Solving the physician recruitment and retention problem

Earlier this week the Newfoundland and Labrador Medical Association (NLMA) suspended its contract negotiations with the provincial government because it has not responded seriously to the health-care crisis in our province.

The crisis is about how to recruit and retain physicians, particularly to care for 99,000 patients who cannot find a family doctor.

Many people ask what is needed in a recruitment and retention strategy. Part of the answer lies inside the physician contract and the other part lies in policies and programs that the government and regional health authorities can initiate. One part cannot work without the other.

The physician services contract addresses fees and salaries for physicians and other rules of compensation. Newfoundland and Labrador must be competitive with other provinces. Unfortunately, the reality is that many physician groups have fallen below the Atlantic average and our family doctors are the lowest paid in Canada.

For 20 years the government and the NLMA have used the Atlantic Parity formula as part of contract negotiations to maintain competitiveness, and this should continue.

The contract must also contain a new payment model, called blended capitation, that will enable family doctors to practice in teams and deliver medicine the way they were trained.

Other workplace rules are needed to alleviate stress and burn-out from the excess workload that doctors face in their practices, a key reason why physicians leave our province, and a key reason why so many rural emergency departments and hospitals are now without physicians.

Inside or outside the physician contract, the government should initiate a physician human resources plan to forecast the number of physicians we need over 10 years.

Outside the contract, the government can initiate the following:

Restore the provincial recruitment office with expanded number of recruiters to achieve the targets in the human resource plan.

Provide resources to attend recruitment conferences, build relationships with medical students and residents, plus advertising and social media.

Improve the medical student and resident bursary program including commitments to return of service.

Reinstate the discontinued signing bonus program to assist new doctors with the expenses of setting up a practice.

Support new doctors through training and mentorship on how to establish a practice.

Create partnerships with municipalities to involve them in recruitment and retention, showcasing their communities, welcoming medical students and new doctors, and supporting integration into community life.

Fixing the physician shortage is possible. The government must embrace the challenge and show patients and doctors that it will invest in the solution.

The solution will only work if it addresses issues both inside and outside the physician contract. Both sides of this equation must be fixed. You cannot promote Newfoundland and Labrador to new doctors without being competitive in working conditions and compensation.

While we are rebuilding our health human resources, we must provide interim medical services to patients who do not have a family doctor or other primary care provider. These can be provided in-person or virtually. Over time these patients should transition from interim services to a permanent family practice or team where they can receive long-term continuity of care. Interim services are stop-gap but necessary measures while we are fixing the long-term problem; they are not a solution to the physician shortage, and they are not the standard of care our patients deserve.

We call upon the government to address all these issues as an integrated strategy. The patients of the province deserve no less.