North Peace Division of Family Practice Physician Recruitment and Retention: A Strategy Development and Planning Workshop March 17, 2014 Facilitated by Dr. David Snadden UBC Faculty of Medicine, Executive Associate Dean, Education Report produced by Kelly Gunn Northern Health Regional Director, Medical Affairs
Page 2 Introduction The community of Fort St John is experiencing a critical shortage of primary care physicians. The community currently has 20 general practice physicians i. The Northern Health Physician Resource Plan calls for 31 general practice physicians meaning that at a minimum, the community is 11 physicians short of the recommended supply. Adding to the concern, it is probable that 4 more physicians will be leaving the community within 6 months with additional departures anticipated within 18 months. The reasons for the physician shortage are varied and range from a reduced supply of foreign recruits, significant competition to attract general practice physicians nationally and within BC as well as the changing practice needs and interests of new graduates. The problem of the physician shortage in Fort St. John is compounded by rapid economic growth in the area and the related increase in population and need for medical services in the community. All this being said Fort St. John is a community with tremendous assets, not the least of which is a shared commitment and willingness to partner to address physician recruitment and retention concerns. Workshop participants are thanked for the time and energy they invested in developing the solutions and action plans identified in this report. The value of locally developed solutions, partnership and collaboration across sectors cannot be overstated in efforts to address physician recruitment and retention challenges. Workshop Membership and Purpose The workshop was attended by stakeholder representatives from government (municipal, provincial and federal government) industry and community leaders, physicians, BCMA and Ministry of Health members of the Joint Standing Committee on Rural Issues, Northern Health and representatives from the UBC Faculty of Medicine. A complete list of workshop attendees is appended (Appendix A). The purpose of the workshop is to work towards achieving a consensus view of an effective recruitment and retention plan for the North Peace Region. The workshop was premised upon the belief that local solutions are what matter and informed by the following principles: The value of partnerships and collaborations across remote rural areas to contribute to successful retention and recruitment of physicians; The belief that service models that work best in remote rural communities are developed locally, responding to community needs; and That community engagement, in the form of active community participation, contributes to successful retention and recruitment efforts Workshop Process Table Discussions: The Identification, Theming and Prioritization of the Critical Issues To achieve a consensus view of an effective physician recruitment and retention plan for the North Peace, small working groups were created comprised of community, industry, physician, government and NH leaders whose task was to identify the critical recruitment and retention issues. Approximately 27 issues were identified by the groups and are appended to this report (Appendix B). These issues were then themed and prioritized by sticker vote ii. Four themes were identified and ranked in order of priority as follows: 1) Partnership Opportunities (amongst physicians, community, industry, government, etc.) 2) Business Model (Physician compensation, space and infrastructure considerations)
Page 3 3) Service Delivery Model 4) Sourcing new recruits (Recruitment and Retention) iii Workshop participants were then asked to assign themselves to the themes of greatest interest to them or where they felt they could make the greatest contribution to identify workable solutions and develop a plan of action. The group was also asked to articulate the resources required to enact their proposed Action Plan. Groups 1-4 Report Back: Summary of Solutions and Action Plans Partnership Opportunities Solutions Leverage the strength of the collective. Proposed a Community Action Group structure with subsidiary working groups to address the multifactorial elements of successful physician recruitment and retention. Initial thoughts on membership include: A community layperson, industry partners, local government and a physician representative. Communication between groups tasked to address physician recruitment and retention issues will be important to ensure the community is speaking the same language and pursuing solutions in alignment with one another. ACTION #1: A Community Action Group will be constituted whose membership will include: Lori Ackerman (Mayor),MLA Pat Pimm, Dr. Richard Moody (Division member), Dr. Becky Temple (NE Medical Director), Angela De Smit (HSA) Bob Zimmer (MP), John English (Ministry of Health), Paul Winwood (UBC-NMP) Bryant Bird (Shell Canada), Jennifer Moore (Regional Economic Development Officer), Karen Goodings (PRRD) and a Fort St. John community citizen, such as a member of the Patient Voices Network. The work of this group will be informed by the recruitment and service delivery strategies and vice versa. The Mayor has volunteered to lead the Community Action Group. A Terms of Reference document and project management plan may be the first order of business. Business Model Solutions Solutions will include alternatives to the current mode of physician compensation (Fee for Service). There is a need for payment flexibility such as a blended funding model (the coexistence of more than one form of physician compensation in a single community). There is a need to look at options to off-set overhead costs. Turn key business environments are needed to attract the new generation of physicians. Additional sources of funding were discussed: Industry representatives note they are already paying their portion (via taxation) but would consider initiatives that directly impact their employees/operations. The business model will take into