Keeping doctors in Saskatchewan is a challenge, but luckily there is an organization to help communities with this problem.
© Herald photo by Jodi Schellenberg
Ed Mantler, the CEO of Saskdocs, discussed challenges and successes the organization has faced since it started in 2011.
During a visit to Prince Albert to talk meet with the Prince Albert Parkland Health Region, Saskdocs CEO Ed Mantler discussed the challenges and successes the organizations has faced since its inception.
Saskdocs is the Physician Recruitment Agency of Saskatchewan that was started in 2011 and has made a lot of progress in the last few years, Mantler said.
“If you think back to the beginning of 2011 as a province we were really in dire straits when it came to doctors,” Mantler said. “Communities across the province were experiencing disruptions in service. Just down the road, Shellbrook was closed due to a lack of doctors and so on.
“It has been a huge challenge playing catch up to try to address some of those needs,” Mantler added.
The first challenge was keeping the medical graduates from the University of Saskatchewan (U of S) in the province, he said.
“The University of Saskatchewan has an excellent program and produces very good doctors -- unfortunately, historically and even today, we only manage to keep half of the graduates here in the province coming out of the School of Medicine,” Mantler said. “There is such an opportunity to do more, to make Saskatchewan an option for them and such an opportunity to collect on the investment we have made as a province because medical school costs. Medical education is an expensive education and it is highly technical.”
Saskdocs has been working closely with the U of S, the students and residents since it began. Mantler said at first it was shocking to hear the residents say they were not told of the opportunities in Saskatchewan.
“We have put a huge amount of effort into making sure we are connected with those students,” Mantler said. “We have one staff member who fully dedicates all her time to meeting with them. She meets with every group at least once a year and she focuses on family medicine, which is our biggest need in the province at the moment.”
They have put a lot of effort into making sure the residents know about the opportunities.
“She is making sure that the right individuals in places like the Prince Albert Parkland Health Region and other regions across the province have an opportunity to meet face-to-face with those residents early on to develop a bit of a relationship and be able to talk about the great things that are happening here,” Mantler said.
Prince Albert has been lucky because of the distributed medical education in the city. Residents from U of S have been training in the health region for a number of years, Mantler said.
“That has been helpful because most of those residents have decided to stay in the province and many have stayed right here in Prince Albert or close by,” Mantler said. “It really shows that relationship and making that connection and letting them know what the community has to offer and what they are getting here makes a difference.”
A recent survey with the residents showed 83 per cent of them felt they were hoping to practise in Saskatchewan.
“A few more months will tell us if that will come to fruition when they start entering their practices but we are very hopeful that is actually happening,” Mantler said. “Throughout those relationships, even though the size of our medical school here has virtually doubled in the last four to five years, we now have 120 residents who are doing their postgraduate training here in Saskatchewan.”
Despite the large increase in seats at the U of S, three-quarters of the applicants to medical schools are unable to get in across Canada.
“A lot of them, in fact between 3,500 and 4,000 Canadians go and do their medical training offshore,” Mantler said. “What we heard from them was 90 per cent of them were hoping to come back to Canada to practise eventually but almost none did.”
The organization decided to look into why that was happening and discovered it was extremely difficult to come back for training or practice.
“We have worked closely with the University of Saskatchewan and they have created some new opportunities and they have made some changes to the rules to make students studying abroad have easier more reasonable access to programming here and to be able to complete some of their education here and be in a much better position to get a licence in Canada to actually practice here,” Mantler said.
“A very small number of students studying abroad would come back to Saskatchewan or even anywhere in Canada for their post-graduate residency training,” Mantler added. “This year, in 2013, with the changes the university has put in place 36 Canadians studying abroad have actually entered their residency program in Saskatchewan, many of them in family medicine but some of them in other specialties as well.”
They are optimistic that this group of residents and graduates will be more motivated to stay in the province.
“The programs the university has put in place really target those Canadians studying abroad who originated in Saskatchewan,” Mantler said. “They already have ties to the province and already know about the province.”
With these changes, there should be more retention of Saskatchewan graduates.
“A change happening today may not have an impact for us in a functional way for five or six years,” Mantler said. “In the meantime, there is such a huge need in the province and we needed to find a way to address that need much more quickly.”
“We were fortunate that our Ministry of Health and the College of Physicians and Surgeons of Saskatchewan approved and developed a new program for assessing international medical graduates -- these are people who may have done their original medical training in Europe or India or really anywhere in the world to be able to come to Saskatchewan to have a assessment,” he added. “At the end of that assessment they would be licensed to practise in Saskatchewan.”
Prior to the program, graduates were only accepted from specific preapproved countries.
“That is why you see so many doctors from South Africa because that is one of the countries that were eligible to get a licence here,” he said. “With this new program, it is not based on where they trained but what the contents of their training included. We can now look at doctors who have trained anywhere in the world and if they meet certain criteria and they have met the right components and criteria they can be considered for this program.”
The assessment is called the Saskatchewan International Physician Practice Assessment (SIPPA) and runs three times a year -- January, May and September.
“I’m very pleased that in 2013 we had 89 of the available 90 spots filled,” Mantler said. “The pass rate of them going through was around 72 per cent. It resulted in so far 91 doctors practising in Saskatchewan. We have another 25 embedded in the assessment right now and should be available for practice in January. We have another 30 who will begin the assessment in January.”
The recruitment has made a huge impact on the province because many of the communities who had limited services before are now in a better position.
“That is not to say that Saskatchewan is completely stable or that every doctor we need is in place -- there are still many, many opportunities to be addressed but the focus has really been those highest need communities and for the most part a good chunk of those have been addressed,” Mantler said. “Our big challenge now is going to be how do we keep them.”
The turnover rate in the province is historically 18 per cent, Mantler said.
“This upcoming year our focus is working with health regions and working with some communities to say what can we do as a community and the region to work together to make this an environment and community where not only the doctor but the doctor’s family feels embedded in the community and a part of it and wants to stay there,” Mantler said. “When we talk to doctors it really becomes evident that we are not recruiting a doctor, we are recruiting a family.”
There need to be amenities for families and job opportunities for the spouses, he said.
“Everyone always thinks it is the money -- if we pay a big bonus or give them a free house they will be happy and stay,” Mantler said. “It is really those social aspects and the work/life balance to be able to spend time with the family and in the community to fit in that are the most important.”
Exit surveys with doctors who have left the province showed Saskdocs that it often was the spouse who wanted to leave because they were unhappy and did not feel like part of the community.
The biggest priority in PAPHR is the community of Shellbrook, Mantler said.
“With a new state-of-the-art facility there, it is important to have enough resources to make that facility fully functional,” Mantler said. “We are recruiting doctors to that community and it is not just a matter of recruiting one doctor and being happy with that. You need a critical mass of people so that you don’t burn out that one doctor.”