Clinical teaching: a long-term rural recruitment strategy

IMG_4312_web2 Dr. Trina Larsen-Soles and her colleagues in Golden, BC have successfully used clinical teaching as a physician recruitment strategy.

 

There are many strategies used to attract and recruit rural physicians to smaller BC communities. Several of these strategies have been developed and are managed by the Joint Standing Committee on Rural Issues (JSC) or by the individual health authorities. However, rural healthcare recruitment also happens “on the front lines” and is being driven by the most persuasive and effective agents available: rural physicians.

One such rural physician – Dr. Trina Larsen-Soles – lives and practices in Golden, BC – a scenic town located just west of the BC-Alberta border along the TransCanada Highway. She arrived in 1987 fresh out of internship to “try out” the community with her husband. In Golden, Larsen-Soles found a good group of local practitioners who were strongly supportive, and she also found a mentor in Dr. Don Lewis-Watts, a local GP surgeon.

Lewis-Watts was the one of the first preceptors to teach medical students and residents in Golden. He was Golden’s main preceptor for UBC’s Third Year Rural Clerkship program, teaching undergraduate medical students for several years. In 2000, Lewis-Watts was approached by a resident from the Chilliwack postgraduate training site to supervise her rural residency elective. Although the placement wasn’t approved, the resident filled the elective on her own time, and returned to Chilliwack raving about the community. Shortly thereafter, Golden began to receive a trickle of interest from physicians seeking residency placements.

Larsen-Soles took over coordination of medical teaching from Lewis-Watts, at a time when Golden was short on physicians, and UBC was overwhelmed with the need for rural preceptors. She had difficulty getting Golden onto a list of rural communities designated for placements from UBC’s Rural Kelowna residency training site, so she focused her time and efforts on attracting, training, and recruiting residents from UBC’s urban residency training sites.

“Recruitment through clinical teaching is a long process,” observes Larsen-Soles. “It can take a minimum of 10 years to bring a promising student up through the ranks and into your community.” In addition to waiting through four years of training (Years 3 and 4 of MD training, plus two years of residency), Larsen-Soles notes that one or more years may elapse after residency before former trainees will start to seriously consider settling in Golden. Moving to Golden can be a big commitment, which is why Larsen-Soles and her colleagues ensure that they stay in contact with trainees who have shown high potential to fit well medically and socially into the community. “We never sign anybody to a contract, sight unseen. We always ask potential recruits to complete a three to six month locum, just to see how the fit is,” she says. Sometimes, it works out well; other times, unforeseen circumstances prevent potential recruits from staying. The initial locum “try out” allows one or both parties to exit gracefully when the situation doesn’t work out.

Larsen-Soles is up front about the Golden practice group’s intentions when they look for potential recruits: “we recruit as part of our succession planning. We’re looking to eventually replace ourselves, to ensure that the existing medical services in Golden will be sustained over time.” Larsen-Soles and her colleagues keep an eye open for promising young physicians with the right skills for providing surgery, obstetrics, anaesthesia, long-term care, and trauma care in Golden. The group has evolved into what Larsen-Soles calls “collective complementary skills sets” – everyone does emergency care, but beyond that, each physician has a different focus. Larsen-Soles is a GP obstetrician, while other physicians in the group focus on GP anaesthesia, or GP surgery. The group strategizes their resources to ensure that there is a sufficient supply of skills and training at all times, so that no one physician is so overburdened with specialty duties that s/he is unable to  provide primary care services. The group in Golden will often sponsor its newer physicians for enhanced skills training in obstetrics, palliative care, surgery, and anaesthesia, and encourage them to work alongside the community’s experienced GP specialists upon their return. This process ensures that there is continuity, overlap, and mentorship taking place to support the physicians, and the community both immediately and over the long-term.

Golden’s clinical teaching recruitment strategy has paid off well – as of January 2014, there will be 12 physicians in total in the community, five of whom are former trainees. Additionally, two of these former trainees are married to physicians, effectively securing Golden a “two-for-one” deal, bringing the total number of new community physicians recruited as a consequence of clinical teaching to seven.

When asked what strategies the Golden practice group has to retain these new recruits in the community, Larsen-Soles explains that the new physicians have been encouraged to be involved in rural medicine leadership. Two of the newer physicians have started a local trauma/ER committee, while a third has stepped into Larsen-Soles’ medical teaching coordination role. “We’ve had people come through our community and remark ‘look what you’re doing here – it’s amazing!’ The medicine, the lifestyle, and the community are all factors contributing to retention. But the number one reason for staying in Golden that everybody – and I mean EVERYBODY – mentions is the supportiveness of the practice group. Physicians here have the feeling that there’s a safety net, that our practice is truly collaborative.”

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