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
Rural Health
Around the World
access is the rural health issue
• resources concentrated in cities
• communication
and transport difficulties
• rural health workforce shortages
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
“Extended Generalists”
• wide range of services
• high level of
clinical responsibility
• relative professional isolation
• specific community health role
Interprofessional
Teamwork
• Much talked about in the cities
• Actually happens more
in rural communities
- workforce shortages
- community relationship
- “do the necessary”
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
Northern Ontario
• Sioux Lookout
Southern Ontario
In, by and for Northern Ontario
Doctor’s Life Cycle
• high schools program
• local premed programs
• undergraduate program
• postgraduate programs
• professional development
• graduate studies
Admissions 2005-2010
12,000 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 Community
Engaged 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 Curriculum
Phase 1
Year 1
101
102
103
104
105
106
Year 2
107
108
109
110
111
Elective
Case Based
Modules
Phase 2
Phase 3
Year 3
Year 4
Comprehensive
Community
Clerkship
Clerkship
&
Electives
Licensure
Examination
Residency
Years 5, 6
and Beyond
Individual
Specialty
Choice
Patient Centred
Case 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
Medical
Clinical Teachers
Students
Learning occurs
at points of
overlap –
multiple overlap
can lead to richer
learning
Context:
•Clinical setting
•Area of care
•Physical environment
•Practice culture
•Community
Patient & Family
Postgraduate
Interprofessional
Residents
Learners and
Providers
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