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British Columbia Rural Physician Programs Review

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British Columbia Rural Physician Programs Review BRITISH COLUMBIA RURAL PHYSICIAN PROGRAMS REVIEW HARBOUR PEAKS MANAGEMENT INC . FINAL REPORT March 31, 2008 Harbour Peaks Management Inc. www.harbourpeaks.com A review of British Columbia’s programs to support physicians in rural practice was conducted independently by Harbour Peaks Management Inc. to provide recommendations to the Joint Standing Committee on Rural Issues for consideration in future planning. This report was developed independently by Harbour Peaks Management Inc. with input from stakeholders, a review of programs in other provinces and analysis of the data currently available. Not all recommendations will be undertaken in the future, and any implemented may be modified. This is to be expected. As the Joint Standing Committee examines the recommendations, cost and financial analysis will be needed to assess the budget requirements and set priorities. The business case, feasibility and implementation strategy will need to be weighed for each and for the Rural Programs as a whole. Report prepared by Harbour Peaks Management Inc. March 2008-03-31 www.harbourpeaks.com Table of Contents 1. Executive Summary.......................................................................................................... 2 2. Introduction....................................................................................................................... 7 3. Findings and Recommendations....................................................................................... 9 3.1. Current Trends in the Physician Workforce.............................................................12 3.2. Overview of Cross Country Review.........................................................................14 3.3. Rural Retention Program ........................................................................................23 3.4. Isolation Allowance Fund ........................................................................................42 3.5. Northern and Isolation Travel Assistance Outreach Program..................................51 3.6. Rural GP Locum Program.......................................................................................56 3.7. Rural Specialist Locum Program.............................................................................70 3.8. Rural Continuing Medical Education Program.........................................................76 3.9. Recruitment Incentive Fund and Recruitment Contingency Fund............................83 3.10. Rural Education Action Plan ...................................................................................95 3.11. Rural Programs Funding: Year over Year Budget vs. Actual.................................109 3.12. Communication and a Rural Office for Rural Programs.........................................110 3.13. Policy Development and Planning for Rural Programs..........................................113 4. Methodology ..................................................................................................................117 5. List of Recommendations...............................................................................................120 6. References ....................................................................................................................127 Appendix A Cross Country Review......................................................................................128 A.1 Cross Country Review Summary:...........................................................................128 A.2. Approach................................................................................................................129 A.3. Breadth of Programs Compared to Other Canadian Provinces...............................129 A.4. Comparisons of Similar Programs ..........................................................................132 A.5. Defining Rural and Remote Communities...............................................................140 A.6. Concepts for Consideration in Future Program Planning by JSC............................142 A.7. Alternative Models for Organization and Administration of Programs......................143 A.8 Summary of Programs Offered, by Province...........................................................146 Appendix B Participants .......................................................................................................162 Appendix C Rural Retention Program Descriptions ..............................................................165 British Columbia Rural Physician Programs Review Page 1 1. Executive Summary A review of British Columbia’s programs to support physicians in rural practice was conducted independently by Harbour Peaks Management Inc. to provide recommendations to the Joint Standing Committee on Rural Issues for consideration in future planning. The purpose of the review was to assess the effectiveness of the Rural Programs and identify opportunities to enhance and streamline the programs. Completed in March 2008, the Rural Review examined the strengths and weaknesses of the programs, evaluated the scope of services, and provided key recommendations for improvement. The recommendations in this report were developed by Harbour Peaks Management Inc. with input from stakeholders, a review of programs in other provinces and analysis of the data currently available. Recommendations were developed for each rural program and the major factors influencing recruitment and retention. As the JSC examines the recommendations, cost and financial analysis will be needed to assess the budget requirements and set priorities. The business case, feasibility and implementation strategy will need to be weighed for each and for the Rural Programs as a whole. The Province of British Columbia and the British Columbia Medical Association continue to respond to the needs of physicians who serve rural communities. The Rural Programs that fall within the mandate of the Joint Standing Committee have been successful in encouraging and supporting physicians to reside in rural communities. The programs also make it possible for many communities to receive services on an outreach basis. In general terms, the suite of Rural Programs is targeted at recruitment, retention, support and continuing education of physicians in rural communities. In 2007/08, approximately 1,600 physicians qualified for support from the Rural Programs, of which 1,200 reside in a rural community. There is strong support and a great deal of interest by rural physicians to ensure the Rural Programs continue to evolve. While there are opportunities for refinements and enhancements, it is believed the Rural Programs have a solid foundation from which to continue to respond to the needs of rural physicians. While non-financial factors are now the strongest determinants of rural physician recruitment and retention, financial incentives still play a role in ameliorating the extra burden placed on rural and remote physicians. Several key observations were made throughout the review: • There is a need for increased focus on planning, communication and co-ordination of rural programs. In addition to planning and future policy considerations for the current financial incentive programs, non-financial factors need to be considered in the full complement of future rural programs. British Columbia Rural Physician Programs Review Page 2 • There was a general consensus that the current approach to measuring rurality was adequate but improvements were needed. The current methodology designed to measure the ruralness of a community is robust but not precise. Nonetheless, the outcomes provide a reasonable measure of ‘rurality’ for communities. • The Joint Standing Committee (JSC) is familiar with the current A, B, C, and D clustering of communities. It is suggested that, with the addition of two clusters for a total of six, it may be reasonable for the JSC to award the same fee service premiums and flat fees allocated to each cluster to all the communities within it. With the many changes that are occurring in health care, medicine and physician practice patterns, it is becoming more difficult for Health Authorities to ensure the core services of hospital-based emergency room services, community and hospital-based obstetrical services, anaesthesia services and, general surgery. The Rural Programs can be adjusted to support these services. • It is desirable that the effectiveness of each of the Rural Programs be monitored and measured using objective criteria. At this point in time there are a limited number of performance measures that could be developed and monitored, perhaps on a quarterly basis. • Stronger performance measurement is required to enable future planning. Determining whether the programs achieve their intended purpose requires a deeper, ongoing performance measurement strategy. • Ongoing Continuing Medical Education (CME) support for rural physicians is essential to maintaining the level of service required in British Columbia’s rural and remote areas. Participants in the Rural Review were consistently positive about the importance of continued medical education. • The Rural Review identified the need for programs designed to meet the CME needs of rural physicians, delivered locally and jointly designed by CME stakeholders. • Providing training customized for rural physicians as geographically close to their Health communities as is feasible would strengthen support for rural practice. • Recruitment incentives are increasingly falling short,
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