Physician Recruitment –Faculty Recruitment A Complimentary Strategy

2. Physician Recruitment –Faculty RecruitmentA Complimentary Strategy Dr. Tim Zmijowskyj, MD, CCFP Associate Professor Northern Ontario School of Medicine

3. Presentation Outline • Overview of the Northern Ontario School of Medicine • Strategies for Physician-Faculty recruitment in Northern Ontario • Retention and attrition issues • Summary and future directions

4. Northern Ontario • Really big • 89% of Ontario • Pop: 839,549 • 7.4% of Ontario • 1 person/km2 • 101 persons/km2 S.O. • 30+% rural N.O. • 13.9% rural S.O.

5. Introduction • Uneven geographic distribution of physicians in Canada • Less than 3% of rural physicians in Canada are specialists

6. Increased Northern and rural educational exposure to postgraduate family medicine residents hoping they would consider practicing in Northern and rural Ontario communities “This new program promises to help solve the problem of recruitment and retention of physicians in northern, rural and remote communities” Press Release, Office of the Premier: May 22, 1990

7. History of Medical Education • Northeastern Ontario Family Medicine (NOFM) Program • Family Medicine North (FMN) Program

8. NOSM - History in the Making • The first new medical school in Canada in over 30 years • Established with a Social Accountability mandate • Responsive to the needs of people and communities • The first medical school to operate as a faculty of two universities

9. Building a Dream • State of the art buildings at Lakehead and Laurentian campuses featuring: • SMART classrooms • Wet and dry labs • Examination rooms • Health Information Resource Centres (HIRC)

10. Of the North, by the North, for the North

11. It’s hard to be young… • NOSM faces many of the same faculty recruitment issues as established schools • Added challenge of being new • Too few physicians ... But physicians needed to teach • Need to Focus on strengths!

12. Strategic Thinking Define Goals Short and Long Term Undergraduate Postgraduate Define measures of success Numbers Quality Satisfaction Retention Tactical Thinking Specific targets and numbers Current teachers Current physicians Focus on strengths and collaborations Support Practice models Exciting! Fun! It’s hard to be young…

13. Physician Recruitment and Retention • Four Factors Predictive of Recruitment to Underserviced areas (Three can be identified at the time of admission to medical school.) • Member of underserviced ethnic/minority group • Participant in “return for service” agreements • Strong interest in practicing in an underserviced area priorto medical school • Having grown up in a rural area Rabinowitz, Diamond, Veloski, & Gayl e 2000

14. Factors in Recruitment and Retention • Demographics and background of physician • Practice issues • Lifestyle and Community issues

15. Demographics and Background • Gender • Race/ethnicity • Parent’s socioeconomic status • Expressed desire for rural service • Home community/rural upbringing • Place of training • Positive community learning experiences

16. Practice Related • Facilities • Remuneration • Interaction with patients • Cooperation with colleagues • Clinical autonomy • Medical technology

17. Lifestyle and Community • Schools • Employment for spouses • Community involvement • Work/Life balance • Intellectual stimulation • Professional variety • Continuing medical education

18. NOSM Faculty Recruitment Strategic Elements Admission Strategies Medical Education Methods Teaching and Practice Environment

19. Faculty Recruitment Specific Strategy • An ongoing process • Strive to find a “good fit” • Open about challenges of the endeavor • Competitive remuneration • Administrative support • Professional variety

20. Admission Strategies • Class to reflect demographics of Northern Ontario’s population • 70% in Northern Ontario for 10+ years • Aboriginal 11% • Bilingual 17% • Francophone 16%

21. The NOSM Charter Class • Students began in August, 2005 • 24 students at Lakehead campus • 32 students at Laurentian campus • Clinical learning occurs early and throughout

22. Increase the number of Northern Ontarians choosing medicine as a career Presentations to high school students Mentorship Financial support University student medical ‘clubs’ Regular contact – medical students Admissions

23. Educational Methodologies • Curriculum includes rural, remote and underserviced issues • Patient-centered, small group, case-based learning approach • Distributed community-based medical education • Prolonged community attachments throughout Northern Ontario • Broadband communication information technology

24. Teaching and Practice Environments • Challenges • NOSM not currently funded for clinical services • Physicians in Northern Ontario have heavy clinical loads • Variety of models for clinical remuneration throughout Northern Ontario • Remunerative models do not support teaching

25. Northwestern Ontario Thunder Bay Kenora Sioux Lookout Northeastern Ontario Sudbury Sault Ste. Marie North Bay Timmins Elliot Lake New Liskeard / Haileybury / Cobalt South Muskoka Northern Ontario is not Homogenous

26. Teaching and Practice Environments • Inclusive definition of “Faculty” • Support involvement at a distance • Lobby for practice environments that support teaching • Teaching • Capital • Resources

27. Teaching and Practice Environments • Collaborate with Health partners to ensure educational mandate and physician satisfaction with teaching • Infrastructure for health care and education delivery • Broadband internet connectivity • Telemedicine • Interprofessional teams

28. Paradigm Shift • Revised “faculty appointment” definition, i.e., eliminating “Clinical” descriptor • Research values and goals of faculty and physicians to understand how to recruit and support them • Design environments that integrate these findings • Representation of community faculty on key NOSM committees

29. Attrition - Challenges • Average age of practicing physicians is increasing • Retirement on the horizon for many • Retirees interested in alternate working arrangements (e.g. proportional clinical plus instructional role) • Provide flexible and accommodating instructional opportunities

30. Work with communities to keep them connected to people from their areas that are pursuing medical careers. Involvement of the entire community Community placements and clerkships “Local NOSM Group” Community

31. Provide relevant Health Information Resources (HIRC) and CME/CPD opportunities to faculty/physicians. Ongoing dialogue with physicians and communities regarding needs Tools

32. Provide funding, facilities and opportunities for clinicians to engage in research Research the needs of communities and faculty members Maintain database of contacts and expressions of interest Research

33. Assist in the creation of locally-relevant faculty development events Student instruction Research Administration Curriculum development Faculty Development

34. Community Collaborations • Ensure match of needs between School and hospitals • Work with hospitals and CDOs to create common appointment procedures • Provide local administration/coordination • Establishing student bursaries • Ensure ongoing communication and feedback

35. What can NOSM provide? • Leadership • Health Information Resources for: • Communities • Physicians • Students • Administrative support • Financial resources • Research projects • Professional education

36. Informal Survey • 27/32 physicians relocated to Northern Ontario in past 24 months indicated NOSM as significant factor in their decision

37. Innovative Approaches - Summary • Academic program that values community teachers and practices • Community partnerships • Interprofessional curricula and environments • “Opportunities” of underserviced environments

38. CSD Faculty Appointments

39. Summary • Professional variety and support is significant • Collaboration with community partners is essential

40. Future Directions • Increase recruitment in rural and remote communities • Develop mechanisms for funding clinical practice • Enhance research opportunities and facilities for clinicians

41. “Some follow ... some lead … some pioneer.”