NOSM Physician Recruitment

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(No Transcript)
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Physician Recruitment Faculty RecruitmentA
Complimentary Strategy

• Dr. Tim Zmijowskyj, MD, CCFP
• Associate Professor
• Northern Ontario School of Medicine

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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

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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.

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Introduction

• Uneven geographic distribution of physicians in
  Canada
• Less than 3 of rural physicians in Canada are
  specialists

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• 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

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History of Medical Education

• Northeastern Ontario Family Medicine (NOFM)
  Program
• Family Medicine North (FMN) Program

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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

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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)

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Of the North, by the North, for the North
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Its 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!

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Its hard to be young

• 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!

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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 prior to medical school
• Having grown up in a rural area
• Rabinowitz, Diamond, Veloski, Gayl e 2000

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Factors in Recruitment and Retention

• Demographics and background of physician
• Practice issues
• Lifestyle and Community issues

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Demographics and Background

• Gender
• Race/ethnicity
• Parents socioeconomic status
• Expressed desire for rural service
• Home community/rural upbringing
• Place of training
• Positive community learning experiences

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Practice Related

• Facilities
• Remuneration
• Interaction with patients
• Cooperation with colleagues
• Clinical autonomy
• Medical technology

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Lifestyle and Community

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

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

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Admission Strategies

• Class to reflect demographics of Northern
  Ontarios population
• 70 in Northern Ontario for 10 years
• Aboriginal 11
• Bilingual 17
• Francophone 16

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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

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Admissions

• 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

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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

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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

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Northern Ontario is not Homogenous

• Northwestern Ontario
• Thunder Bay
• Kenora
• Sioux Lookout

• Northeastern Ontario
• Sudbury
• Sault Ste. Marie
• North Bay
• Timmins
• Elliot Lake
• New Liskeard / Haileybury / Cobalt
• South Muskoka

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Teaching and Practice Environments

• Inclusive definition of Faculty
• Support involvement at a distance
• Lobby for practice environments that support
  teaching
• Teaching
• Capital
• Resources

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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

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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

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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

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Community

• 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

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Tools

• Provide relevant Health Information Resources
  (HIRC) and CME/CPD opportunities to
  faculty/physicians.

• Ongoing dialogue with physicians and communities
  regarding needs

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Research

• Maintain database of contacts and expressions of
  interest

• Provide funding, facilities and opportunities
  for clinicians to engage in research
• Research the needs of communities and faculty
  members

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Faculty Development

• Assist in the creation of locally-relevant
  faculty development events

• Student instruction
• Research
• Administration
• Curriculum development

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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

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What can NOSM provide?

• Leadership
• Health Information Resources for
• Communities
• Physicians
• Students
• Administrative support
• Financial resources
• Research projects
• Professional education

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Informal Survey

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

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Innovative Approaches - Summary

• Academic program that values community teachers
  and practices
• Community partnerships
• Interprofessional curricula and environments
• Opportunities of underserviced environments

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CSD Faculty Appointments
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Summary

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

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Future Directions

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

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Some follow ...
some lead
some pioneer.