Dr. Alan Ruddiman, sector lead for recruitment and retention, RCCbc
Several rural communities throughout BC continue to experience shortages of healthcare workers. However, despite the many expensive ads posted in newspapers and magazines and job postings on recruitment web sites and Twitter, despite the active engagement of health authority recruiters to attract medical workers to rural British Columbia, recruitment and retention remains difficult and elusive for some communities. Why are some communities so successful at attracting workers, while others struggle to generate interest in their rural locale?
Dr. Alan Ruddiman, Recruitment and Retention Sector Lead for the Rural Coordination Centre of BC (RCCbc), is forthright about the challenges of rural healthcare recruitment: “There’s a huge complexity to recruitment and retention – you honestly need to appreciate a community’s location, and its unique patient population and patient mix. You also need to have an understanding of what their social determinants of health are, what their vulnerable populations look like, what their economic dependency level is like, what their transportation services are like. Additionally, you need to consider the current physician population in that community – who is close to retiring, what is the skill set of the physician population? Is there a community hospital and if so, how is that hospital resourced, what services does it have? Is there an emergency department, acute care, obstetrics, or surgery?”
The key to successful recruitment and retention in any rural community, says Ruddiman, is finding champions and leaders in the community and engaging them in the hiring process. Traditionally, recruitment and retention was considered the responsibility of rural medical staff – physicians and nurses were expected to find replacements (if they were leaving), or seek additional workers to support a burgeoning practice. However, Ruddiman feels that health authorities, town councils, chambers of commerce, and local industries also have roles to play in successful recruitment and retention. “When groups collectively identify a community’s challenges and areas of need, when they identify the best people available to deliver those needed services, they collectively support and raise the population health indices within their communities.”
Improving healthcare in a community isn’t as simple as bringing in more doctors to provide care, says Ruddiman. Rural health practitioners have a higher ratio of patients to doctors than their urban counterparts and additionally are expected to take on broader roles, such as emergency and inpatient care at the local hospital, mental health work, and addictions care, simply because there is nobody else available to provide coverage. “It can’t be assumed that all of the available doctors will take on the additional roles and responsibilities,” warns Ruddiman. “Communities need to be served by the right blend of individuals for an extended period of time, especially in locales where there is a rural hospital; otherwise, a community’s services, such as surgery, obstetrics, anaesthesia, and emergency room services – will start to destabilize when physicians who aren’t a good fit leave the community.”
Community leaders, industries, and health authorities can support rural healthcare recruitment and retention in other ways beyond hiring suitable medical staff. “Recruitment does not end when the new doctors or professionals arrive,” asserts Ruddiman. There are simple, but important things that need to be done when welcoming a new practitioner. Have someone meet the new physician as well as their family and orient him/her to the community. Consider what supports are in place for the practitioner’s spouse and/or children if s/he has a family. Is there employment and/or support for the spouse in the community? Is there suitable education locally for the children? Will the practitioner be able to travel and/or address any ongoing educational needs? Ruddiman observes that any new recruit and his or her family will be developing long-term professional and social relationships with the community, so ensuring that there is strong longitudinal support for them will increase the chances of retaining that family in the community. “Healthcare workers are an incredibly strategic resource to a community. If you don’t manage them very carefully, you end up losing them.”
Ruddiman points out that communities struggling to recruit and retain medical workers for the long-term often have gaps in their understanding of the complexity of service delivery in the community. For communities in need, Ruddiman suggests conducting debriefing interviews of exiting practitioners to learn why they are leaving and what was missing or deficient for them personally and professionally. What worked well in the community? Ruddiman would also like to see the health authorities engage and work more closely with local physicians to support new recruits and their families in an ongoing way. “It would be helpful to have health authorities providing mentorship support to new recruits through their first few years of practice. Also, having health authorities work with local physicians and community leaders to develop physician supply plans would ensure that communities have enough doctors to meet their healthcare needs – working in isolation does not benefit anyone.”
Dr. Alan Ruddiman is a rural physician practicing in Oliver, BC. He is one of the 100 original founding members of the Society of Rural Physicians of Canada (SRPC) and is a Fellow of the Society. He sits on numerous working committees and the board of directors of the British Columbia Medical Association (BCMA), chairs the BCMA Rural Issues Committee, and is a member of the provincial Joint Standing Committee on Rural Issues (JSC).