‘Trained here, for here’

By Sharon Gray | July 29, 2014

Upon the recent completion of a two-year family medicine residency at Memorial University, 31 newly qualified doctors have begun planning their future practices—many of them in rural Newfoundland and Labrador. Dr. Laura Edwards says the Family Medicine Residency Program provided her with the opportunity to complete her second year of family medicine training in her hometown of Lawn on Newfoundland’s Burin Peninsula.

Dr. Laura Edwards and Dr. Cathy MacLean“It was an amazing and very rewarding experience to work at home in both the clinic and emergency room settings,” she said. “The experience enabled me to follow patients over time and develop strong and trusting doctor-patient relationships.”

Because of her positive experience in Lawn, Dr. Edwards has chosen to start practice, for at least a year, as a fee-for-service family practitioner based out of the community hospital in St. Lawrence, located just 10 minutes from Lawn. The practice will include clinic and emergency room coverage, as well as long-term care responsibilities.

Dr. Cathy MacLean, chair, Discipline of Family Medicine at Memorial, says the Family Medicine Residency Program is succeeding in its mission to prepare more doctors for practice in Newfoundland and Labrador, especially in rural areas.

“A study last year showed there were 300 of our graduates practising in the province,” she said. “That’s a lot of family doctors, all trained here, for here. This year we have added 16 more well-trained family physicians who are going to places all over the province, including Happy Valley-Goose Bay in Labrador.”

Dr. MacLean says Memorial’s medical school can train residents, but it also has to create the conditions the graduates want in order to stay and practise in Newfoundland and Labrador. She says one of those conditions is a primary care model, such as the Patients Medical Home (PMH).

The PMH is a vision presented by the College of Family Physicians of Canada for the future of family practice in Canada. The goal of the initiative is for every family practice in each community across Canada to be able to offer comprehensive, co-ordinated and continuing care to their populations through a family physician working with health-care teams. Dr. MacLean says Newfoundland and Labrador needs a model like the PMH to facilitate the integration of family doctors with family practice nurses, pharmacists, social workers and psychologists.

Medical graduates are also attracted to group practices that have an Electronic Medical Record (EMR) system in place, says Dr. MacLean. EMRs allow authorized health professionals to access patient information electronically rather than through a traditional paper chart.

“Once Newfoundland and Labrador puts this model in place, we will retain more of our trainees.”

Dr. Raie Lene Kirby spent the last 10 months of her family medicine residency in Botwood, N.L. She is currently scheduled to remain in the community for the summer to provide locum coverage—holiday relief for local physicians. The locums will allow her to get some experience in a variety of practices and emergency room coverage, plus get a better idea of what she wants her future practice to look like.

“I have loved my journey through the Family Medicine Residency Program at Memorial,” she said. “The two years have given me so much exposure through rotations both in the city as well as rural and remote parts of the province and beyond—including Nunavut for maternal health and obstetrics.”

In addition to providing vacation coverage and putting down initial roots in rural Newfoundland and Labrador communities, Dr. MacLean says that seven members of the newly graduated class will be taking additional training in palliative care, care of the elderly and developmental disabilities to better serve particular areas.

Another piece to the family physician retention puzzle is encouraging the province’s health-care regions to start recruiting for primary care within the community itself—not just in regional, health authority-run, primary-care clinics. Dr. MacLean says retention rates are growing in Canadian rural communities where family doctors have been recruited in groups—cohorts of two to four residents at a time for a specific location.

Looking forward, the next step in encouraging new graduates to build practices in Newfoundland and Labrador is to change the program’s training model from a “nomad” model to streams. The change will allow more residents to train in one region of the province for the full two years of their residencies, says Dr. MacLean. Some have already been focusing on a particular area of the province—such as the Northern Family Medicine Education program in Happy Valley-Goose Bay or at the Notre Dame Bay Health Centre in Twillingate.

Many family doctors in regions across the province are coming on board with the idea, and some have already submitted proposals for streams in their particular region. Dr. MacLean says the Family Medicine Residency Program is in the process of reviewing the proposals; program administrators hope to have changes made to some locations as early as 2015 so that students can begin to select their preferred locations.


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