Recruitment & Retention of Health Care Providers in Remote Rural Areas: The View from Up Over
and Down Under
Professor Roger Strasser
Northern Ontario School of Medicine
Recruitment & Retention Strategies
• education and training
• regulatory initiatives
• financial incentives & rewards
• personal & professional support
• sustainable service models
access is the rural health issue
• resources concentrated in cities
• communication
and transport difficulties
• rural health workforce shortages
Rural Health Around the World
Rural Health Services
• access is the major issue• “safety net”• local services preferred• limited resources• workforce shortages• different from cities
Rural Health Care
•specialists’ support role
•partnership not putdown
•consultant support local service
•not assume patients will travel
Rural Practitioners
• wide range of services• high level of clinical
responsibility• relative professional
isolation• specific community health
role
“Extended Generalists”
Interprofessional Teamwork
- workforce shortages- community relationship- “do the necessary”
• Much talked about in the cities• Actually happens more in rural communities
Sustainable Rural Health Services
• health service authority/agency
• health care providers
• community participation
Recruitment Facilitators
for Rural Practice • rural upbringing• positive undergraduate rural clinical experiences• targeted postgraduate training for rural practice
Retention Factors
• academic involvement
• recognition and reward
• support from “the system”
• active community engagement
Rural Based Medical Education
• response to workforce shortages• specific knowledge and skills• high quality learning environment
Rural Clinical Education
• more hands-on experience• greater procedural competence• more common conditions
Impact of Rural Based Medical Education
• more skilled rural doctors
• enhanced rural health care
• improved rural health outcomes
• broader academic developments
• economic developments
Australia
• Rural and Remote GP Program
- Rural Workforce Agencies
• Retention Payments
• Rural Postgraduate Training
- GP and Specialist
• Rural Based Medical Education
Australian Rural Academic Initiatives
• Rural Undergraduate Support and Coordination• University Departments of Rural Health• Rural Clinical Schools
Canada
• Differs Province to Province
• Recruitment incentives
• Alternative funding models
• Rural postgraduate training
• Rural medical school programs
Northern Ontario School of Medicine
• Faculty of Medicine of Lakehead
• Faculty of Medicine of Laurentian
• Social Accountability mandate
• Commitment to innovation
In, by and for Northern Ontario
Northern Ontario
Southern Ontario
• Sioux Lookout
Doctor’s Life Cycle
• high schools program
• local premed programs
• undergraduate program
• postgraduate programs
• professional development
• graduate studies
Admissions 2005-201012,000 applications for 346 places
• 20% of applicants interviewed• 15% of interviewees enrolled
Class Profile• 91% Northern Ontario• 7% Aboriginal 22% Francophone• GPA 3.7• Age 26 (except 28 charter class)• 68% Female 32% Male
Distributed CommunityEngaged Learning
An instructional model that allows widely distributed human and instructional resources to be utilized independent of time and place in community partner locations across the North
Organization / Delivery
of NOSM CurriculumPhase 1 Phase 3
Year 1
101102103104105106
Residency
Year 2
107108109110111
Year 3
Comprehensive Community
Clerkship
Year 4
Clerkship&
Electives
Licensure Examination
Years 5, 6and Beyond
IndividualSpecialtyChoice
Case Based Modules
Phase 2
Elective
Patient CentredCase Based Learning
• complex “real life” scenarios
• structured discussion, analysis
and problem solving
• informed tutor / facilitator
Principles for Longitudinal Integrated Curricula
• comprehensive patient care over time• continuing learning relationships with clinicians• achieve core clinical competencies across multiple disciplines simultaneously
Rural Distributed Medical Education
• high quality clinical and educational experiences• electronic access to information and educational resources• maximum human contact
Integrated Clinical Learning
InterprofessionalLearners and
Providers
MedicalStudents
Clinical Teachers
PostgraduateResidents
Patient & Family
Context: •Clinical setting•Area of care•Physical environment•Practice culture•Community
Learning occurs at points of overlap –multiple overlap can lead to richer learning
Community Engagement
• community active participant - interdependent partnership• ensures student “at home”• contributes to student’s learning experience• education and research activities• community capacity building
NOSM Outcomes
• CaRMS - 100% matched• 63% rural family medicine• 33% general specialties• 11 medical schools (of 17)• 35% residency with NOSM• “deep roots” in Northern Ontario• >65% of NOSM residents stay
NOSM Charter Class
NOSM
NOSM Residents
Benefits of NOSM
• More generalist doctors• Enhanced healthcare access• Responsiveness to Aboriginal, Francophone, rural, remote• Interprofessional cooperation• Health research• Broader academic developments• Economic development
Essentials for Success
• Context counts• Community participation• Standards and quality• Definition of success • Challenge conventional wisdom• Vision, mission and values• Program blueprint
References• Strasser R. Rural Health Around the World: Challenges
and Solutions. Family Practice 2003; 20: 457-463.
• Strasser R., et al. Canada's new medical school: the Northern Ontario School of Medicine - social accountability through distributed community engaged learning. Academic Medicine. 2009; 84: 1459-1456
• Strasser, R. Community engagement: a key to successful rural clinical education. Rural and Remote Health 10: 1543. (Online), 2010. Available from: http://www.rrh.org.au
• Strasser R, Neusy, A-J. Context Counts: Training Health Workers in and for Rural Areas. Bull World Health Organ 2010; 88: 777 – 782