RECRUITING AND RETAINING GPS TO REMOTE AREAS IN NORTHERN NORWAY: THE SENJA 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 Northern Norway 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 Norway has 430 municipalities (4 858 200 inhabitants per 01.01.2010) 50 % of the municipalities have less than 5 000 inhabitants 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 Beautiful nature, but cold climate Rich fishery, but few jobs besides fishery and municipal posts Long distance to hospitals (3-4 hours by car) Heavy workload and long hours on call duty for GPs Professional isolation High short time temporary employment of doctors Difficult to find jobs for GPs spouses 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 Finnsnes – the centre of Lenvik municipality Gryllefjord – 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 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) Troms county and the Senja region Local office, Skaland Local office, Gryllefjord Local office, Sifjord Main office, Silsand Local office, Stonglandseidet 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) Reduced from two times a week to two times a month • Enhanced focus on life long learning Education programs for medical students, interns, residents and senior doctors • More opportunities to participate in research projects 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 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!.