Study looks at factors in doctor retention
By Al Beeber - Lethbridge Herald on December 7, 2021.
LETHBRIDGE HERALDabeeber@lethbridgeherald.com
A retired University of Lethbridge professor feels the conclusions he drew in a study he conducted in 2008 about the recruitment and retention of doctors in rural eastern Ontario has weight here in 2021.
Gordon Hunter, who was a professor in the Faculty of Management at the University of Lethbridge, looked at the issue from a qualitative perspective, doing his investigation into the motivations of physicians.
He did one-on-one interviews over a four-week period in 2008 with 18 participants. His research documented aspects that physicians deemed important to them regarding their medical practises.
Those included recruitment and retention issues.
In an interview Monday, Hunter said “in my biased opinion,” the conclusions he reached in 2008 hold merit in Alberta today but he’s had no luck convincing anyone at a university in Alberta to try to replicate his study here in 2021.
His desire is to hear “what Hunter did in 2008 really is fine or no, these are the differences between the provinces and the dates,” he said.
Hunter said “let’s not get into politics” when asked whether the doctor shortage here is a UCP issue or something else is at play.
“The long-term is to try and find those people who want to be out in the rural communities and it seems like Lethbridge gets defined as a rural community sometimes,” Hunter said.
In his report, Hunter said it’s important to consider who wants to come here.
“My major point is don’t throw a bunch of money at them and this wasn’t my point; it’s a number of the people I talked to back in ’08 who said ‘we throw a whole bunch of extra money at the person that comes out here and we tell them we’re only to give them extra money for three years. After three years, they’re gone’. So the important thing is finding out what the person is interested in and what his or her family is going to be interested in, as well. And do recruiting kind of based on that. The other thing is too, and again I was told this doing this research, don’t necessarily go to a high school in Thunder Bay and say ‘who wants to be a doctor’? Because, a bunch of hands will go up. Come down to Toronto, get educated to be a doctor ‘and the majority of them will want to stay in Toronto,” Hunter said.
“In general terms, adults living in a small town think they’re very, very successful if their kid goes to university and goes to a big town,” Hunter said.
And the interpretation is their children aren’t as successful if they come back to a small town, Hunter added.
One issue that came up in Ontario was doctors were concerned about the amount of time they were working.
“It was more about ‘I need some time off. I don’t want to work 12 hours a day seven days a week,’ is kind of what they were saying in Ontario in ’08. It’s not that they don’t work at all, it’s that they don’t want to be overworked. I think that was more the opinion back then,” Hunter said.
One possible solution for retention is to get multiple doctors in a smaller community, he said.
“Let’s not put one doctor in Fort Macleod; let’s put two or three who want to be there.”
He also suggested online meetings with doctors in other locales who are relatively close “who are into the same kind of specialty that a doctor might be wanting to get into. I say that because most of the time, a doctor will go to a small town as a GP. You want to get into some specialty when you’re out there then maybe via technology, you should be interacting with those folks in Lethbridge, Calgary or Edmonton or other small towns even so you have a virtual larger group,” Hunter said.
Recruitment issues in Ontario “were related to connections with colleagues, community and family; the desire for a certain lifestyle, the provision of financial incentives; and previous exposure to a specific area,” his research stated.
Retention issues involved practice, community and family.
“The participants in this investigation identified motivation aspects for physicians. They indicated that they enjoyed the practice of medicine and the variety it offered. They are excited about helping and caring for patients. They prefer a collegial environment working with other physicians who take a similar approach to their practice. The participants also identified that they felt well compensated for their efforts,” his research stated.
Hunter’s investigation stated that 20,000 doctors were surveyed by three medical entities back then with the results indicating “that the medical profession in general is experiencing a crisis situation regarding the capacity of the medical care system to address patient needs.”
The crisis was due to several factors including that the Canadian healthcare system was underfunded; that medical schools haven’t been able to graduate sufficient numbers of doctors; and that the healthcare system is an ineffective bureaucracy with doctors burdened with paperwork. The survey also showed doctors were retiring or reducing the amount of time spent practicing and that those who were coming into the system weren’t replacing departing doctors or were cutting back on workloads.
To attract doctors, Hunter’s research showed that in terms of recruitment, “the emphasis should be upon ensuring that a potential physician is aware of the community in which they will practice. This community, he wrote, relates to colleagues and patients and family.”
He also stated that community and family considerations are also important for doctor retention and that there were other factors at play aside from pay.
His research stated that “many physicians noted their enjoyment of practising medicine and the variety of situations encountered. They like their work and some enjoyed the thrill of uncertainty. They were keen to be challenged and were gratified at solving a problem,” his research stated. Doctors also wanted to serve in a practice with like-minded individuals “in a collegial environment. Fitting in with a group of colleagues contributed to an enjoyable… atmosphere.”
Hunter’s research also showed that “medical schools must train more physicians. It was also suggested by participants in this investigation that it is important that individuals who are trained must thoroughly understand the culture in which they will practise.”
In his summary, Hunter said in 2008, “there are no easy answers to the issues surrounding recruitment and retention of medical doctors.”
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