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Canadian Journal of Public Health

, Volume 101, Issue 1, pp 79–82 | Cite as

Physician Retention in Rural Alberta: Key Community Factors

  • Pamela J. Cameron
  • David C. Este
  • Catherine A. Worthington
Qualitative Research 2008 Student Award Winner

Abstract

Objectives

As part of a larger case study exploring physician retention factors and strategies employed by rural communities, the objective of this analysis was to explore the community factors that promoted physician retention.

Methods

A qualitative, collective case study design was employed to study four rural communities (cases) in Alberta that retained family physicians for four years or longer. Participants included physicians, staff members, spouses and community members (all were patients from the communities studied). Communities were selected through a retention-specific matrix; each quadrant represented a particular community typology. Case data collected from interviews, documents and observations were analyzed, and similarities and differences among cases were assessed.

Results

A range of community factors that could influence physicians’ decisions to stay in a particular community were described by participants. Four themes, Appreciation, Connection, Active Support and Physical/Recreational Assets, were positively related to physician retention in the four communities studied. These community factors existed to different degrees but were present in all communities. Reciprocity was a fifth factor that emerged in three of the four communities studied.

Conclusion

Physicians, policy-makers, community members and health care professionals are encouraged to consider the community domain when planning and implementing strategies to retain rural physicians and other health care professionals. The four communities studied were able to promote retention of their primary care physicians by showing appreciation to them, building connections with them and their families, actively supporting their physicians and local health facilities, maintaining and improving local physical/recreational amenities, and nurturing reciprocal rapport with physicians.

Keywords

Physician; retention; community; rural health services; case study 

Résumé

Objectifs

Dans le cadre d’une vaste étude de cas sur les facteurs et les stratégies de fidélisation des médecins en milieu rural, nous avons voulu analyser les facteurs communautaires qui favorisent le maintien en poste de ces médecins.

Méthode

Nous avons mené une étude qualitative et collective dans quatre communautés rurales de l’Alberta (les « cas ») ayant conservé leurs médecins de famille quatre ans et plus. Les participants étaient des médecins, des membres du personnel, des conjoints et des résidents (tous des patients des communautés à l’étude). Les communautés ont été choisies selon une matrice portant spécifiquement sur la fidélisation; chaque quadrant représentait une typologie communautaire particulière. Nous avons recueilli les données au moyen d’entretiens, de documents et d’observations, analysé ces données, puis évalué les similitudes et les différences entre les cas.

Résultats

Les participants ont cité divers facteurs communautaires ayant pu influencer la décision des médecins de rester dans une communauté donnée. Quatre thèmes (appréciation, relations, soutien actif et équipements physiques/récréatifs) étaient positivement liés à la fidélisation des médecins dans les quatre communautés étudiées. Ces facteurs étaient présents à différents degrés dans toutes les communautés. Un cinquième facteur, la réciprocité, était présent dans trois des quatre communautés.

Conclusion

Nous encourageons les médecins, les stratèges, les résidents et les professionnels de la santé à tenir compte de l’aspect communautaire lorsqu’ils planifient et mettent en œuvre des stratégies pour fidéliser les médecins et autres professionnels de la santé en milieu rural. Les quatre communautés à l’étude ont réussi à fidéliser leurs médecins de premier recours en leur montrant leur appréciation, en tissant des relations avec eux et leurs familles, en appuyant activement leurs médecins et leurs établissements de santé locaux, en entretenant et en améliorant les équipements physiques et récréatifs locaux et en entretenant des rapports de réciprocité avec les médecins.

