Rural Physician Recruitment & Engaging Your Community CASPR Conference, Wednesday, 22 February 2006

1. Rural Physician Recruitment & Engaging Your Community CASPR Conference, Wednesday, 22 February 2006 David Kay, Executive Director Phone: 1-866-423-9911 or (780) 423-9911 Fax: (780) 423-9917 E-mail: Alberta-RPAP@rpap.ab.ca Web sites: www.rpap.ab.ca Web sites: www.arfmn.ab.ca Web sites: www.ruralhealthweek.ab.ca © The Alberta Rural Physician Action Plan. All rights Reserved

2. Outline Background Typical Recruitment & Retention Activities Community Challenges & Opportunities Questions

3. Alberta RPAP • Corporate Overview • An independent not-for-profit company funded by Alberta Health & Wellness established in 1991 • Provides a provincially-focused comprehensive, integrated and sustained program for the education, recruitment and retention of physicians for rural practice • The RPAP is not a recruitment agency. It was designed and operates as a longer term, indirect recruitment and retention tool to support the direct recruitment efforts of health regions, local communities and physicians. The RPAP uses an “education pipeline” strategy to accomplish that goal • Serves all communities outside of metro/suburban Edmonton & Calgary • 6 person board from CPSA Council, AMA Board, AMA Section of Rural Medicine, Alberta RHAs (Council of CEOs & Council of Medical Directors). AHW has a non-voting observer • 7 FT & PT employees; 12 independent contractors; 3 joint RHA-RPAP employees • Jointly fund 2 Associate Dean Rural/Regional positions

4. The RPAP Vision is having the right number of physicians in the right places, offering the right services in rural Alberta. It does this by offering a sequential series of initiatives (“the education pipeline”) in rural medical education, recruitment and retention; and enhancing collaborative partnerships. The “education pipeline”- Start in rural high school Post secondary influence Undergraduate experience in rural medicine Postgraduate/Resident rural medical training Indirect recruitment of rural physicians Retention through the development of rural preceptors & spousal/family programming RPAP Vision

5. Alberta RPAP • Recruitment Initiatives • Rural school outreach • Recruitment fairs • “Path finding” • Practice opportunities listing • Orientation Guide & newcomer calls • Community development • Community R&R Guide, grant & tools • Supports • Matching signing bonus • Medical school awards & bursaries • Recruitment expense reimbursement program • Facilitating assessments

6. Alberta RPAP • Retention Initiatives • CME • Regional conferences • Video-teleconference program • Weekend & Seniors Locum Program • Enhanced skills – Skills Brokers • Enrichment Program • GEMS program • Emergency Enrichment program • Family support • Rural Physician Spousal Programming • Rural Health Week – 3rd weekof June www.ruralhealthweek.ab.ca • Award of Distinction • Early Careerist Award

7. Typical R&R Activities Each of your hospitals, health regions -/+ communities probably use most or all of the above tools plus others.

8. Recent Reports • Health Council of Canada (2005) is representative of most reports since 1998 addressing recruitment & retention. It concluded that efforts should be directed to: • Increase interest in health careers • Increase supply • Reduce barriers for IMGs • Improve utilization of existing providers • Improve working conditions

9. Why Community Participation? • Given the above R&R issues, we believe no one entity can be successful by itself • Instead a sustainable effort requires a collaborative community development approach

10. Community Participation • (Community) R&R Tools: • RPAP Orientation Guide (2002 & 2004) • RPAP Community Resource Guide (2004)- based onA Pocket of Good News (1994) & its updatePhysician Retention In Rural Alberta: An Update Of Pockets Of Good News (2002) • Facing a Physician Recruitment Crisis: Information You Need to Know • Avoiding a Physician Recruitment Crisis: Physician Sustainability in Alberta

11. Strategic Considerations • RPAP never wants to come between an RHA and its communities. RPAP should not be seen as advocating or taking one side over another. RPAP’s role is to be a neutral and credible resource. • There is a need for an individualized approach. Because of the significant differences in circumstances in Alberta’s rural communities, the deployment of this resource must be situation-based. There will be a need for RPAP to do some advance research and to be aware of local factors that may influence development and implementation of physician recruitment and retention planning. Communities will be at varying stages of “readiness” and an assessment of their stage will be a critical factor in successful deployment. • To ensure that these new resources are not simply put on bookshelves and never used, there will be a need to identify for the communities why they should care about physician recruitment and retention, why they should feel that despite current difficulties there is reason to feel that most difficulties can be overcome, and to create the belief that they can make a difference.

