Draw to Practice: A Qualitative Study Examining Factors Attracting Physicians to Rural Northern Ontario.

Introduction Physician shortages are a persisting issue in rural regions around the world, and rural Northern Ontario, Canada, is no exception. Even with significant government interventions, financial incentives, and rural-specific contracts, physician recruitment to the region remains an ongoing challenge. Refining recruitment strategies based on specific factors that attract physicians to rural practice could help address staffing shortages and, ultimately, enhance healthcare access and outcomes in rural communities. However, the draw to rural practice among physicians is poorly defined. Therefore, this study aims to bridge this knowledge gap and, in doing so, offers insight to better inform recruitment strategies for rural communities. Methodology As part of a larger qualitative study on physician retention and recruitment, semi-structured interviews were conducted with 12 physicians who had previously practiced in rural Northern Ontario communities. Interviews captured information about their individual experiences, including perspectives on factors that attracted them to establish a practice in rural Northern Ontario. Transcribed interviews were analyzed to identify recurring themes associated with the factors that affect the decision to practice in rural Northern Ontario. Results Participants described the draw to rural practice as being multifactorial and based on overlapping motivations. Key motivations described by participants could be categorized into three broad themes, including rural community connection and exposure, lifestyle and personal preferences, and career considerations. Specifically, participants emphasized the importance of pro-rural mentors and gaining firsthand experience in rural communities as important facilitators that created a connection with these areas. Interest in exploring new parts of the country, alignment with life plans, support of family, and the challenge of rural practice also played pivotal roles in the decision to pursue rural practice. Finally, the opportunity to have a broad scope of practice and serve a need in the healthcare system while receiving fair compensation within the framework of a flexible and supportive contract was also cited as a draw to practice. Conclusion The draw to rural practice is multifactorial and based on a wide array of motivations. As a result, recruitment strategies should move beyond single-pronged approaches and recognize the need to design strategies that address the multifaceted motivations and considerations that drive physicians towards rural practice. Designing and implementing recruitment approaches that consider the diverse factors influencing physicians interest in rural career paths is likely to enhance recruitment initiatives and more effectively address shortage of physicians in the region.

Northern Ontario's Rural Physician Teams: Who, why and for how long.

Introduction: This study examines the state of Rural and Northern Physician Group Agreement (RNPGA) physician teams in rural Northern Ontario in terms of demographics, intent to stay, length of stay, number of physicians relative to the RNPGA-designated complement and perceptions of various workplace and community factors. Materials and Methods: Data were based on a survey mailed, in 2018, to Ontario physicians in RNPGA communities having a designated complement of 2 or more physicians. Physicians reported on aspects of the work environment, community and intentions to stay. Results: Sixty-five percent of all practices and 91.7% of those with a designated complement of 2 physicians were at or above their government-designated complement. Intent to stay was higher in groups below complement. The mean length of stay was 11.3 years. More physicians were male (58.7%). Older physicians were more represented in smaller practice groups. Physicians reported positive ratings on several aspects of their work environment, community and intentions to stay. Length of stay in the community was related to strong family ties and was a predictor of intent to stay. Many physicians had neither strong family ties (65.3%) nor a rural upbringing (57.3%). Conclusion: The results show positive outcomes in terms of: high intentions to stay, satisfaction with workplace and community factors, and full recruitment into RNPGA groups designated for a complement of two physicians. Further research is needed to understand the role of family ties to length of stay, and the role of level of physician complement and group size in retention and recruitment.

Résumé Introduction: Cette étude examine l'état des équipes de médecins de l'Entente relative au groupe de médecins en milieu rural et dans le Nord (EGMMRN) dans les régions rurales du Nord de l'Ontario en termes de données démographiques, d'intention de rester, de durée, de nombre de médecins par rapport à l'effectif désigné par l'EGMMRN, ainsi que de perceptions de divers facteurs liés au milieu de travail et à la communauté. Méthodes: Les données sont fondées sur un sondage envoyé par courrier en 2018 aux médecins de l'Ontario dans les communautés associées à l'EGMMRN ayant un effectif désigné de 2 médecins ou plus. Les médecins ont fait état des aspects du milieu de travail, de la communauté et de leurs intentions de rester. Résultats: Soixante-cinq pour cent de tous les cabinets et 91,7% de ceux dont l'effectif désigné est de 2 médecins se situaient au niveau ou au-dessus de leur effectif désigné par le gouvernement. L'intention de rester était plus élevée dans les groupes en dessous de l'effectif. La durée moyenne de présence était de 11,3 ans. Plus de médecins étaient des hommes (58,7%). Les médecins plus âgés étaient plus représentés dans les petits groupes de pratique. Les médecins ont attribué des notes positives à plusieurs aspects de leur environnement de travail, de leur communauté et de leur intention de rester. La durée de présence dans la communauté était liée à des liens familiaux forts et constituait un facteur prédictif de l'intention de rester. De nombreux médecins n'avaient ni des liens familiaux forts (65,3%) ni une éducation en milieu rural (57,3%). Conclusion: Les conclusions montrent des résultats positifs en termes d'intentions élevées de rester, de satisfaction à l'égard du lieu de travail et des facteurs communautaires, ainsi qu'un recrutement complet dans les groupes désignés de l'EGMMRN pour un effectif de 2 médecins. D'autres recherches sont nécessaires pour mieux comprendre le rôle des liens familiaux sur la durée de présence, ainsi que le rôle du niveau d'effectif de médecins et de la taille du groupe en matière de rétention et de recrutement. Mots-clés: Recrutement, rétention, rural.

Teams of rural physicians matter: Testing a framework of team effectiveness.

OBJECTIVE: To examine how rural physician team effectiveness predicts outcomes of team performance, team commitment, and intentions to stay. DESIGN: Surveys measuring team climate, team efficacy, and team performance were sent to rural physician team members. Surveys measuring team performance were sent to external observers in supervisory positions. SETTING: Northern Ontario communities. PARTICIPANTS: Rural physicians and external observers, the latter including hospital chief executive officers, family health team executive directors, and clinic managers. MAIN OUTCOMES MEASURES: Total scale scores were generated using mean substitution. Cronbach α was used to assess internal consistencies of team member-level measures. Team-level measures were created by averaging the responses across team members, and intraclass correlation coefficients for each scale of each team of 2 or more members were calculated to yield a measure of rating consistency. A t test was used to assess the possible difference between team performance ratings by team members and external observers. Team-level relationships within the team effectiveness model were assessed using mediated regression, and generalized estimating equations were used to assess the relationships in the model between team-level (team efficacy) and individual-level (affective team commitment and intentions to stay) variables to address the nonindependence of these data. RESULTS: Overall, 70 rural physicians from 26 Rural and Northern Physician Group Agreement communities with 2 or more physicians and 25 external observers from 19 of the 26 Rural and Northern Physician Group Agreement communities participated in the study. The findings showed that team climate (composed of decision making, communication, and conflict resolution measures) positively predicted team efficacy, which in turn positively predicted team performance. This fully mediated set of relationships held whether team performance was rated by the physicians themselves or by the external observers. Team efficacy significantly predicted affective team commitment (b value=0.69, standard error=0.08, Wald =13.89, P<.001) in the first analysis and intentions to stay (b value=0.34, standard error=0.15; Wald =5.42, P=.020) in the second analysis. However, when the other variables impacting physician retention were added to the model in predicting intentions to stay, team efficacy did not predict it above and beyond these additional predictors. CONCLUSION: The findings support initiatives that attempt to enhance physician team effectiveness in rural physician teams by influencing team decision making, communication, and conflict resolution to improve team performance, physician attitudes, and commitment.