Rural locuming — one final adventure before retirement: An interview with Dr. Rainer Borkenhagen

Dr. Rainer Borkenhagen in the northern community of Kugaaruk (Pelly Bay), Nunavut during a locum placement

When Dr. Rainer Borkenhagen transitioned out of his Vancouver practice and moved with his wife to Gibsons, BC, he was “looking for a challenge with a bit of adventure thrown in.” A semi-retired physician, Borkenhagen found that taste of adventure working as a locum with the Rural GP Locum Program (RGPLP). In preparation for the next phase of his medical career, he voluntarily undertook retraining and rigorous preparatory work to upgrade his skills for rural practice. His personal account of his educational journey into rural locuming was published in Canadian Family Physician in 2013.

The extra time and effort he invested in additional courses, skills enhancement and emergency room shifts were worth it; Borkenhagen currently locums for four months of the year, which translates to two weeks on, six weeks off. “It’s easy to do locums in [the Lower Mainland] but it doesn’t inspire me. I have more flexibility doing rural locums – I can get away from working fee for service and I can organize my lifestyle, time, and work commitments better in a rural setting.”

Rural locuming is becoming a viable option for many physicians looking to retire their full-time practice; however, being a rural locum comes with a unique set of challenges. Lack of a province-wide credentialing system, multiple electronic medical record (EMR) systems, irregular routines, and social and physical isolation, are a few challenges identified by Borkenhagen in his “Rural Locuming: Things to Consider” document. Additionally, rural locums must be prepared to treat a wide range of cases in rural practice. Borkenhagen explains that in addition to family medicine, rural locums must feel able to attend cases involving emergency medicine, pediatrics, newborn care, along with some obstetrics, prenatal care, and obstetrical emergencies. “You have to be comfortable with taking that on and know what your comfort zone is.” While Borkenhagen acknowledges that it’s possible to locum without providing obstetrical care, he emphasizes that pediatrics is a must, and recommends the Pediatric Advanced Life Support (PALS) course for physicians looking to improve this skill set. During his preparation for his transition to rural locuming, Borkenhagen did a voluntary, self-arranged month-long mentorship with his former medical student, Dr. Simon Reznick, a rural GP in Sechelt. Borkenhagen appreciated the experience: “It made me realize what full service, single practice is about. There were skill sets [required] that I was rusty at, so I found the mentorship really helpful. ” He notes that in rural BC, there are few situations where a locum will be the only doctor available in the community, and that when a practitioner requires assistance, expert help is frequently only a phone call away.

Adjusting to new communities and processes, a variable routine, and extended time away from home and family can make rural locuming quite challenging. In order to combat the loneliness that can come along with being a locum in an isolated rural community, he suggests that physicians consider locuming regularly with a handful of communities, allowing relationships with the local health care teams and rural patients to develop. Alternatively, Borkenhagen and his friends have, on occasion, secured locum opportunities where more than one physician is requested to make the experience more fun. (“We call ourselves the ‘Seniors’ Rural Locum Group’.”) The group shares stories and spend time together, a process which Borkenhagen credits for helping him transition into his new identity as a rural general practitioner (GP).

Borkenhagen will travel to Nanaimo on Feb 27, 2016 to meet other rural locums and engage in CME/CPD specifically geared for rural locums at the Rural Locum Forum. This event will gather rural locums and physicians interested in locuming from around to province to meet, network, and engage in skills enhancement training. While Borkenhagen is interested in the topics being discussed at the forum, he is most excited to network and be among other physicians doing similar work.

As a physician in semi-retirement, Borkenhagen plans to continue working as a rural locum for another year and a half to two years. He values this unique phase in his career, but recognizes that eventually it will come to a close. It will be difficult to let go of a career that has spanned more than 37 years, but Borkenhagen is looking forward to contributing to his community once he fully retires his license. “I like the adventure, but I also know that as you get older, routine is important. I need to get my mind out of medicine.”