12. Community Resources Deployment Algorithm • Through routine discussions, RPAP consultant identifies local issues/readiness re: R&R: • Recurring recruitment/retention cycles • MD malcontent/turnover • RHA concerns or MD-RHA tension • Community/civic concerns, apathy or hostility • Community readiness to get involved/proactive • Request from community for RPAP presentation or support: • Community/civic request • MD request • RHA request RPAP consultant or officer recommends local meeting • RPAP consultant conducts background research: • Recruitment/retention history, statistics, strengths, etc. • Community concerns, mood, knowledge & history • Community capacity/willingness/ability to participate • MD relationships – issues or obstacles • RHA concerns & political issues • MD-RHA-community relationships & potential • Need for external expertise (e.g., mediation, Community Development) • ID & solicit commitment from respected community champion

13. Community Resources Deployment Algorithm – cont’d • Schedule community meeting & ID key players to attend: • Community/civic leaders & activists • RHA & hospital representatives; clinic managers • AB Community Development resource people • Economic development & business partners • Educational representatives • News media • Conduct MD & community meetings, ensuring: • Presentation is customized with local info • RPAP remains neutral in tone, perspective & allegiance • All groups understand “big picture” before considering solutions • 3-way partnership is critical take-home message (RHA, MDs, community) • Group commits to researching & developing strategy before identifying solutions • SWOT analysis process begins • Supporting RPAP programs & grants are explained & offered. • Ongoing planning group & next steps are meeting endpoint. • Meeting is evaluated using form provided. • Ongoing RPAP support • Follow-up with community • Link with community resources & expertise as required • Encourage strategy development

14. Avoiding a Physician Recruitment Crisis: Physician Sustainability in Alberta & Facing a Physician Recruitment Crisis: Information You Need to Know • Overall Purpose - Compile resources which can be used by rural community committees/groups to recruit a doctor before the lack of a doctor becomes a crisis • Expected Results - The manuals are to be used to: • develop rural Community, Organization and Individual capacity to avert a physician recruitment crisis; • move towards sustainable medical services model where communities shift from the Crisis to Crisis Model, to the Averting of Crisis Model; • transfer the skills learned and the capacity acquired by individuals and organizations for recruiting other rural professionals

15. Avoiding a Physician Recruitment Crisis: Physician Sustainability in Alberta & Facing a Physician Recruitment Crisis: Information You Need to Know • What is common with both manuals: • Asset Mapping - what specifically • Clinic available, medical facilities • financial assets for community • Readiness • Clear and measurable outcomes • Roles of stakeholders • 3. Defining the Opportunity • Community Marketing Tools • Community/District Profile • District Business Directory • 5. Defining our Ideal Candidate • 6. Preparing for Spouse Recruitment • 7. Planning for the Site Visit

16. Avoiding a Physician Recruitment Crisis: Physician Sustainability in Alberta & Facing a Physician Recruitment Crisis: Information You Need to Know • What is unique to the “prevention” manual: • Community organizing for the long term • Critical Path for Prevention Coalitions • Community Self Assessment tools • Community Marketing Tools • Farming for recruits • Community Education (Social marketing) • Burn out rates in doctors, in team leaders • Reason for why doctors leave • Budget for recruitment • Fundraising

17. Doctor Recruitment Phase 1 Flow Chart 12. Resumes arriving at Dir. Health Services office (Hospital Administrator) 1. Identify where the potential Dr.s are located 2. Talk to locums and students and try to recruit 11. Provide an address in e-mail or letter for interested Dr.s to send resumes to Some are looking for IMG’s who have already immigrated to Canada 3. Look outside province of Alberta: -Province 1 -Province 2 -Province 3 *color indicates higher priority items Post answers to questions potential Dr.s want to know: -the towns, shopping, banking, housing, etc. -the clinics: who works there? -the driving: how much? -the hospital: what is there? 10. Develop a specific website for Dr.s, (re: link from #9) -innovation grant? 4 weeks to do this! 4. Medical Chief of Staff to obtain College of Phys. & Surg. “Physician Mailing Lists” for current year from other provinces, (prefer. electronic versions) 9. How? -send letters -send e-mails with website link attached -Online search “public info.” -Also national database (i.e.) Southam Med. Database Difficult to do without RHA support Expensive to do! 6. Talk to RPAP and Rural Locum Program of AMA regularly. Establish strong relationship, Med. Chief of Staff to phone Difficult to do! • 5. Look outside the country: (RHA) • - South Africa • Commonwealth • USA 8. Contract a Physician Recruitment Firm to recruit (RHA?) 7. Recruit from Alberta Medical Schools (RHA)

