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From http://www.timminspress.com/webapp/sitepages/content.asp?contentID=159899&catname=Local+News

Docs vacating the North, study reveals

James Wallace  /  Osprey News Network
Saturday, August 19, 2006

A third of all doctors living in Northwestern Ontario expect to leave their practices by 2009, shows an Ontario Medical Association study obtained by Osprey News.

The study not only confirms that doctor retention continues to be a chronic problem in the North but it also found current doctor-retention initiatives for underserviced areas are not working.

Almost nine out of 10 doctors believe there is a "serious physician retention problem in Northwestern Ontario" and 41 per cent believe that "regardless of physician-retention initiatives, more and more physicians will leave Northwestern Ontario to practise elsewhere."

Dr. David Bach, president of the Ontario Medical Association, said although the study focused on doctors in Northwestern Ontario, it likely reflects physician sentiments across the North and in rural, underserviced communities.

"I suspect it is broadly applicable because the issues that are identified here are common issues in semi-rural and northern places," Bach said.

The study found doctors decide to leave for a combination of professional and personal reasons but significantly concludes personal and family issues are the "most significant" factor influencing doctor intentions.

"Most physicians who expect to leave practice in Northwestern Ontario within five years state that they are leaving for personal/family reasons (54 per cent) as opposed to retirement (37 per cent), professional (25 per cent) or community (eight per cent) reasons," the study found.

Younger and female physicians are most likely to leave for personal and family reason and the more "rural" the community is, the higher the risk it will lose a physician.

While 18 per cent of Thunder Bay physicians intend to leave their practice within five years, 44 per cent of regional physicians outside of the city of Thunder Bay plan to move elsewhere.

Meanwhile, doctors who came to the North for "good income" were also more likely to leave within five years.

The study surveyed 200 doctors in Northwestern Ontario, almost two-thirds of all doctors in the region, and 100 spouses.

Specific personal concerns affecting doctor decisions to leave communities included a lack of time for family life, lack of access to relatives and friends and uninterrupted free time away from work, the study found. Other concerns included:

• Ease of travel in and out of community;
• Quality of education for children;
• Availability of cultural events;
• Spouses/partners' contentment in the community;
• Availability of recreation;
• Compatibility with the medical community.

Spousal satisfaction was found to be very influential in family decisions to stay or leave the North.

Professionally, physicians were most strongly dissatisfied with workloads, their relationship with hospitals and health care organizations and access to medical services including hospital and long-term care beds, home care services, social and psychological counseling for patients and technology.

Any of these personal or professional concerns could represent a "tipping point" for doctors who plan to leave their northern practice, and should be addressed in future retention strategies, the study found.

Strategies need to be developed that involve the provincial government, local health care systems and communities with more emphasis on a "personal," highly individualized approach to retaining physicians.

"Physicians are not commodities that can be supplied according to demand; communities must compete for physicians in an environment of physician shortages," the study concluded. "Because physician satisfaction and intention to stay is so individualized, planning and implementing retention strategies is a challenge."

Measures could be taken to address both personal and professional concerns.

The study suggests innovative measures are needed to improve personal and community satisfaction including lobbying airlines to facilitate easier access in and out of town and free family fares for doctors to visit relatives every six months.

Doctors who responded to the survey stated that "the community could be more welcoming and accepting toward physician families as newcomers, and that local medical colleagues and healthcare administrators could be more supportive."

Regarding their professional lives, physicians suggested a number of retention incentives including disability and dental benefits, pension plans, reduced workloads, premiums for doctors who stay in the North, paid sabbaticals, more medical education opportunities, higher income to reflect workloads and increased availability of visiting doctor locums.

"It was not the purpose of this study to recommend models for physician retention, however, the findings do suggest that new models are required," the researchers found.

"Retention strategies that target only professional factors and offer only monetary incentives are not supported by this research." The study was sponsored by the Thunder Bay Medical Society, funded by the Ontario Medical Association and conducted by a team of researchers at Lakehead University School of Social Work led by Professor Mary Lou Kelley.

Bach said the erosion of doctors from the North is also exacerbated by the number of doctors approaching retirement, approximately 20 per cent all the doctors in the province.

"This is a problem in the North but it is also a problem elsewhere," he said. "We could lose a fair number of doctors fairly quickly if things don't change."

"The physician shortage is an issue that's been with us for a while," Bach said. "It's an issue that's worrisome across the province and it's going to be with us for a while.

"So we all have to work on this together," he said.