Choosing the rural route
CMAJ 1997;157:644
Re: "Medical recruitment in rural Canada: Marathon breaks the cycle" (CMAJ 1997;156:1593-6 [full text / en bref]), by Michael OReilly
We were certainly proud to have been featured on the cover of the June 1 issue of CMAJ and to provide evidence that all is not doom and gloom when it comes to rural recruitment. OReilly's article did a good job of outlining the recent events in Marathon. We feel, however, that one aspect that did not receive the attention it deserved was the central role of our group's philosophy toward recruitment and retention.
Early in the recruitment phase, our group met to devise a philosophy that was instrumental in cementing the recruitment. It incorporated group practice, consensus-based decision-making, emphasis on quality of patient care and lifestyle, use of alternative health care providers, a commitment to continuing education, and sustainability. We realized that sustainability might not always mean that our group consisted of the same faces, but would mean that it would continue to share the same philosophy. Ironically, we included the concept of ease of exit as a means to sustainability. Our reasoning was that, in a group that allowed physicians to leave to pursue other life goals, those physicians would be likely to assist in recruiting their replacements.
We are not satisfied with our current arrangement. We still hope to negotiate a fair means to free ourselves from fee-for-service payment (we have not already negotiated an alternative payment plan, as the article implied). We are recruiting an additional 1 or 2 family physicians because our waiting lists are still too long and our workloads still threaten our commitment to a fulfilling northern lifestyle.
Incidentally, Dr. Rupa Patel is a graduate of the Queen's Rural Family Medicine Program and not the Northwestern Ontario Medical Program, as stated in the article.
We feel that herculean recruiting efforts and serendipity in finding the right individuals are insufficient to address the problems of recruitment and retention. Only by combining these with a sustainable group philosophy will rural communities have a realistic chance of finding a solution.
Gordon Hollway, MD
Ruby Klassen, MD
Steve Klassen, MD
Sarah Newbery, MD
Eliseo Orrantia, MD
Rupa Patel, MD
Mike Sylvester, MD
Marathon, Ont.
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