Healthcare recruitment in the Valley discussed by visiting trainees

Mention health care in any crowded living room in the Valley and somebody will say they don’t have a family doctor. In that respect we’re exactly like the majority of rural communities across Canada. So how can we convince prospective healthcare providers that they should settle here? The Current recognizes that this is a critical issue for MV residents so we spoke to three young healthcare providers who visited Barry’s Bay this year:

  • Dan Asch, physiotherapy student at Queen’s University
  • Stephanie Hughes, resident at McMaster University
  • Medical student Alexandra Morra in second year at Queen’s University

These young professionals in the early stages of their careers were happy to share their opinions. The Current also spoke to our Physician Recruiter, Taflyn Janzen; Dr. Jason Malinowski, Primary Educational Lead here; and Joanne Olsen, Physiotherapist at Ottawa Valley Physiotherapy Clinic. Photo: Facebook/Barry’s Bay And Area Physician Recruitment

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The Valley boasts plenty of positives:

  • It is a beautiful area with many outdoor activities on offer.
  • We enjoy a wealth of musical performances here, often live.
  • There is a thriving arts and crafts culture.
  • Our small communities share a deep-rooted sense of connection and pride in our heritage.

The appeal of rural life to young professionals

That small town feel means a lot to a physician practising family medicine, says Malinowski. He calls it “community ownership” and says, “I’m looking after this whole family, their extended family, their neighbours, their neighbour’s extended family. It’s invaluable to have that vibe – to walk downtown and say I’m helping look after this part of the world.”

Hughes, who wrote her final exam in October and will graduate before Christmas, said it’s a great feeling to be in demand: “You’ve worked so hard for such a long time and it feels nice to be recognized for that. For people to feel comfortable welcoming you into their community is a nice feeling as well.”  She said in medical school “We are always told when thinking forward to ‘find your people.’ ….I think some people definitely have stronger ties to some communities but I think people who are more interested in rural medicine are generally much more open minded to going further afield.”

Morra grew up in Mississauga, trained in the suburbs and worked as a nurse doing emergency psychiatry in downtown Hamilton. As a first-year medical student at Queens she came to Barry’s Bay during Community Week two years ago. When it came time for this placement, she asked Malinowski if she could return. She agrees that Community Week opened her eyes to the joys of the rural lifestyle but says she’s still “teetering.” Morra explained that rural practice “was not on my radar whatsoever. But after Community Week here — that’s what started the ball rolling for me — now I’m at the point where I was very, very interested in psychiatry and still have a passion for it, but since being here I’m starting to maybe consider what it would be like to practise family medicine. In family medicine there’s a lot of mental health.”

Asch acknowledged the strong sense of community and said that people practising here often have deep family ties to the area. He suggested the community could capitalize on this by encouraging Valley young people to consider a career in healthcare. As an example, he said the clinic is open to being shadowed by high school students.

Like the medics, Asch said, “One of the great things about health care in a rural area is you see everything … whether it is pediatrics, return to work, complex conditions, post-surgery, you see everything here. That was one of the reasons I wanted it, because I knew I could have exposure to a lot of different conditions.”

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Asch, Morra and Hughes all felt that rural practices have a lot to offer compared to urban practices. Morra likes the continuity of care she sees in a rural environment. At the Hamilton hospital, she would “see them in Emergency and that’s it. Or if you’re on a ward you see them there and you don’t know what happens to them. A lot more fall through the cracks.” Inset: Dr. Stephanie Hughes and Alexandra Morra at St. Francis Memorial Hospital

Hughes was complimentary about the links that SFMH has with Renfrew Victoria Hospital and The Ottawa Hospital. She said, “I was a bit nervous to come here and feel was on my own and didn’t have the diagnostic testing or specialty support that I’m used to, [to] be able to manage patients effectively and give them the care that I felt they deserved. But the network has been super easy to navigate…. I’ve never felt like the care that people are getting here is any less than they’d be receiving elsewhere. Geographically we are fairly isolated but I really don’t think that’s impacted care in the slightest.” Morra agrees, saying, “I feel they are getting better care vs. an urban centre because it’s a bigger focus on health promotion and prevention here, vs. reactive-based care.”

Asch said that physiotherapy is very different in a rural setting and becomes complicated when a patient does not have a primary care provider. He said this means that instead of getting treatment for something that would otherwise be a small problem, patients wait until it becomes a large complex problem: “By the time they come to see us, they often need to see other physicians too.”

joanne-olsen-dan-asch Olsen grew up in the Valley and returned a few years ago after a 40-year career in Southern Ontario which included not just clinical practice but Peer Mentoring in Regulation. She had encouraged The Current to meet with her physiotherapy student during his placement, indicating his perspective would interest our readers as it is distinct from that of medical students. Inset: Joanne Olsen, Registered Physiotherapist, and Dan Asch

Asch pointed out the challenge presented by the lack of public transport, saying patients who need specialized medical care have to go to either Ottawa or Toronto. He experienced the transport issue himself during his six-week placement in Barry’s Bay. Without a car, he was limited to rented accommodation in the village and could not get out as much as he would have liked to experience what the Valley has to offer. He missed a weekend away with friends when the bus didn’t arrive.

