1. Recruiting Medical Students and Residents Dr. Cathy MacLean CASPR April 25, 2016

2. Disclosure of Commercial Support No relationship with Commercial Interest: Faculty member at MUN CFPC Committees: Patient Education (Chair), FMF, Patients’ Medical Home No current pharma or industry support NL/NLMA CSF funding support/ CIHR Family Medicine

3. Objectives Participants will be able to: 1.Describe current challenges in the recruitment of medical students and residents and possible solutions 2.Engage in effective strategies for connecting with faculty, medical students and residents 3.Discuss a future collaborative model of recruitment that betters meets societal needs. Family Medicine

4. Review of the Literature on Recruitment of Students and Residents Family Medicine

5. Current Challenges – Medical Students Developmental/ life cycle challenges and generational differences Career choice is still individually driven often without knowledge of societal needs Systems issues – no solid PHR planning nationally and sometimes provincially Timing – medical education imperative overrides future careers considerations

6. Challenges continued Visibility of recruiters in medical schools Access of recruiters to students Hidden Curriculum influences Knowledge of where students come from linked to where they might want to go Lack of research Conflicting needs of potential pools – CMG, IMG, CSA

7. Solutions Co-locate recruiters in Student Affairs/UGME – where the students are – a “liaison” Link with researchers Link with student interest groups – FMIG, RMIG, specialty interest groups Communicating physician resource plans and projections

8. Solutions Career counselling – accreditation requirement Advocacy – using popular media Use Social Media Recruiters need to know about social accountability mandate of Med Schools Explore relationships between CASPR and CFMS

9. Family Medicine Family Medicine Training at MUN and Recruitment and Retention in NL YOU ARE NEEDED! Cathy MacLean Discipline of Family Medicine, November, 2015

10. Specialties with employment challenges Anaesthesiology ENT Hematology Orthopedics Obs /Gyne Radiation Oncology Neurosurgery Hematological Pathology Nuclear Medicine Plastic Surgery Urology Gastroenterology Cardiac Surgery RCPSC Physician Employment Summit 2015

11. Transition from Medical School to Residency - Facilitators and barriers to contact How to keep track of med students when they leave a province in the hopes that you might recruit them back when they finish residency Family Medicine References

12. Current Challenges - Residents Inadequate interest in FM as a career choice overall 2 year FM residency is a short time to do a residency and look for positions Locum focus Access – privacy and confidentiality but also tracking is a challenge due to rotations and moving in DME models

13. New Triple C Family Medicine Training in Canada The old curriculum The “suitcase” residency Time based rotations Not needs based “A rolling stone gathers no moss” The new curriculum Have a home base Regionally trained in longitudinal blocks Relationship and continuity based Competency based “Putting down roots” NEW

14. Social Accountability of Medical Schools AFMC FMEC projects UG and PG “Ensure the right mix, distribution and numbers of physicians to meet societal need.” Family Medicine References

15. Right mix and distribution of physicians Social accountability Create positive and supportive learning/work environments Competency based approach with appropriate assessment systems Education continuum that is integrated and manages transitions Develop and support teachers Leadership development Improve PGME governance and align accreditation standards U of S Family Medicine Faculty Development March 2016 15

16. Can MEDS – Family Medicine “ CanMEDS-Family Medicine’s purpose is to guide curriculum and to form the basis for the design and accreditation of residency programs. Its ultimate goals is to improve patient care and to ensure that postgraduate training programs in family medicine are responsive to societal needs.” U of S Family Medicine Faculty Development March 2016 16 CanMEDS-Family Medicine, CFPC Working Group on Curriculum Review, Oct. 2009

17. FM Training in Canada There are 1,395 first year entry positions for family medicine in Canada There are on average 1,200 graduates from FM training programs per year ES programs = plus one programs = 3 rd year programs - additional training

18. Residency - Solutions FM Triple C competency based curriculum - less movement in residency; more longitudinal blocks Distributed Medical Education Relationship with RDocs and regional PHOs Regional meet and greets/ job fairs PGME and PG directors/chief residents

19. U of S Family Medicine Faculty Development March 2016 The Patient’s Medical Home Family Medicine

20. New Models “Every system is perfectly designed to get exactly the results it gets.” Donald Berwick MD So let’s think differently…

21. Enhanced Skills programs in FM – Certificates of Added Competency are available in: Care of the Elderly Emergency Medicine Palliative Care FP Anaesthesia Sports and exercise medicine

22. CFPC Communities of Practice Addiction Medicine Family Practice Anesthesia Cancer Care Child and Adolescent Health Chronic Pain Dermatology Developmental Disabilities Enhanced Skills Surgery Global Health/Care of Underserved Populations Hospital Medicine Maternity and Newborn Care Mental Health Occupational Medicine Prison Health Respiratory Medicine

23. Rural Recruitment Family Medicine

24. Rural and Remote R & R Mythbusters “ INTERNATIONAL MEDICAL GRADUATES ARE THE SOLUTION TO THE DOCTOR SHORTAGE IN UNDERSERVICED AREAS” Canadian Foundation for Healthcare Improvement, May, 2013. Focus has to be on retention in rural areas and recruiting students from rural areas into medical school and then recruiting them back. They are more likely to stay. Retention is the key. Collegial groups are critical to success.

