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Community has role to play in attracting, keeping doctors

Another physician is set to arrive in Creston in the early summer.
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Small communities across the country are in a dire battle to attract and keep physicians, but the Creston Valley has created a model that has seen seven physicians make a permanent home here in the last seven years.

Marilin States, who works as a recruiter for the Creston Valley Health Working Group, said last week that another physician is set to arrive in Creston in the early summer. She will be coming on a two-year commitment, and States said the community itself has a lot to do with making the Creston Valley an appealing place for physicians to put down stakes here.

“One of the ways to both recruit and retain physicians is to appreciate them for what they do,” she said. “The best possible outcome is akin to the ‘You catch more flies with honey than vinegar’ adage.”

While there are those that think a drop-in clinic should be a goal, States, with her long career in nursing and health administration, said what looks like a simple solution often isn’t the answer.

She said it is important to understand that physicians in Creston each fill a number of roles.

“Each physician in Creston provides services in multiple venues,” she said. “Doctors care for their patients within the clinic they work, as well as dealing with urgent needs of other patients within that clinic as they are able. They cover the hospital’s emergency department on an equitable rotating basis; they admit, assess and treat hospitalized patients until discharge; they provide services to their long term care patients at Swan Valley Lodge and similar care facilities; and they immediately assist as needed when called upon by their colleagues for extenuating critical circumstances at the hospital.

“In addition, several of our physicians cover specialty services such as anaesthetic, surgical, and/or obstetrical.”

Another common misconception is that newly arriving physicians simply assume their predecessor’s patient list. No so.

“A newly arrived physician often, guided by the practice of the clinic to which he or she has joined, will go through a process of interviewing and accepting patients that apply. This is usually done in a gradual way, so as to give the patient the best possible care, and also not to overwhelm the newly arrived physician. In this way a rapport can be developed and the physician can carefully ‘learn’ the history and care of the patient and discuss their treatment plan. This takes time, and therefore their practice builds slowly over time.”

New arrivals have a number of decisions to make before they begin their practice. Doctors generally like to practice in a group setting. This means that they have colleagues close at hand to review challenging cases, as well as someone within the practice to provide coverage in instances of sudden illness and other unforeseen circumstances.

While there may be physical space in any particular clinic, it is important that there is a collegial atmosphere to maintain retention. So while there may be an office space in a clinic within a town, it has to be a good fit for the incoming physician, and there must be services available to support a physician. Physicians who prefer to work alone must also hire their own staff, purchase equipment, establish their own office systems and more.

“It is the responsibility of each clinic, when a new doctor arrives, to determine how they will manage the intake for new patients. This is not something that is in the hands of anyone other than the clinic itself in collaboration with the incoming physician. Generally speaking, the Town of Creston will provide a welcoming announcement of a newly arriving physician. Following with the clinic providing an announcement in the Creston Valley Advance ahead of the intake as to the process to be followed. It is imperative that persons without a physician (whether new into town or residents without a current local family doctor) act quickly, following the process outlined.”

Full-time, permanent physicians are only part of the equation for a well-served community. Under the direction of the Health Working Group, which is funded by the Town of Creston and RDCK Areas B and C, States has also worked to recruit what has been a large number of short term and long term (up to two years) locums, who provide relief for physicians on vacation or planned absences.

In addition, Creston Valley residents benefit from the local association with the UBC Resident Training program, in which local physicians provide opportunities for “physicians of the future” to learn within our rural setting.

“These physicians have several times returned as locums,” States said. “Many of them have already determined the next steps for their own practice, with some joining the Rural Locum group which provides rotating physicians to underserved communities. Others choose to work in the Lower Mainland where they provide only clinic medicine without ER call or inpatient coverage. We are very fortunate to have recruited and retained physicians who wish to provide full patient care including clinic, ER, inpatient, and long term patient coverage.”

Newer physicians recruited by the Health Working Group have often commented on the collegiality of local doctors, and the encouragement they get to seek a sustainable work/life balance.

“There was a time when physicians had a larger patient load and worked all hours until they completely burned out. It has been learned over time that this is not sustainable. Work/life balance is very important. Physicians have families. They are active in the community. To retain physicians it is critical that we appreciate that they are here, and offer the level of service they are comfortable and able to provide.”

Mayor Ron Toyota, who has been part of the Creston Valley Health Working Group since he was first elected, says the local program has worked beyond his expectations.

“In my ten years as mayor, there are few aspects of my job that I am more proud of. In addition to bringing seven permanent physicians to Creston since Marilin States has been our recruiter, the active recruitment for more physicians continues, and Creston is seen widely as being the ‘benchmark community’ for successful recruitment and retention of physicians. Our recruiter is frequently contacted by other communities to find out what our ‘recipe’ is for our successes.”