Commentary: Dr. Roger Strasser


Roger Strasser
Founding Dean, Northern
Ontario School of Medicine

Many years ago, people used to say rural doctors were one of three things: missionaries, mercenaries or mad men.
Missionaries were on a crusade to change the community to match their own world view.
Mercenaries were drawn to rural medicine by the financial incentives.
And mad men were eccentrics, who, due to personality characteristics, were unable to secure work in the city where medicine “really happens.”
I hope it goes without saying this notion is absurd. (After all, I’m a rural physician—surely, I don’t fit into any of those categories… although my wife may disagree about the last one).
In my time as dean of the Northern Ontario School of Medicine (NOSM), I am glad to say that I’ve seen these notions changed.
Many highly sought-after accolades have been awarded to NOSM faculty members. Our faculty are completing innovative research projects to provide better care for their patients and push medical knowledge, all while educating the next generation of health professionals.
Since 2011, more than 160 NOSM-trained family physicians have begun practising in the North.
This translates to better access to care for more than 190,000 Northern Ontarians—approximately 20 per cent of the population of our region.
Of the NOSM-trained physicians who have done both their MD and residency at NOSM, 94 per cent choose to practise in the North, with 33 per cent choosing to practise in rural and remote communities.
Reading this might give you one of two reactions. You might think, “Wow, that’s great news. I’m glad our community has more health professionals to provide health care to me and my family.”
But, if you live in a community that continues to struggle recruiting health professionals, I suspect you may think, “That must be nice for those communities, but we haven’t seen those benefits. Has NOSM forgotten about us?”
We have not forgotten about you. Just because graduates are now entering practice in the North, it doesn’t mean that our work at NOSM is done.
In years gone by, many physicians chose to work much more than a regular work week—commonly 80-hour weeks. Patients of those physicians are aging, and require more complex care. It is simply not feasible for graduates to provide care for this ever-increasing need. So, as physicians retire, each one is being replaced by two or more recent graduates.
In addition, physicians are being expected to take on new roles beyond clinical service like clinical lead roles with the LHINs and, of course, academic (research and education) roles with NOSM.
Not only this, but recruiting a doctor is about the whole family. Physicians and their families need to feel at home in a community. Spouses need jobs, and children need recreational activities and educational opportunities. If a physician’s family isn’t happy, they won’t stay in a community for long.
So, what’s the answer?
There are many things that NOSM can and has done.
Knowing that health professionals need to feel at home in their communities, we partner with more than 90 communities across the North where learners live and receive hands-on education, so that they can get to know the community and hopefully see themselves practising there.
We also select medical students who have ties to Northern Ontario and who know the North and want to stay.
We help our learners build professional networks in the North, so they feel comfortable practising independently in our context.
But there are also many recruitment factors that are outside of NOSM’s current education and research activities.
That’s why, in 2018, NOSM is hosting a Health Human Resources Summit. The summit will address the continuing struggle many communities face in recruiting and retaining health-care professionals.
We will bring together everyone with a role to play, and brainstorm what we can do collectively to improve recruitment in the North toward an action plan to assure health services for all Northern Ontario communities.
So, to all those communities feeling left out of the success in recruiting health professionals: we hear you.
Though we are not missionaries, NOSM is most certainly on a crusade to make shortages of health professionals in your communities a thing of the past. n

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