18. 10. If “yes, I’d like to work there.” then paperwork begins, incentives applied for, sign contract, etc. Done by Dir. Health Services 1. Resume arrives at Dir. of Health Services desk. -identify. if Dr. “licensable” by College -email receipt of resume notice to Dr., and outline of review timeframes. Doctor Recruitment: Phase 2 Flow Chart 11. Dir. Health Services contacts chair of local Phys. Rec. & Ret. Comm. for collaboration before arrival of new Dr., then the following takes place: A Welcoming Reception B. Housing Assistance C. Credit Assistance D. Vehicle Assistance E. Spousal/Family program and Networking F. Ongoing support and follow-up G. Church/Recreation/Social H. Welcome banner on street to welcome Dr. and family 2. Sent to RHA (if this happens, then they should get sent back to Dir. Of Health Services ) Color denotes events we may not want to occur, but do occur. 2. Resume goes to local Medical Chief of Staff. He/She must forward it within 7 days. 9. Follow-up on Dr. visit by Medical Ch. of Staff,, 7-10 days after departure. A. Potential New Dr. Visit -Use community bus to tour Dr. and family and others around -reception for visiting Dr. -Fishing Metaphor “Flashy Lures” -Capitalize on their interests -catered meals -opportunity to have a meal with the other Dr.’s and their wives -golfing, skiing, quading, snowmobiling, etc. and other outdoor activities -goody baskets Resumes could also go to both at same time. Communication 3. Resumes should go to Dir. Health Services within 7 days of receipt by Medical Chief of Staff If answer is “no” then thank for interest. 8. Dr. visit: Dir. Health Services and local Phys. Rec. & Ret. Comm. (See box A. on right side of document) If “no” absolute, answer to coming to visit, then thank for interest. Communication 4. All Dr.’s in area and Dir. Health Services will meet/conference call to discuss resume’s merits. If “no” is “not now, but can visit in a couple of months”, then go to 6.b. B. Spouse Recruitment Pay attention to this! -help find employment, recreation, social, etc. 7. If “Yes, I can come within 2 months,” then Dir. Health Services makes Dr.’s travel arrangements, provides $, then calls local Phys. Rec. & Ret. Comm. to plan Dr. tour and assist. 6. Medical Ch. Of Staff to make contact with Dr.(s) within 4 days with invitation to come and visit A.S.A.P. 6.b. (Someone in Dir. Health Services office will keep track of timeline and stay on top of follow up to Dr.’s of interest to this community.) 5. Decision made on resume: Yes No ttt uuu 6. If no, we would prefer a phone call made or letter sent by Dir. Health Services to the applicant to thank them for their interest.

19. Avoiding a Physician Recruitment Crisis: Physician Sustainability in Alberta & Facing a Physician Recruitment Crisis: Information You Need to Know - #1

20. Avoiding a Physician Recruitment Crisis: Physician Sustainability in Alberta & Facing a Physician Recruitment Crisis: Information You Need to Know -#2

21. Avoiding a Physician Recruitment Crisis: Physician Sustainability in Alberta & Facing a Physician Recruitment Crisis: Information You Need to Know - #3

22. Current Issues Facing Rural R&R • Who wants to be a generalist anyway? And in Rural Canada? • Does anyone care about rural health care? Who’s problem is it? • Replacement of “full service” GPs and GPs w/ additional skills • Rebalancing expectations between the health care wants/needs of our communities & the physicians of today/tomorrow, i.e. rural practice, lifestyle, boundaries • The issue of late careerists • The impact of Primary Care Networks

23. Engaging Your Community

24. Rural Physician Recruitment & Engaging Your Community CASPR Conference, Wednesday, 22 February 2006 Thank-you! David Kay, Executive Director Phone: 1-866-423-9911 or (780) 423-9911 Fax: (780) 423-9917 E-mail: Alberta-RPAP@rpap.ab.ca Web sites: www.rpap.ab.ca Web sites: www.arfmn.ab.ca Web sites: www.ruralhealthweek.ab.ca © The Alberta Rural Physician Action Plan. All rights Reserved