25. There are now about 160 rural training sites for FM in CaRMS 85% of medical care in Canada are met in primary care by Family Physicians 50/50 targets There are millions of visits to FP’s Rural FM Training in Canada

26. The Role of the “Physician Recruiter” As a physician, this is not about “bums in seats” It is about fit, collegiality, continuity, and quality of care Working together collaboratively and not taking over or crossing boundaries When possible – think to recruit GROUPs and not individuals Remember retention - nurture Family Medicine

27. The Role of the “Physician Recruiter” Role of remuneration versus other factors – family, collegiality, lifestyle Partners a key focus Succession planning needs to be considered allowing for mentoring and appropriate overlap Family Medicine References

28. Blowing up the Booth Family Medicine References

29. The Role of the Faculty Must know local /provincial needs Need to understand R & R role Need to be collaborative to meet societal needs Should get to know recruiters and understand we play a role Can give recruiters air time with students and residents We need to be open to new models & IPE Family Medicine

30. The Role of the Community as Recruiter Need to be involved in recruitment and retention of MD’s Positive and realistic approach Need to understand what they ask for Do what they can to welcome MD and families and help them get involved Need to be open to new models of care Family Medicine

31. The Role of the Province/ Provincial Recruiters and Health Human Resource Planning Fully understand Supply and Demand Create realistic Projections Have a plan Manage Carms positions Funding incentives Avoid creating negative PC messages Family Medicine

32. Nurturing the right soil conditions Recognize the drivers for change Support new models at the practice level Show how recruits can make a difference Link training, healthcare redesign and recruitment Collegiality one of the key factors for both R&R

33. Relationships Family Medicine

34. CASPR CASPR should be creating a relationship with Resident Doctors of Canada and with CFMS CMA practice management programs PHO’s organizations provincially Nurturing Collaborations Connecting the dots nationally Supporting more research Family Medicine References

35. Research/Data CAPER PG training program tracking CMA/ PT MA Provincial databases …..

36. Useful Links http://www.cfpc.ca/triple_C/ http://www.cfpc.ca/A_Vision_for_Canada/ http://patientsmedicalhome.ca/ http://www.cfpc.ca/FTA/ http://www.cfpc.ca/ARFM_document_Jan18_2016/ http://www.cfpc.ca/uploadedFiles/Education/CanM eds%20FM%20Eng.pdfhttp://www.cfpc.ca/uploadedFiles/Education/CanM eds%20FM%20Eng.pdf http://www.royalcollege.ca/portal/page/portal/rc/ca nmedshttp://www.royalcollege.ca/portal/page/portal/rc/ca nmeds https://www.afmc.ca/future-of-medical-education- in-canada/postgraduate- project/pdf/FMEC_PG_Final-Report_EN.pdfhttps://www.afmc.ca/future-of-medical-education- in-canada/postgraduate- project/pdf/FMEC_PG_Final-Report_EN.pdf U of S Family Medicine Faculty Development March 2016 36

37. Summary There are challenges and solutions for recruiting medical students and residents There are roles at all levels – community, recruiters RHA/Provincial & CASPR PHR planning is needed and links made between medical education outputs and societal needs We need better data and more research We need to nurture relationships! Family Medicine

38. Thanks! Cathy MacLean cmaclean@mun.ca

39. Family Medicine U of S Family Medicine Faculty Development March 2016 39 References Brodenheimer, T and Sinsky, C. From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider. Annals of Family Medicine 12(6) 573-575, Nov/Dec, 2014. Frank, J. R., & Snell, L. (2015). CanMEDS 2015 Physician Competency Framework- Series I. Ottawa: The Royal College of Physicians and Surgeons of Canada. The Association of Faculties of Medicine of Canada. The Future of Medical Education in Canada (FMEC): A Collective Vision for MD Education. Ottawa: The Association of Faculties of Medicine of Canada; 2010. The College of Family Physicians of Canada. (1999). Postgraduate Education for Rural Family Practice - Vision and Recommendations for the New Millenium. Ottawa: The College of Family Physicians of Canada. The College of Family Physicians of Canada. (2009). CanMEDS-Family Medicine. Working Group on Curriculum Review. The College of Family Physicians of Canada. The College of Family Physicians of Canada. (2011).Triple C Competency-based Curriculum. The College of Family Physicians of Canada. The College of Family Physicians of Canada. (2011). A Vision For Canada. Family Practice: The Patient's Medical Home. Ottawa: The College of Family Physicians of Canada. The Future of Medical Education in Canada. (2012). A Collective Vision for Postgraduate Medical Education in Canada. The Future of Medical Education in Canada. Ogle, K et al. Family Medicine in 2018. Can Fam Physician. 2010 Apr; 56(4): 313– 315. Mythbusters on IMGs for Underserved areas, CFHI, May, 2013 39