account the services of other members of the health care team (e.g. work in support of a multidisciplinary team service model) Amendments to the business model must be in support of the preferred service delivery model (integrally related) Recommend a 3 rd party, independent review of the current business model of the largest private medical clinic in Fort St. John to identify opportunities for efficiency gains and other improvements. The volume of unattached patients is problematic for physicians and medical office staff (workload and stress). A short term, priority solution is to create a physician locum pool to deal strictly with the unattached patient problem. The locum pool is a potential source of permanent recruits to the community. Look at space options and office staff requirements to support this unattached patient service. Longer term options include: Consider a co-operative business model (community coownership of a medical or primary care clinic). This potentially involves a new bricks and
Page 4 mortar structure near the hospital to support an idealized, multidisciplinary health service delivery model. Service Delivery Model Solutions The theme of the solutions discussed by this group is to re-imagine the service delivery model and the physical environment within which this care will be delivered. Both short term and long term solutions are required. Teaching models within the service delivery model must be explored and appropriately compensated. The unattached patient issue must be addressed in the short term- this will involve physician recruitment, securing office staff and space for the service. A long term initiative may be to build a purpose built brick and mortar structure to house and support the provision of multidisciplinary primary care services. The group foresees a need for a collaborative action plan to build this structure which should be located close to the new hospital. The group envisions the co-location of GPs, allied health services (e.g. mental health), NP/nursing, ambulatory care and also itinerant and/or resident specialists to promote the seamless interface between primary and secondary levels of care. Laboratory/diagnostic services would remain in-hospital but would be highly accessible. ACTION#2: A) Actions related to the development of the alternative business and service delivery models are inextricably linked. B) In the short term: Implement, as a matter of urgency, an integrated service delivery model as conceptualized by the prototype team in Fort St John. It was proposed that the Fort St. John Clinic be used as the initial facility to implement this new service model. Blended funding models need to be considered to support turn- key operations to attract new physicians to Fort St John. This work will be led by Betty Morris (NH) and Dr. Willie Watt (from the Division/Fort St John Clinic). Dr Chapman will support both leaders in the development of this work. Dr. Granger Avery (JSC Co-Chair) and Dr. Becky Temple (NE Medical Director and JSC member) will bring a request for exemption to the Rural GP Locum Program rules to facilitate RGPLP locum support for the community of Fort St. John. C) An action plan to address the unattached patient service need will be developed. The Division, in collaboration with NH, will lead. Locums will be a critical resource to address the unattached patient issue. D) In the longer term: Betty Morris (North East, Chief Operating Officer), Dr. Ronald Chapman (NH Vice President of Medicine and Clinical Programs) and Dr. W. Watt (Division) will be the primary leads to develop sustainable business and primary care service model development work. Developing a purpose built health centre is considered to be important to developing a sustainable service model. E) The Division s Collaborative Services Table will contribute to the development of this work. F) The Ministry will consider more than one compensation model in this community. Sourcing New Recruits (Recruitment and Retention) Solutions Options for housing and cost of living support for physicians will be identified. Identify and collate available recruitment incentive options to create a recruitment package for prospective recruits. As a priority action, an RGPLP exemption will be pursued to create the locum supply necessary to reduce the workload and stress in the practice environment. This will make the practice opportunity in Fort St. John more attractive to potential recruits, including new grads. Need a working group comprised of physicians, community, industry and government leaders to develop the incentives described above.
Page 5 Consider expanding the focus of physician recruitment and retention work to include efforts to recruit and retain all professional groups (to address issues such as the need for spousal employment, access to certain amenities and levels of service within a community, etc.) ACTION#3: A) A recruitment and retention plan will be developed with an articulation of the roles of the health authority, Division and other stakeholders. The initial physician recruitment work will be led by the Division s recruitment team in collaboration with Northern Health recruitment (Dr. Becky Temple and Sheilagh Wilson (NH Physician Recruitment Coordinator). Northern Health will deploy a recruitment specialist (Ms. C. Thomas) paired with a physician. Members from industry, community representatives and other members of Northern Health will assist. A Terms of Reference Document and project management plan may be the first order of business to guide this work. B) A communications strategy will be developed. Communications teams within the participating organizations (e.g. NH, Ministry, and the City of Fort. St. John and Industry) will be brought together to develop a communication strategy for this work. Summary and Next Steps A draft report will be written and released to workshop participants for review by April 1, 2014. As agreed to in the workshop, two collaborative tables will facilitate the processes identified in this report: The Community Action Group The North Peace Division of Family Practice Collaborative Services Committee Once finalized, the report will be shared with the Community Action Group and the North Peace Division of Family Practice Collaborative Services Committee. The Committees will facilitate good communication to ensure unity of purpose
