Plus Ça Change…

Over the years I’ve observed many attempts at recruiting to rural communities.  Believe it or not, there was a time when communities as large as Lethbridge and Red Deer were certainly underserviced.

It certainly seemed that way for me as a newly minted family practitioner starting out at age 25 in Lethbridge. I was to arrive and start my first day at the Haig Clinic at a reasonable 0900 hrs but was jolted awake by a phone call at 0600 from the case room at St Michael’s. A new colleague had a patient in labour and, apparently, I was covering.  Needless to say, I wasn’t even sure where the case room was, let alone what the labour and delivery culture was for that hospital. By the time I arrived at the clinic, I had been christened an attending doctor by delivering the first of many children.  The staff eventually got used to the fact that I was not, in fact, a medical student or a respiratory tech or a porter.  I eventually got used to taking action after realizing what needed to be done, while not having the luxury of the internet or of back up specialists immediately at hand (our trauma team was a married couple that lived out of town).

My first pericardiocentesis was done after entering practice, alone in an emergency room, mid forceps extractions as a family practitioner were not unusual, and I remember my first lumbar puncture in practice.  I still have those semi-fenestrated Simpson forceps…yes… that old.  Clinical practice has changed a lot.  Whether I think we are better off now or that there is evidence of safer outcomes now will be the subject of a future blog/rant.

How recruitment is done really hasn’t changed at all. We’ve researched it, published about it and communities need to pay attention. Residents or students considering where they might practice also need to pay attention.  The recruiter and the recruited are really just the opposite sides of the same coin.

The Alberta evidence shows that a community has less than one week after a locum or resident arrives to recruit them. Less than one week… with few exception, its more on the order of five days.  The time line to create that relationship is exceedingly short.

Believe it or not, recruitment is not about money… really it is not.  Recruitment based on dollars, for example a signing bonus, sets the value of the relationship as a commodity; its about short term gain only. The long term, however, is what is rewarding for everyone involved.  Recruitment is about “fit”.

So what is “fit”.

Certainly lifestyle is a large part of that.  Having adequate coverage for time off, recreational activities that recharge our batteries, and opportunities for a family, however you define it, to grow are important. Communities need to realize that, in most circumstances, they are recruiting a family and not a solo practitioner.  What is your partner going to do?  For Canadian graduates, and certainly we know in Alberta, this is a joint decision that is thoughtfully made.

But lets us look at some other considerations.

How about if you import your own coverage?  What’s to say that you shouldn’t approach a community or a clinic with a classmate and suggest that they secure both at once.  You have support, the town benefits doubly and, hopefully, the partners also benefit.  And that is the point.  Communities are recruiting the partners of the doctors more often than the practitioner. The partner’s needs are often the tipping point.

And who do you work with?  Yes, we need to have the assurance that we respect the skills of the docs we share a practice or a call list with.  But, who do you see more often?  Well, that would be the office and hospital staff.  A former resident of mine enlightened me to the fact that his time as a locum was not spent in assessing doctors and communities for practice.  He found many groups he could easily work with… it was the office staff and the hospital staff that he was assessing. Even if he returned to the community for a number of locums, he had made his mind up based on his interaction with the non-medical staff in that first week. 

So focus on the overlooked but essential “fit”. Have confidence in your skills; your residency programs will deliver them and you will be competent to practice in small communities. Be confident that you will have a comfortable paycheck and you will pay off those loans.

Use your rural rotation to help you get a foothold into where you want to establish a fulfilling and supported practice that allows your family to do what it wants to. Be creative and maybe import a classmate and their family to make it work for everyone.  Take your partner along on that rural rotation and have them meet the office staff.