Integrating Medical School with Rural Practitioners in Northern BC

An interview with Ms. Kelly Gunn (Northern Health) and Dr. Dave Snadden (UBC)

At the April 2012 SRPC 20th Annual Rural and Remote Medical Course, Dr. David Snadden, Executive Associate Dean, Education, Faculty of Medicine, UBC, and Ms. Kelly Gunn, Regional Director, Medical Administration, Northern Health, led an intensive discussion about the integration of medical schools with rural practitioners. The session was attended by a standing room only crowd of more than 50 people. Rural physicians are very interested in improving their practices and creating environments where doctors will stay and thrive – but they’re also becoming interested in helping medical students and urban physicians find their way into a long, satisfying rural practice.

Why do you think people are concerned about how medical schools are working with rural practitioners to get doctors and health professionals into their communities?

Dave Snadden: This a Canadian issue about getting the right mixture of doctors into small town Canada. I don’t think we’ve figured out how to do it yet. There are growing themes that I’m hearing about: relationships, building community engagement, and trying to find students that are interested in a rural lifestyle.

Do you feel that you’re learning to choose the right people?

DS: There is a ways to go. Currently, roughly 85 per cent of students in the Northern Medical Program (NMP) are from a rural background. In fact, about 50 per cent are from a northern background. I don’t know what the long-term effects of that will be, but we are seeing students who are contemplating going back to their roots once they finish training.

Our integrated clerkship programs are having a big impact in Fort St. John and Terrace as well as in other parts of the province. A lot of medical students have really enjoyed those experiences, and some are asking “would it be okay if I stayed for my residency because I’d like to work here.” I’ve replied “of course it’s okay – you’re going to get very good training.” We’ve had good success with integrated clerkship students staying in Fort St. John as residents, and who now practice in the community.

There is no one solution to [recruiting and retaining rural physicians] but the things that we’re doing are beginning to have some impact. There’s a lot that still needs to be done. A lot of the conversation [at the session] was about the remodeling of health care delivery in rural areas. My sense is if we don’t tackle that issue, and if we don’t have conversations about how we could make [rural communities] stable and attractive to young physicians, we’ll not solve the rural problem.

Do you feel there’s pressure on the Northern Medical Program to evolve models of health service delivery and medical school admissions at the same time?

DS: There’s a huge expectation over the outcomes of the Northern Medical Program that I’m not sure will be completely realized. [The NMP’s] role is to prepare students to become residents and graduate yet also to show them the attractions of rural practice, but we don’t really get involved with the health care system and the changes that many think are needed to make rural practice attractive to new physicians. This is where I think our relationship with Northern Health is critical because if we weren’t listening to our students and if we weren’t connecting them with Northern Health, [there] wouldn’t be a real sense of how we’re going to make rural practice work for new graduates in the future. We couldn’t [collectively] create a system for the future if we didn’t hear what those we anticipate will work in it have to say.

Kelly, is there a lot of expectation within Northern Health to provide as many rural physicians as possible?

Kelly Gunn: Northern Health certainly plays a critical role in recruiting rural physicians. Part of this involves facilitating a seamless transition from the Northern Medical Program into northern rural practice environments. Northern Health and the NMP share a common goal in wanting to see new rural physicians “stay rural”. We’ve been given this tremendous gift and opportunity with the Northern Medical Program; it’s a priority for us to retain this talent in our rural communities.

During the session, there was discussion about the need to offer alternative payment  and practice systems to rural physicians. Is that something you feel Northern Health can address?

KG: The relationship [with the NMP] certainly helps shape our understanding of  the new graduate’s specific payment and practice interests- including what would be attractive to a new recruit. We are forced – and I say this in a positive way – to be more creative than we’ve been in the past in terms of finding the right business model in some of our primary care clinics. For example, when students want to work in multi-disciplinary teams (Northern Health’s ideal approach to primary care), the health authority needs to respond by finding compensation models that support this way of delivering care. We want to offer practice opportunities that enable the physician to work in  innovative and collaborative ways. This is our opportunity and our challenge – and we can only respond to those opportunities and challenges if we know what the issues are for these new graduates. The relationship with UNBC helps inform that piece.

What are you [doing] that’s new and innovative to try and address the differential in admissions between urban students and rural students?

DS: We already have a rural-specific stream within the admissions system – it’s just a question of refining that. The bit that really needs work is addressing what rural practice looks like and what supports are available after residency? Rural practice is challenging, it can be scary for people. There’s always that edge and uncertainty, and that edge of being alone. It’s important that we help people work with that because [rural practice] is a great way to be a doctor but you need to be confident that you’ve got the supports around you to do it.

KG: Another exciting piece of work that [NHA and the NMP are] doing together involves bringing a group of rural leaders together to discuss rural mentorship opportunities. We’ll look at how we’re going to wrap support around our new physicians, whether they’re new graduates or just new to rural medicine. What could that look like? How will we mobilize our existing rural talent to really welcome and support our new physicians so that it’s not such an isolated, scary experience? There are two ends of the medical spectrum that we’re looking at – those that are new to rural practice, but also, as rural physicians wind down after better than 30 years of practicing in a rural community, how to really retain that wisdom, knowledge and expertise and deploy it in a different way to support our new practitioners.

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