Port McNeill doctor weighs in on health care recruitment and retention efforts

Dear Editor,

I wanted to echo the previous letter writer Albert MacFarlane’s comments on the complicated nature of recruitment and retention of staff in the North Island. This is especially true for health-care professionals.

While professionals do seek out places which they find the most suited and with the best opportunity, I believe that several other factors play a role in our local health-care staff recruitment.

Value: Remuneration undoubtedly plays a role and includes recruitment incentives and relocation expenses. For non-physician staff like nurses and lab staff, these are fairly standard and somewhat uniform for the rest of the province. Discretionary factors around where on the scale one lands regarding experience are also taken into account.

How else do you add value when there isn’t a lot of wiggle room on remuneration?

I have seen over the years and believe that value is added when one is truly seen as part of a team,where one has a relationship and regular supported check-in from responsive and accountable management that allows for dialogue,team growth,consolidation and course correction of a constantly evolving health-care delivery model. The trend for us all to work lots has become a reality and has impacts on non-work quality time with family, our health, making our overall work cohesion and psychological health even more important. This is currently not the case in our region. There is minimal management presence or meaningful engagement. Team-based care is not a new concept in a clinical setting, but there is some layering in it’s implementation for staffing resilience. While the staff coffee days and occasional meals are appreciated, it does not make up for an absence of active management.

Equality and fairness: The divided approach to the region’s needs, including recruitment, continues. There remains no pooling of our resources to better serve our region, leaving us to continually fumble in replicating full services at each site instead of predictable and sustainable services at one. We are told that this is political. Sites cannot be closed while sites are being closed.

That aside, physician recruitment has been especially challenging. There were historically three mechanisms that physicians individually and collectively could have a voice to engage with the health authority which are the designated representatives of the health ministry. All of these opportunities have been stymied and engineered to further distance and isolate the physicians. This is far from collaborative or productive. The exodus of physicians in Port Hardy and Port McNeill has not helped. Some have left because of personal circumstances, while others have left for the lack of support professionally and financially. Doctors in Port Hardy and Port McNeill have not been paid for services by the health authority. There is a lack of transparency in the contracts offered to new to practice doctors, return of service doctors, regular physicians, or locum doctors. This is outside of the different models of remuneration in the region be that APP, FFS or LFP. It would be fair to say that there isn’t a handle on this which predictably creates a path of disharmony amongst the doctors in the region and directly affects recruitment and retention.

Locum physicians are currently paid an exceptional $4,000 dollars for 10 hours of work with no cumbersome paperwork or patient follow-up to do. It remains the best recruitment incentive at present. Is this sustainable? There are solutions from a macro-economics perspective, but what we’re doing isn’t it. To effect that change requires tools and temerity which there appears no sign of.

Apart from locums, recruitment in our region seems to be solely dependent on the two mandated return of service programs in the province (IMG and PRA-BC) where docs stay for two or three years. These are often newly qualified doctors or internationally trained doctors who now receive no mentorship or benefit from experienced regional doctors in the clinics or hospitals. They end up counting down their expected time as work fodder in the region and then leave not because it isn’t a beautiful place to live and work but because of a poorly supported work environment.

Recruitment of health-care staff is definitely complicated but I feel it can be improved with ensuring some basic principles that would help set us up for better staff retention. I remain hopeful that we will have a leadership team that can lead by example and that have a vision for our region that values the people and providers in the provision of care to our rural community and in their advocacy to the ministry of health on our behalf.

All the region’s staff are working hard and burnout is rampant. We have some incredible staff in our region that are in danger of leaving unless there are urgent local changes. A single source health-care system that exists as form with no substance lacks the foundation for improvement. Can we build one together?

Dr. Prean Armogam,

Port McNeill