CALEB NICKERSON
PONTIAC Sept. 9, 2020
Note: This is the second instalment of a series on the crisis in rural health care that attempts to discuss as many facets of the issue as possible. If you haven’t read the first portion, check out page two of our Sept. 2 issue. This article will examine some possible solutions to the problem of doctor attraction and retention in the region. The next part in this series will focus on mental health care in the Pontiac. If you have a story or perspective you want to add to the conversation, send an email to editor@theequity.ca or call 819 647 2204.
Last week’s article, which kicked off this series, focused on the difficulties that face rural health care providers in attracting and retaining doctors. These physicians have workloads that look very different than those of doctors in the city, who tend to be highly specialized. The rural doctor has to be more of a generalist and have a broad range of skills to . . .
bring to the table. Many of the doctors currently working in the region have family practices with a larger patient load than the average of 500, in addition to their duties at the local hospital or CLSC.
The situation faced by local doctors is not unique to the area, or even Canada for that matter. Back in 2013, 200 people from 19 countries gathered for the first World Summit on Rural Generalist Medicine in Cairns, Australia, and came up with a list of resolutions and recommendations for improving rural medicine, known as the Cairns Consensus Statement. The signatories to the statement came from a wide variety of locales, specialties and organizations, including the Society of Rural Physicians of Canada (SRPC), but they agreed that rural medicine is a much different animal than urban medicine, and needs to be administered differently.
The document defines rural generalist medicine, identifies why it’s important and lays out the specific actions required for it to advance. Some of those actions include recognizing rural generalists as a distinct specialization in medical schools, and ensure that there are sufficient training pathways to produce doctors to work in these regions.
“The pathway to rural generalist medicine is a ‘pipeline’ that begins prior to medical school and extends through postgraduate training to lifelong learning,” it states.
Dr. Keith MacLellan, a local physician who also co-founded the SRPC, said that it’s typically people that grew up in rural areas that end up practicing medicine in the same kinds of places. However, even if a doctor grew up in a rural setting, the training they receive at school doesn’t prepare them for the kind of work that’s required.
“The type of doctor you see out there is not the type of doctor that is generally being produced by our medical system, which is based on [models for dense populations],” he said. “The doctors that do come out here … the breadth of the work, and the responsibility can be intimidating. One problem in recruitment is recruiting and finding doctors that not only have broad set of skills, but also aren’t intimidated by uncertainty.”
Dr. Tom O’Neill, the chief of the anesthesia service at the Pontiac Community Hospital (PCH) and a medical teacher with more than 35 years experience said that they had recently begun implementing the Rural Roadmap, a document (available online at srpc.ca) that lays out recommendations for sustaining and improving rural health care. The road map includes additional training modules meant to introduce residents to the situations they would face in a rural setting, such as cardiac arrests.
“If you work in [the CLSC in] Fort Coulonge, you’re basically there on your own, without much support, so whatever intervention you make, you need to have the skills,” he explained. “If you’re in the city and a family physician writing prescriptions, that’s totally different than a man coming in to you at 50 years of age and having a heart attack and stopping breathing. You need to teach them those skills. That causes anxiety in some family physicians, particularly in the city if they haven’t been trained.”
Joanne Romain is the founder of the Lotus Clinic in Shawville, which, since its creation in 2014, has served as a training ground for more than a dozen residents a year. Since the training stints can last anywhere from several weeks to six months, she said that an emphasis on longer training periods would allow the new doctors to become more comfortable in their practice.
She said that of all the doctors that have come through the clinic over the years, only one has stayed.
O’Neill said that longer training stints would be optimal.
“We’ve discussed trying to bring residents here for the longest period possible,” he said. “What we try to do in that time is give them the skills necessary to survive in a rural area. As they become confident in their skill sets, they’re more likely to go to a rural area.”
O’Neill, who himself originally hails from Ireland, said that they’ve had a lot of success with hiring experienced doctors who have emigrated from other countries. When they come to Canada, they usually have years of experience and are more comfortable adapting to uncertainty.
MacLellan agreed.
“We got a lot of our doctors that stayed a long time, not from recent graduates, though they are important… but international medical graduates,” he said. “We could not have run our medical system in the Pontiac without international medical graduates. They’re very important.”
McGill University recently opened a new campus for their medical school in Gatineau and both O’Neill and MacLellan said they hoped that students from the Pontiac and surrounding regions would be more inclined to work in the area.
O’Neill stated that the local hospital foundation offers a bursary to students interested in rural medicine.
“What we’re trying to do is show that we’re here, get these residents here and try and convince them that the Pontiac is the centre of the universe,” he said.
O’Neill pointed out that often one of the main issues is finding employment for the potential doctor’s spouse and schooling or extra-curricular activities for their children. He said he has met with local officials to try and initiate a full-court press when it comes to selling doctors on a rural practice.
“We need to get the community involvement,” he said. “If you want to attract physicians to an area like this, they’re not just going to come out of heaven, they have to be made to feel welcome, you need to show them what’s available in the Pontiac … It’s a team effort … They’re not going to come out of the blue and you’ve got to sell something like so many other places are trying to sell it.”
At the last meeting of the MRC council on Aug. 19, a committee was formed to look at what kind of incentives could be offered local health care workers.
MacLellan said that local officials should be lobbying the health minister to appoint someone to study the implementation of rural health care across the province. He added that it would be more constructive than taking individual issues, like Shawville’s obstetrics unit, to CISSSO or the minister’s office.
