doing their best to match what the physician wants to where would be a good fit within the region. Dr. Lenferna even acknowledged the fact that he had come for three months initially, but has now been in Weyburn for over twenty years.
"I think we have to really try to match what their lifestyle is to the communities," Marga Cugnet, President and CEO of Sun Country, explained.
Included in this is the honesty of the community when attempting to recruit a physician to their area.
"You're doing this online, you're talking on the phone and you've got to be honest about the community because there are physicians that actually come from small rural communities and they like practicing in rural Saskatchewan," Cugnet said.
Being honest about the community is important because if someone is coming from a big city they can be unaware of what rural Saskatchewan is like.
"You have to be honest because you might get them there, which has been our experience; but, they're not, well you know, they don't stay two or three years anymore they're gone in six months or a year," Cugnet stated. "So, we can look at the numbers and you could almost argue that we're not that bad at recruitment because we have recruited dozens and dozens of doctors. It's the retention piece, so matching is very important."
Money and incentives are ways that communities attempt to recruit and retain physicians, but this does not always work.
"People say throw more money at it, throw more money at it. When the physician recruitment agency talks to physicians about why did they come, why did they stay in Saskatchewan. It isn't money on the top of the list. It might get people there. Sure, I'll go there for two years, get there, then I'll go to where I really want to be," Cugnet explained.
So, what's really important is bringing the physician into the community and making them feel a part of it while respecting their boundaries as a doctor. Doctor's today like to have their free time in order to do what they like. The lifestyle of doctor's has changed in general as 30 years ago one could knock on the doctor's house door and be on their way to help right away. Being on-call 24 hours a day seven days a week is no longer an accepted lifestyle for many, as lots of graduates hope for a 9 a.m. to 5 p.m. Monday to Friday position without on-call duties.
On-call is very demanding and when a hospital closes because the physician who is willing to work on-call hours are unable to keep up with the lifestyle when short-handed. They feel the pressure of the community and at times this can be too much.
"It puts tremendous pressure on the docs because they're feeling guilty, feeling pressured and yet they know they can't run an emergency room on their own. They're tired, they have family responsibilities, and so at some point some of them are saying, 'I just have to leave because it's too much,'" Cugnet said.
So, it is important to find where these boundaries are and accept the fact that doctors are not able to work 24/7.
In order to get the physician and their families involved in the community on their down time then, a part from their work, communities can offer incentive packages including a free golf membership, free swimming pool access, or any number of items; but, it is important to invite them to events and welcome them into the community as something more than just a new doctor.
Though these incentive packages do not always work and it is difficult to retain a doctor because cultural differences might be too much. Despite engaging them in a community the doctor may not stay because their spouse is unhappy and feels out of place. It could be placed on religious beliefs or a difference of culture as well. For example, in the immediate area surrounding Carlyle there are no mosques or Mormon Churches; so, the physician and their family are unable to fill this part of their life here and will likely move to a community, which can offer this.
This factors into the recruitment of doctors both with the questionnaire Sun Country facilitates and with the dialogue between physician and community before the doctor chooses where to go.
In response to, ultimately, culture shock the health region backs a bursary for rural students. This bursary is given to those entering medicine with a commitment to come back to the area. The students pick the areas they are most interested in and will be expected to practice for four years in Sun Country. If unable to fulfill their requirements at the areas they specified interest in they understand they may have to go elsewhere in the region to meet the bursary conditions. Coming from a rural area it is unnecessary to convince them it is a good lifestyle.
Sun Country is also planning on working with a Distributive Learning Model, which is currently being used in the Cypress Health Region in the southwest and to the north in Prince Albert. This particular model looks at students who have recently completed their medical degree and are looking to enter family medicine to become a general practitioner. To do this they need to complete a two year residency, which the College of Medicine has been having difficulties finding placements in Saskatoon and Regina after increasing the number of seats available in their program to 100.
"They're going to live in a community, work with physicians in a practice, and get more comfortable with it [the rural lifestyle of a physician]," Cugnet said.
They will become more confident in a rural setting where they are not needing to rely on specialists and have more freedom to practice.
The question Dr. Lenferna suggests all communities ask themselves is this, "What can the community do to make it enjoyable here for them to practice?" This is on each community to figure out as each rural town is unique and those who live there are the best to answer this question.
Regionally they continue to recruit doctors and look into alternative health care models, which may assist communities in both recruitment and retention.
Provincially it could be suggested that within the College of Medicine a number of seats should be reserved each year for rural candidates. As long as these candidates meet all other requirements for entry to the program there could be a precedent set looking for rural oriented physicians by setting aside a number of seats for this purpose.
Overall, the one thing that will continue is a need for doctors in the rural areas. This has been plaguing rural locations for a number of years already. In response rules and regulations concerning recruitment are constantly changing. The need for physicians is high and attempting to both recruit and retain them are priorities for rural communities.
