RECRUITING AND RETAINING GPS TO REMOTE AREAS IN NORTHERN :

THE DOCTOR PROJECT

WONCA 2010, Cancun, Mexico

Area: Community Health Planning and Policy Development

Author: Svein Steinert, Director, MD, MPH National Centre of Rural Medicine (NCRM) UiT, NORWAY NCRM - a national centre of competence from 2007

Objectives: • Promote research, education and network building among health care professionals in rural areas

• Create a bridge between practical medicine and academia

• Contribute to recruiting and retaining health care professionals in rural areas Area 113 000 km² - 34 % Inhabitants 464 649 - 9 %

Anchorage RUSSIA

Winnipeg Senja – a typical rural area in Northern Norway

Troms county and the Senja region Some key elements in the Norwegian health care system

• The central government is responsible for specialized health care (hospitals)

• The municipalities are responsible for primary health care, including GP services

ƒ Norway has 430 municipalities (4 858 200 inhabitants per 01.01.2010)

ƒ 50 % of the municipalities have less than 5 000 inhabitants

ƒ Most of the small municipalities are located in rural areas The Senja doctor project - Background

• Recruiting and retaining GPs to the Senja region has been increasingly difficult for decades • Some characteristics for the Senja region ƒ Beautiful nature, but cold climate ƒ Rich fishery, but few jobs besides fishery and municipal posts ƒ Long distance to hospitals (3-4 hours by car) ƒ Heavy workload and long hours on call duty for GPs ƒ Professional isolation ƒ High short time temporary employment of doctors ƒ Difficult to find jobs for GPs spouses ƒ Depopulated area with an elderly population Population in the Senja municipalities Source: National statistics, 2009

Municipality Population Population Change April 1999 April 2009

Berg 1 119 929 - 17.0 %

Lenvik 11 018 11 258 + 2.1 %

Torsken 1 171 908 - 22.5 %

Tranøy 1 684 1 527 - 9.3 % Senja – expenditure to GP services

Total expenditure Municipality on GP services per capita/year (2007)

Berg 405 USD

Lenvik 168 USD

Torsken 363 USD

Tranøy 274 USD – the centre of Lenvik municipality – the centre of Torsken municipality Retaining problems in Torsken

Hans Peder Pedersen, mayor in 2007: y ”In Torsken municipality we have seen 73 different GPs over the last 10 years! y We are not able to deliver GP services of sufficient quality, we need help and want to be part of an inter- municipal health collaboration project” Key elements in the Senja doctor project

• Develop a collaborative model for GP services in the four Senja municipalities where Lenvik is responsible for daily operation of services (host model)

• Establish a new main GP office near Finnsnes ƒ 4 GPs, 2 interns, nurses and administrative staff

• Develop new working shifts where doctors and staff are responsible for serving the main office 5 days a week, and the local medical offices and remote nursing homes 2 days a week

• Establish a new emergency unit with 18 000 people in the catchment area (4 + 2 municipalities) county and the Senja region Local office,

Local office, Gryllefjord

Local office, Sifjord Main office,

Local office, Positive recruiting and retaining factors

• Enhanced professional networking • Driving by car to remote areas within normal working hours • Few patients listed per GP (less workload) • Fixed salary (predictable income) • Less out of hours work (more time with family and friends) ƒ Reduced from two times a week to two times a month • Enhanced focus on life long learning ƒ Education programs for medical students, interns, residents and senior doctors • More opportunities to participate in research projects ƒ 3 months a year for one doctor Preliminary results

• February 2007: Start of the project • December 2008: Recommendations from the working groups • March 2009: All four municipal councils gave support to “the Senja doctor plan” • April 2009: A new emergency unit for six municipalities was opened • June 2009: Four of ten GP applicants signed a job contract, two with GP specialist qualifications and two residents • August 2009: A new main GP office close to Finnsnes was officially opened • September 2009: Lenvik municipality was given the responsibility of all GP services in the Senja region – the new working program started Elements of success

• A bottom-up process • The population wanted change • Collaboration with local health care professionals • The municipalities had positive experiences from other joint projects • Support from local and central health authorities ƒ The Senja doctor project is also an important collaboration model in the new national interaction reform • Focus on quality of care - not on saving money! Challenges

• Municipal collaboration projects are fragile • Economy is always difficult • Instability in the municipal administrations challenges the need for collaboration projects

• Will the stability among physicians increase? • What about the other health care professionals? • What about quality of care?

• There is a need for further evaluation Thank you for your attention!