Motsclés

médecin; fidélisation; communauté; service santé milieu rural; études de cas 

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References

  1. 1.
    Ministerial Advisory Council on Rural Health. Rural Health in Rural Hands: Strategic Directions for Rural, Remote, Northern and Aboriginal Communities. Ottawa, ON: Ministerial Advisory Council on Rural Health, Health Canada, 2002;1–10.Google Scholar
  2. 2.
    Hays R, Wynd S, Veitch C, Crossland L. Getting the balance right? GPs who chose to stay in rural practice. Aust J Rural Health 2003;11(4):193–98.PubMedCrossRefGoogle Scholar
  3. 3.
    Pathman DE, Konrad TR, Dann R, Koch G. Retention of primary care physicians in rural health professional shortage areas. Am J Public Health 2004;94(10):1723–29.PubMedPubMedCentralCrossRefGoogle Scholar
  4. 4.
    Richards HM, Farmer J, Selvaraj S. Sustaining the rural primary healthcare workforce: Survey of healthcare professionals in the Scottish Highlands. Rural Remote Health 2005;5(1):365.PubMedGoogle Scholar
  5. 5.
    Romanow RJ. Building on Values: The Future of Health Care in Canada - Final Report. Ottawa: Commission on the Future of Health Care in Canada, 2002.Google Scholar
  6. 6.
    Pitblado RJ, Pong RW, Irvine A, Nagarajan KV, Sahai V, Zelmer J, et al. Assessing rural health: Toward developing health indicators for rural Canada. Sudbury, ON: Centre for Rural and Northern Health Research, Laurentian University, 1999.Google Scholar
  7. 7.
    Statistics Canada. Portrait of the Canadian Population in 2006: Subprovincial Population Dynamics. 2008. Available at: https://doi.org/www12.statcan.ca/census-recensement/2006/as-sa/97-550/p11-eng.cfm. (Accessed February 3, 2008).Google Scholar
  8. 8.
    du Plessis V, Beshiri R, Bollman RD, Clemenson H. Definitions of rural. Rural Small Town Canada Analysis Bull 2001;3(3):1–13.Google Scholar
  9. 9.
    Buske LM, Yager SN, Adams OB, Marcus L, Lefebvre FA. Rural Community Development Tools from the Medical Perspective: A National Framework of Rurality and Projections of Physician Workforce Supply in Rural and Remote Areas of Canada. Report to Health Canada. 1999.Google Scholar
  10. 10.
    National Physician Survey. Canadian Medical Association. 2007. Available at: https://doi.org/www.nationalphysiciansurvey.ca (Accessed March 28, 2008).Google Scholar
  11. 11.
    Pong RW, Pitblado RJ. Geographic distribution of physicians in Canada: Beyond how many and where. Ottawa: Canadian Institute for Health Information, 2005.Google Scholar
  12. 12.
    Williams AM, Cutchin MP. The rural context of health care provision. J Interprofessional Care 2002;16(2):107–15.CrossRefGoogle Scholar
  13. 13.
    Gil-Soo H, Humphreys JS. Integration and retention of international medical graduates in rural communities: A typological analysis. J Sociol 2006;42(2):189.CrossRefGoogle Scholar
  14. 14.
    Williams ES, Konrad TR, Scheckler WE, Pathman DE, Linzer M, McMurray JE, et al. Understanding physicians’ intentions to withdraw from practice: The role of job satisfaction, job stress, mental and physical health. Health Care Manage Rev 2001;26(1):7–19.PubMedCrossRefGoogle Scholar
  15. 15.
    Wade ME, Brokaw JJ, Zollinger TW, Wilson JS, Springer JR, Deal DW, et al. Influence of hometown on family practitioner’s choice to practice in rural settings. J Family Med 2007;49(4):246–52.Google Scholar
  16. 16.
    Pope ASA, Grams GD, Whiteside CBC, Kazanjian A. Retention of rural physicians: Tipping the decision-making scales. Can J Rural Med 1998;3(4):209–16.Google Scholar
  17. 17.
    Cameron PJ. Physician Retention in Four Rural Communities in Alberta: A Collective Case Study. Calgary, AB: University of Calgary, 2008.Google Scholar
  18. 18.
    Yin RK. Case Study Research: Design and Methods, 3rd ed. Thousand Oaks, CA: Sage Publications, 2003.Google Scholar
  19. 19.
    Stake RE. The Art of Case Study Research. Thousand Oaks: Sage Publications, 1995.Google Scholar
  20. 20.
    Kamien M. Staying in or leaving rural practice: 1996 outcomes of rural doctors’ 1986 intentions. Med J Aust 1998;169(6):318–21.PubMedGoogle Scholar
  21. 21.
    West PA, Norris TE, Gore EJ, Baldwin LM, Hart LG. The geographic and temporal patterns of residency-trained family physicians: University of Washington Family Practice Residency Network. J Am Board Fam Pract 1996;9(2):100–8.PubMedGoogle Scholar
  22. 22.
    Patton MQ. Qualitative Research and Evaluation Methods, 3rd ed. Thousand Oaks: Sage Publications, 2002.Google Scholar
  23. 23.
    Miles MB, Huberman AM. Qualitative Data Analysis: An Expanded Sourcebook, 2nd ed. Thousand Oaks, CA: Sage Publications, 1994.Google Scholar
  24. 24.
    Merriam SB. Qualitative Research and Case Study Applications in Education, 2nd ed. San Francisco, CA: Jossey-Bass Publishers, 1998.Google Scholar
  25. 25.
    Thommasen HV, Berkowitz J, Gryzbowski S. Community factors associated with long-term physician retention. BC Med J 2000;42(9):426–29.Google Scholar
  26. 26.
    Backer EL, McIlvain HE, Paulman PM, Ramaekers RC. The characteristics of successful family physicians in rural Nebraska: A qualitative study of physician interviews. J Rural Health 2006;22(2):189–91.PubMedCrossRefGoogle Scholar
  27. 27.
    MacIsaac P, Snowdon T, Thompson R, Crossland L, Veitch C. General practitioners leaving rural practice in Western Victoria. Aust J Rural Health 2000;8(2):68–72.PubMedCrossRefGoogle Scholar
  28. 28.
    Phillips DM, Dunlap PG. Physician recruitment and retention. National Rural Health Association. 1998. Available at: https://doi.org/www.nrharural.org/dc/issuepapers/ipaper13.html (Accessed March 28, 2008).Google Scholar
  29. 29.
    C.A. MacDonald & Associates. Physician retention in rural Alberta: An update of pockets of good news (1994). Prepared for the Rural Physician Action Plan, Edmonton, AB, 2002.Google Scholar
  30. 30.
    Pathman DE, Steiner BD, Jones BD, Konrad TR. Preparing and retaining rural physicians through medical education. Acad Med 1999;74(7):810–20.PubMedCrossRefGoogle Scholar
  31. 31.
    Gardiner M, Sexton R, Durbridge M, Garrard K. The role of psychological well-being in retaining rural general practitioners. Aust J Rural Health 2005;13(3):149–55.PubMedCrossRefGoogle Scholar
  32. 32.
    Jones JA, Humphreys JS, Adena MA. Rural GPs’ ratings of initiatives designed to improve rural medical workforce recruitment and retention. Rural Remote Health 2004;4(3):314.PubMedGoogle Scholar
  33. 33.
    Rabinowitz HK, Diamond JJ, Markham FW, Rabinowitz C. Long-term retention of graduates from a program to increase the supply of rural family physicians. Acad Med 2005;80(8):728–32.PubMedCrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2010

Authors and Affiliations

  • Pamela J. Cameron
    • 1
  • David C. Este
    • 1
  • Catherine A. Worthington
    • 1
  1. 1.Faculty of Social WorkUniversity of CalgaryCalgaryCanada

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