Rural communities in Canada have had difficulties recruiting and retaining physicians for decades.
According to Elizabeth Wenghofer, Associate Professor for Laurentian University’s School of Rural and Northern Health, there isn’t a shortage of physicians in Canada per se as much as a problem of “maldistribution.”
According to Statistics Canada and the Canadian Institute for Health Information, 13.8 per cent of British Columbians were living in rural areas in 2011 while only 6.3 per cent of physicians were working in those areas.
The reason for this maldistribution might be that many urban-dwellers often see limitations to living in small communities.
“Physicians are just like everyone else; they want sports opportunities for their kids, places to worship and connections with cultural roots, meet new people and get married, and good career opportunities for their spouses,” said Wenghofer. “Many small rural centres cannot offer the same breadth of services and variety of opportunities that are found in urban centres, and they never will.”
Wenghofer points out, however, that the main challenge is not attracting physicians to rural areas, but retaining them.
“There have been numerous policy initiatives and incentives to recruit physicians to rural areas,” she said. “The problem is that they [physicians] often leave afterwards.”
According to Jonathon Dyck, Northern Health’s Spokesperson, finding “the right person” that will have better chances of adapting to life in a rural setting has proven to be the best strategy.
“As we recruit to rural areas, we want to make sure they are the right fit for the practice and lifestyle in the area to retain that person,” explained Dyck. “The marketing strategy must be about rural living and practice, and finding the right person.”
Another common concern among physicians wishing to relocate to a rural community is the challenge of finding work opportunities for their spouses.
Dyck said Northern Health has been partnering with local governments and organizations to find work opportunities for spouses of health care professionals, as well as networking opportunities within the community.
However, ensuring a physician feels at home in an isolated community takes more than government incentives. According to Dyck, an essential part of this process is community involvement.
“It is not just finding a physician to cover a practice, instead finding a physician that will integrate well into the community,” he said. “Recruitment and retention of health care professionals takes a community, and having strong community involvement helps encourage health care professionals not only to relocate, but also remain in that community.”
Burns Lake currently has 3.25 full-time equivalent physicians with an additional one full-time equivalent providing office locum support. However, the ideal number of physicians required to service the population in and around Burns Lake would be of eight full-time equivalents, explained Dyck.
“There are a variety of health care professionals required for Burns Lake and the surrounding area,” he said. “We [Northern Health] continue to actively recruit for these positions.”
According to Dyck, the new Lakes District Hospital and Health Centre – opened in February 2015 in Burns Lake – will help attract more health care professionals to the area.
“People enjoy working in new, state-of-the-art facilities,” he said. “With a new hospital and health centre in Burns Lake, we know this will be an attractive environment for health care professionals and physicians seeking to relocate to a rural community.”
Physicians considering Burns Lake as a place to live could be eligible for a $20,000 signing bonus, as well as $15,000 in relocation assistance from Northern Health. In addition to their salaries, new physicians are eligible for an annual flat fee payment of $22,922.83, and between $2000 and $10,000 for continuing medical education.
In March 2013, the B.C. government and the B.C. Medical Association partnered to establish a new incentive – the rural physicians for British Columbia incentive. Aimed to fill 20 pre-designated family physician and specialist positions, the incentive provided each physician with a one-time payment of $100,000 if they committed to a three-year return of service.
Northern Health designated Burns Lake for one of these positions, and a new physician, recruited in January 2015, received the one-time incentive of $100,000.
While the provincial government continually works to increase monetary incentives to address the shortage of physicians in rural areas, some people argue a different approach would be more effective.
Wenghofer believes that investing in medical training in rural areas would encourage more students to choose rural locations after graduation.
“If you take young people who grew up in rural areas, provide them with medical education in rural settings, then they might be more likely to set up and stay in rural settings,” she said.
The Northern Medical Program (NMP) in Prince George had 30 graduates this year, including 14 graduates from Northern B.C. Out of the 30 graduates, nine are entering residency training programs in Northern B.C.
Sonya Kruger, Communications Officer for the NMP, said she is pleased with the number of NMP graduates who chose to continue living in the area.
“There were 21 family practice residency positions in Northern B.C, which were opened to new medical graduates from across Canada,” she said. “We consider it a success that nine of those 21 positions were filled by NMP graduates.”
Many medical students choose to practice in the place where they completed their medical education or residency training, she added.
A few months ago, medical student Arsalan Hassan had a chance to experience life in a small town for the first time.
Hassan has lived in the Lower Mainland since he was a child. At the end of 2014, he had the opportunity to work in Burns Lake for four weeks as part of his medical program.
“Burns Lake was definitely the most time I’ve spent in a fairly small town,” he said. “When I had the chance to live there for a month, I was surprised at how satisfied I felt.”
“It was easy to make friends,” he said. “I felt like part of the community and I had a rich social life with many interesting activities including going to the gym, curling, hiking and playing hockey.”
Hassan is finishing his third year of medical school at the University of British Columbia in Vancouver. According to him, working in small communities such as Burns Lake has many advantages over working in bigger centres.
“Rural communities have less specialist coverage, and thus the general practitioner gets to have a very wide scope of practice,” he said. “The variety is very interesting to me; I think you get less variety in the middle of a big city.”
“Plus real estate is so cheap, you can have an amazing house by the water, and with the money you save you can go travelling more often,” he added. “I think I could be quite happy to settle down in a small town.”