Dr. James Card enjoying fresh powder on the lake with his daughter in tow.
Dr. James Card practices in Mackenzie, BC a community of about 4,200 people located 192 km north of Prince George. He first arrived in the town as a locum in December 2010, and eventually began a full-time practice in August 2011. Surprisingly, he began teaching in the fall of 2011, even though there was no teaching program in Mackenzie. Card is blunt when asked what inspired him to become a preceptor while he was launching a full-time practice: “As soon as I got to Mackenzie, I realized that the workload was unsustainable – it was way too much. We needed to do something in terms of recruitment.”
Card formulated a plan to recruit at a number of depths – rural clinical teaching was only one prong of his plan. In addition to exposing residents and medical students to Mackenzie, he also invested time into looking for rural physicians to join the community. Card based his recruitment plan on observations from his own rural residency rotation in Hazelton: he noticed that two physicians in Hazelton were graduates of the UBC Prince George residency program like himself, and that other Prince George trained physicians frequently locumed in the community. “I thought ‘wow, this actually works – exposing people to a place and then having them come back.’”
In the scant two years that Card has practiced in Mackenzie, his recruitment program has been remarkably successful. There are now five physicians in the community, two of whom (including Card) practice half-time. Card convinced a fellow resident from his graduating class to join him in Mackenzie. He also went back to the Prince George training site and promoted the community practice in a presentation, and netted a new graduate fresh from residency. This resident, in turn, recommended the practice to a friend who eventually joined the group. “Word of mouth gets around,” says Card, who notes that despite its small size, Mackenzie has much to offer physicians looking for a rural practice. “It’s an alternate payment plan (APP) site, which is ideal for new grads. They can move to the community and focus on practicing medicine. They don’t have to worry about learning how to run a business or open a practice while they’re trying to establish themselves.”
Card credits his teaching and recruitment successes to the supportive nature of the Mackenzie practice group. “New grads going into rural can feel intimidated, so we’ve built a supportive environment where the doctors don’t feel like they’re alone.” Support in the group extends beyond asking for help. “We all cover emergency, and do call. We all teach and enjoy helping students and residents see pathology, see acuity, and get hands-on experience. We practice similar styles of medicine – we don’t overprescribe narcotics or antibiotics, and prefer an evidence-based approach to practice.”
Despite recent successes, the community is still struggling medically. Even with four full-time physicians in the community, due in part to the support of Northern Health, the physician workload in the community is not entirely sustainable as most of the locums in Mackenzie go unfilled. Card notes that when he promotes locums in Mackenzie to physicians in Prince George, although many express an interest in visiting the community, some are put off by the extensive application process for the Rural GP Locum Program, which involves securing reference letters and submitting a resume. “We are somewhat selective with our locums, but that said, we’ll take almost anybody. Our preference is for locums who are Prince George residency graduates because they know our colleagues in the region, the EMR systems, the referral centre, and the specialists. It’s very easy to integrate somebody like that into our clinic.”
Although Card has been able to bring physicians to Mackenzie, he recognizes that keeping the physicians there for the long-term remains a challenge. “Given that our major issue is workload, all it could take is for one physician to leave. If we can’t fill that vacancy quickly, it could destabilize the practice.” Card points to the revival of the local forestry and mining industries as contributing factors impacting practice sustainability. “There are a lot of new people in town, and there are a lot of transient workers coming into Mackenzie at different times. I worked emergency today, and 20 per cent of the people had never been seen by either our office or the hospital before. That adds to the physician workload.”
Card is hopeful that his recruitment efforts with students and residents will have a trickleback effect in the future. “I had a resident here, who has since done a short locum in Mackenzie, even though she settled in Prince George. Then we’ve got a resident coming based on the recommendation of a fourth year student we taught two years ago. Word does circulate – it starts to work after a bit of time.”