Retaining your recently recruited rural doc

I. Make them feel welcome. Seems obvious, but encouraging all docs to individually welcome the new doc will make a difference. Honestly. Just do it.

II. Give them a list of things that they need to know about in town. Best place to buy groceries, list of housekeepers, electricians, plumbers, etc., restaurants, good place to go for a quick weekend with their partner, vets. Start the list now. Add to it as other ideas come up. These people are not in the yellow pages or local paper when you are in a small town.

III. Prepare a list of commonly used billing codes in your office, hospital, nursing home, wherever you tend to make your money. Each clinic has different common codes. Never assume new docs know them. They’re not taught in residency, and the codes they used elsewhere may not be appropriate. If your new recruit is making money to pay down the debt they have, they will be happier, promise.

IV. Check in frequently. Have someone who is their designated mentor that actually wants the job. Someone who will make sure they don’t feel like they are bothering the mentor. Knowing which docs to refer for what kind of issue is important. Knowing what to do when that doc then turns down all referrals is essential. Weirdness happens every day in the clinic.

V. Have regularly scheduled check ins. Both of you will be ready for the meetings and know that you are safe to say what you need to. If either of you have concerns, a regular meeting makes it easier for both of you to come up with solutions. If you just chat about a few cases, it will be time well spent.

VI. Be clear about numbers. How many days of vacation? How many months of free rent? How is overhead calculated? Everything needs to be in writing so that everyone knows the rules up front. That way when snide remarks like “but no one takes vacation in their first year” can be taken as the jokes they are meant to be.

VII. Make sure their new office and exam rooms are clean. Seriously. No one wants to work in someone else’s year’s of dust and outdated hand outs. That’s gross and indicates that your group doesn’t care about your new recruit.

VIII. Have a welcome dinner. Make spouses welcome. Spouses are the bomb for making new docs feel welcome. They know what their partners went through and will help make your new recruit feel like they belong. While you're at it, ask those spouses to add to this list.

IX. If you notice your new doc is not making it to the lunch room, it’s not a good sign. Check in to see what can be done to lighten the load. They will want to hear your advice.

X. Help them get a family doc. Know that they will NOT be comfortable with one of their colleagues doing their DRE or pap. Follow up to make sure that your friend actually took them on. You’d be surprised. It took my nurse begging a former colleague to get a doc for my partner and I.

XI. If your recruit comes to you with concerns, deal with it. While it’s true that things get better in 5 years (it’s OK to tell them that), it’s not enough. Help them through whatever is going on or you won’t see how much better they are in 5 years.

XII. Baby docs are just out of residency where they are taught that if they don’t have the answer to something, they’re useless. This will be a hard habit to break, but essential that they feel safe in stopping it. 

XIII. Consider a community meeting/doctor to introduce people in town to the new doc. Getting formally introduced may reduce assumptions and gossip that comes later, or at least keep it kind hearted. 

Why the Ontario MD funding cuts are a feminist issue (a rural focus)

There is a lot of talk among my colleagues on what to expect from the Ontario Liberal government with respect to our fee claw backs. The government’s hope is that by decreasing our fees, that we will work less and therefore the system will be charged less overall. They see lowering access to physicians by patients as the solution to their health care finance challenges. 

Sitting in my rural family medicine office, I see how these actions will spill out into my community. 

First of all, less work by the MDs in the office means less available salary and less work for our staff. Staff cutbacks always seem to be the first suggested when overall income decreases. In my office, and every other one I’ve worked in, this staff is comprised almost entirely of women. These women work full and part time in our office and obviously depend on their wages to keep their family in the black. Many of them live on farms and require the supplemental income.  

Female patients are interrupted more than male patients (1). If there is a push to decrease our time in the office, we will revert back to the one item per visit that was seen before the introduction of FHOs. Our female patients won’t get a chance to be heard. Their “door knob” questions will be left to the next visit, and likely the visit after that since many of our rural patients do not “want to be a bother”. Some of these “door knob” questions I have heard in the past two weeks have included: I was raped last week - can I get tested for HIV? I’m worried about my drinking, how can I cut down? There’s a growth on my back that seems to be getting bigger. I worry that these women will be shooed out the door too quickly to check in on what might have really brought them into the office.  

Women in rural areas tend to be the caregivers for ailing relatives, elderly parents and neighbours, children (2). “Rural women caregivers are faced with such issues as limited access to adequate and appropriate healthcare serves, culturally incongruent health care, geographical distance from regionalized centers and health services, transportation challenges, and social/geographical isolation.” These women have several roles to fulfil - spouse, employee, parent, volunteer, caregiver. Decreased availability of physicians will put their own health at risk as well as that of those for whom they care. This increases the odds that the caregivers and their charges will end up in the Emergency Department and/or admitted to the hospital (where the real cost to the health care system begins). 

Less MDs in rural areas as they look for ways to make their practice lucrative enough to continue practicing will lead to less choice of an MD for families. Having a therapeutic relationship with your physician is essential to good health. As it is, those in my area are happy to get any physician let alone someone with similar ethics and values. Decreasing the supply of MDs will make it even harder for patients to advocate for themselves to get a physician they can connect with. Families need to keep their MDs to ensure that their children are vaccinated on time and will often stay with a doctor for years despite not feeling comfortable with them. I’ve met women who have suffered sexual assault who have gone more than 30 years without a pap because she was too scared to have her (previous) male physician perform it. Her cervical cancer treatment would have paid to have a female physician in their area for at least a year.  

Finally, and least importantly, female physicians spend more time with their patients (3). They are interrupted more than their male colleagues. This means that with the decrease in pay, that their time is worth less per hour than the men in their practice. Already we are dealing with no maternity or paternity leave for physicians. This is a step in the wrong direction, pushing women out of medicine. 

There are many concerns about physicians choosing to leave Ontario, not being available for their patients while they are here. My hope is that the OMA and the Ontario Government can work out an agreement to keep my patients, and all the rural female patients in Ontario, safe and well. 

(1) http://www.ncbi.nlm.nih.gov/pubmed/11456245

(2) Crosato, KE, Leipert, B.; Women caregivers in Canada; Rural and Remote Health; June 5, 2006

(3) West, C; When the Doctor is a “Lady”: Power, Status, and Gender in Physician - Patient Encounters; Symbolic Interaction; Spring 1984