Physician recruitment in the Valley

Barry’s Bay and Area Physician Recruiter Janzen explained there are various incentives available at different stages:

  • The Joint Municipal Physician Recruitment and Retention Committee provides a package but doctors must meet specific criteria, such as long term care, emergency shifts, etc.
  • Health Force Ontario provides incentives for physicians in rural areas including a longevity payment if they stay five years.
  • There is Income Stabilization Program and Education Program funding to help pay back student loans.
  • Community Week meals and board for students are provided by the Ministry of Health.
  • Unusually, the students here are treated to outings to Madawaska Kanu Centre, ATV tours and receive a Welcome Package of local products. “Barry’s Bay stands out in this regard,” says Janzen, “as not everywhere does this.” See The Current’s report of Morra’s Community Week visit.

JMPRC-Taflyn-JanzenJanzen says that because different aspects of physician recruitment are funded by a variety of sources, she is limited to offering opportunities to physicians only and cannot reach out to allied healthcare professionals. The local municipalities fund her position. Inset: Janzen at centre with members of the Joint Municipal Physician Recruitment Committee (from left) Desmond Quade of Brudenell, Lyndoch, Raglan, Janet Reiche-Schoenfeldt of North Algona Wilberforce, Mayor Jane Dumas of South Algonquin, Mayor Kim Love of Madawaska Valley

She explained that it averages one and a half years to recruit a single physician to a rural practice in Canada. She likened her work to a duck swimming: everything appears very calm on the surface but a lot is going on underwater. In her role Janzen deals with students at least twice: for Community Week during their first year and then during third year when medics look for locum work. As a member of a physician recruiters association, she tries to stay connected with different pools, various job fairs at universities and works with a list of contacts provided by Health Force Ontario. She also advertises for doctors in national medical student magazines. She uses social media to attract prospects and is updating the physician recruitment website.

Are incentives needed?

Hughes, Asch and Morra agree that incentives are an essential part of recruitment. Hughes said, “In the cohort above me, that’s definitely played into where people choose to go. Because debt is such a terrifying prospect, for people starting families every little bit helps, especially when communities offer things like helping with housing or school for kids or various community resources.”

Saying it was needed for patients too, Asch said he would have liked to use a fitness centre when he was here this summer but without a car he couldn’t reach one. Morra agreed that a bigger gym would be good but because her placement happened during the school term she enjoyed the opportunity to participate in volleyball and other activities at the high school.

Students in physiotherapy at Queen’s University are not courted at job fairs or offered incentives. Asch was provided with a list of placement locations, some of which were accompanied by a brief description written by previous students. He chose Barry’s Bay because of a review from last year’s placement student. He had some specific suggestions:

  • Recruiting healthcare professionals would be easier if the Valley was better known outside Renfrew County. As a BC native, he asked his colleagues where Barry’s Bay was but most of them confused it with Barrie.
  • An increased number of placements would result in better retention, pointing out that the clinic had only filled two out of ten placements the previous year.
  • Like Hughes, he said many students labour under a heavy burden of loans. He suggested that free or reduced cost billeting with local families, possibly with other healthcare students, could address both financial and social needs. This might make placements more enjoyable and more effective.

Could the community step up?

Valley residents are justifiably proud of our local healthcare facilities – from SFMH to Valley Manor, from St. Francis Health Centre to the Renfrew County Paramedics, and all their hardworking staff. Public response to campaigns from St. Francis Valley Healthcare Foundation shows that Valley residents and businesses form a very caring community.

The recent article in The Current reported on MV Hospice Palliative Care training high school students to volunteer at St. Francis Memorial Hospital – an example of encouraging Valley youth to stay here and consider a caring career. Last spring The Current reported that our new dentist, Dr. Zulfar Moledina, commutes here from Kanata for two days a week because it’s easier to recruit an associate to work at his practice there.  And during the term of the last MV Council, in recognition of both our aging demographic and limited public transportation, Loyalist College ran a course for Personal Support Workers here in Madawaska Valley.

The shortage of family physicians in rural areas of Canada has been well documented for several decades and we have a strategy in place for that. But recruiting physicians alone doesn’t address community needs, especially when you consider we are competing with most other rural communities nationwide — sometimes a strategy isn’t enough on its own.

And sometimes we stay within our own silos. Something as simple as including a visiting stranger in a community occasion can be significant. Everyone in the community can potentially be part of the process, whether it’s an offer to help with billeting, a bit of social interaction, sharing a lift to Blues Night, or being alert to students’ challenges that could be solved with some ingenious outside-the-box thinking. We all can play a part when it comes to encouraging the healthcare providers of the future to return here to set up practice.