The Port Hardy Primary Health Care Centre. Doctor retention is a challenge for many remote B.C. communities.

Doctor retention an ongoing issue

Attracting and keeping doctors in remote B.C. communities is a challenge

Attracting professionals to isolated and remote areas of the country has always been an issue, whether they are doctors, teachers, lawyers or dentists. Many young professionals will move to a remote region to gain work experience for a few years, but move on and put down roots elsewhere.

Access to high quality health care and doctors is a critically important need. For many people living in rural B.C. towns, however, including some on northern Vancouver Island, the difficulty for their communities to retain doctors can mean a lack of consistency in care and in some serious cases, doctor shortages. While doctors can certainly provide good health care to patients they are new to, it can be comforting for some to see a doctor who knows their history and has a professional relationship with them, especially when it comes to sensitive issues.

“A lot of people enjoy being in an urban centre,” says Dr. David Whittaker of the Port McNeill Collaborative Clinic. He moved to Port McNeill three years ago from South Africa. He says that many people studying and doing their residency in the North Island enjoy it, but when it comes to living and working long-term, it becomes more difficult to retain them. While the tranquility and close proximity to nature may appeal to some, for others the convenience and variety of a city or bigger town may win out in the long run. Dr. Whittaker feels that Port McNeill is a good fit for him, and says that several things helped him form a connection to the area, including moving with his then-fiancé and enjoying the people he works with.

Sharon Mah, communications manager for the Rural Coordination Centre of B.C., says that isolation can be an issue with remote communities, and adds that one factor contributing to longer retention can be if the doctor is part of a couple, that their partner is able to find meaningful employment. In some smaller towns, the variety of opportunities for a partner may not be there, requiring the couple to move. Mah says some communities acknowledge how important this is, and make a conscious effort to ensure the doctor’s partner is happy in the position they work in.

Pat Corbett-Labatt, councillor for Port Hardy, says that while there are great doctors working in the town, she definitely thinks doctor retention is an issue in Port Hardy. “I think a lot of doctors and their families have a hard time making a connection up here because of the semi-isolation of the area,” she says. She says that the key is “hooking the doctors into the lifestyle of Port Hardy,” something that could encourage them to move here initially as well as stay for a longer period of time.

Port Alice Mayor Jan Allen says they are very happy with their physician situation, with two local doctors who share a clinic/family practice and also have the help of a locum. They have worked there for many years. The only concern Allen has is that Port Alice only has medical care Monday to Friday, so weekend medical needs require residents to go to Port Hardy, whether on their own or by ambulance in urgent cases. With 600 people coming for the Port Alice Reunion weekend Aug. 2, Mayor Allen says having weekend medical care would have been beneficial. The B.C. government acknowledges the serious issue of doctor retention for rural communities through incentive programs and bonuses that work to attract doctors to the less populated areas of Canada’s most westerly province.

The B.C. Ministry of Health said in a statement that they have one of the most comprehensive funding and incentive programs in Canada to encourage health care workers to move to rural parts of the province. Between 2014-2015, the B.C. government spent $100 million on incentives to attract doctors, and in 2012 announced $22.2 million per year to bring more nurse practitioners to rural areas. Other important programs are the Practice Ready Assessment program, a pilot program for family doctors to assess their skills to make sure they are up to standard. If they are, they receive a provisional licence to practice. As of press time, 14 International Medical Graduates (IMG) family doctors are being assessed, and 16 more will enter the program in fall of 2015. Dr. Whittaker explains that this program is being utilized in Port McNeill, where two physicians in the IMG program have recently begun, and a third is set to begin shortly. Two are from Iran and one is from the Philippines, and they will all be in their positions for the next three years. Two IMG program doctors have also recently begun in Port Hardy, one from China and one from South Africa.

Another incentive is that doctors can also receive additional funds for working in specific B.C. communities under the Rural Retention Program (RRP), intended to improve the supply and stability of doctors.

Port Hardy, Port McNeill, Port Alice, Woss, Zeballos, Holberg, Alert Bay and Sointula are all communities covered under the RRP. Other programs include a locum program that gives rural doctors leave when required, and a travel allowance for doctors visiting certain isolated communities to provide services.

This summer, Quesnel faced a potential crisis as the departure of multiple doctors threatened to leave a big gap in their ability to provide emergency care for residents. Temporary doctors are being brought into Quesnel to cover the period before more permanent replacements begin. Quesnel Mayor Bill Simpson says that covering the cost of housing and car rentals for the temporary doctors makes it more attractive for them to cover emergency care short term, as those doctors will still be paying for expenses at home while in Quesnel. Simpson says that Quesnel’s population {10,000} requires 32 doctors, but they only have 23 at the moment. “It has become a bit of a critical situation for us,” he says, although he does feel optimistic that work with Northern Health to establish a primary-care clinic means that things are looking better for the future.

Some interviewed for this article say the broad range of duties rural physicians cover may intimidate young doctors or cause burnout.

“Rural physicians do tend to work more hours than their urban counterparts,” says Mah, as many have a broader range of practice and cover both an office practice, an emergency room and may travel to provide services to very remote communities. For the last 18 months in Port McNeill, Dr. Whittaker and another doctor have been running the ER, the clinic and remote outreach to places like Kingcome Inlet, with the help of a few locums.

Mah says this larger scope of responsibility can be a nervous point for some younger doctors beginning their career who are unsure if they can handle the demands. Mah says that while most of them probably can, a “specific kind of student or physician does really well in rural communities,” a physician type she refers to as a rational risk taker. These rational risk takers don’t have to have everything in place, are confident with their competence and know they can handle most things that come their way. For the things they cannot handle, they know they can rely on the support of their colleagues.

“Rural primary care practice is pretty strenuous,” agrees Mayor Simpson.  He says some doctors reach a stage in life where they wish to spend more time with their families, and the demands of rural practice no longer fit their needs.

While the ability to retain doctors in small towns is an ongoing issue been addressed through various programs, Dr. Whittaker for one enjoys working in his rural community, saying he values the ability to really see the difference he is making.