Page 6 Appendix A: List of Workshop Participants Facilitator: Dr. David Snadden- Executive Associate Dean, Education- UBC Faculty of Medicine Ms. Betty Morris, North East Chief Operating Officer Northern Health Ms. Dianne Hunter, City Manager- City of Fort St. John Ms. Moira Green, Economic Development Officer City of Fort St. John Dr. Pieter de Bruyn, Physician Ms. Angela De Smit, Fort St. John HSA Northern Health Ms. Lori Ackerman, Mayor of Fort St. John Ms. Jennifer Moore, Regional Economic Development Officer- North Peace Economic Development Commission Mr. Pat Pimm, MLA Peace River North Ms. Celine Southwick Mr. Bryant Bird, Shell Canada Dr. Danette Dawkin, Physician - (UBC Family Medicine Residency Program Alumni) Mr. Steve Dunk- Progress Energy Dr. Geoff Payne, Assistant Dean, Education and Research Associate Professor - UNBC Dr. Becky Temple, North East Medical Director- Northern Health (JSC member) Mr. John English, Director of Physician Compensation Ministry of Health (JSC member) Mr. John Turner, Manager of Government Relations- Spectra Energy Dr. Stephen Breen, UBC Resident (R1) Ms. Joanne Frank, Corporate Officer Peace River Regional District Ms. Kathy Miller, President of the Chamber of Commerce Fort St. John and District Ms. Nancy Pepper, Program Administrator - BC Hydro Dr. Willa Henry, Program Director Postgraduate Education- UBC Department of Family Practice Resident Dr. Ronald Chapman, Vice President of Medicine Northern Health Shared Services BC Mr. Bob Zimmer, MP Prince George - Peace River Ms. Karen Goodings, Chairperson, Board of Directors - Peace River Regional District Ms. Mary Augustine, Executive Director -North Peace Division of Family Practice Mr. Sean Thomas, President- Fort St John Petroleum Association (sent his regrets) Ms. Kelly Gunn, Regional Director Medical Affairs- Northern Health
Page 7 APPENDIX B: List of Critical Issues (Prior to theming) 1. Greater support for Residency training program 2. Promoting awareness of the residency opportunity in Fort St. John 3. Addressing new barriers to recruitment (change in foreign recruitment supply, changing practice interests and needs of new graduates, higher cost of living, business costs, etc.) 4. Industry notes prospective employees seek information about access to health care and services available for family members with complex health concerns when considering locating to Fort St. john for work (health as part of the ecosystem of the community) 5. There is a need for a new business/practice model(s) and a model of service delivery for long term sustainability. The present system is not sustainable 6. Need to look at the NP option and the effective use of multidisciplinary teams 7. Provide turn-key practice opportunities 8. Blended funding models are key to future success 9. Space and infrastructure options need to be looked at creatively to accommodate alternative service models 10. Short term- look at ways to use existing space. Long term- look at purpose built space to support new service model(s) 11. Offer accommodation for students, locums, new recruits. Suitable accommodation is a challenge in this community- a barrier to attract potential recruits 12. The cost of doing business in Fort St. John is high. Overhead is very high 13. Explore physician compensation options. Alternatives to Fee for Service 14. There is a need for Specialist physicians to support GPs- critical issue for recruitment in the primary care realm 15. Public messaging is required about issues and solutions to the recruitment challenge. Information about the role of various players in team based care should be shared with the public. It is important for the public to understand the role of the GP, the role of GPs with specialist training, NPs, etc. 16. The loss of the South African GP supply 17. Debt forgiveness and other incentives should be considered for potential recruits including new graduates with high student debt loads 18. Business models should consider a different income splitting percentage (from 70/30 to 80/20) and a head charge should be considered for industry patients- plough the money back into health care services unique or targeted to this population (e.g. sick notes, return to work clearance notes) 19. Profile the opportunity of full scope rural practice- as challenging, exciting, appealing work 20. Make clinics more locum friendly 21. Use locums to address the significant unattached patient population (need space, office staff, etc.). 22. Standardize certifications across the nation to reduce inter- Canadian competition 23. Physician supply is not viewed as a critical issue but physician distribution is viewed as a problem. Should medical licenses be restricted in areas with an over-supply of physicians? 24. Understand the basic nature of the new generation of physician- little interest in owning their own practice, seek work/lifestyle balance, do not tend to commit to communities long term 25. Acknowledge that we are asking a lot of our new recruits- full time practice and lifetime commitment to the community is not realistic. 26. Profile what Fort St. John has to offer that is unique/special: The community is not well understood provincially or nationally (also likely not well understood internationally) 27. The community must commit to the interests and needs of the whole family
Page 8 *The aforementioned issues were listed on flip charts, validated and then distilled into themes i Three physicians are employed by NH for Medical Health Officer and Medical Administration services and are counted in the 20 positions cited. ii Workshop participants were given stickers to place beside the themes they believed to be the most important/highest in priority. The themes were ranked 1-4 based on the number of sticker votes assigned to them. iii It was acknowledged that the themes, while described as being discrete and ranked in order of priority, are areas of focus that are highly interdependent.