Dr. Amy Hendricks is passionate about rural medicine. When she moved to Antigonish, Nova Scotia in 2016, she left one small community for another.She’d been working in Yellowknife for 14 years, caring for patients in remote areas across the Northwest Territories and Nunavut. “There’s joy in looking after people who are close to the land,” says Dr. Hendricks. “It makes such a difference in their lives to have local health care, and visiting small indigenous communities was a real privilege. The gratitude and fulfillment you receive is tremendous.”

Dedicated to rural medicine
Dr. Hendricks is an internist, a physician who specializes in treating serious medical illnesses in adults. In the north, she’d focused on insulin management, tuberculosis, pacemakers and eventually, echocardiography. “We had 40,000 patients and we could only do one echocardiogram per day. It was a real gap,” she recalls. After training in Edmonton, she began providing the scans for her patients.

Moving to Nova Scotia might have seemed like the chance to leave service gaps behind. But as a physician in a health-care system under extreme strain, Dr. Hendricks has found that isn’t the case.

Recruitment challenges
Like many rural areas in Nova Scotia, Antigonish has been struggling to recruit and retain specialists. Dr. Hendricks practices at St. Martha’s hospital, the regional hospital that serves patients from surrounding communities.

“When I started, I was the seventh internist. Our magic number is eight. Now we’re only four,” Dr. Hendricks says. Her team still grapples with the loss of their respirologist and gastroenterologist last year. “It’s a huge loss.”

What will it take to keep specialists in rural Nova Scotia? Dr. Hendricks says there are three key ingredients.

 1. Let specialists work to their strengths
This means allowing physicians to focus on providing the care they’re trained to do – their full scope of practice. Due to a shortage of family physicians, specialists in regional hospitals often provide inpatient care for unattached patients from other communities, on top of their other duties.

They also serve as the specialist-on-call for much smaller sites – four of them, in the case of St. Martha’s – and usually they must be involved for patients to be transferred from a rural ER to a regional centre.

The problem with this situation isn’t just a matter of workload – it’s also the type of work. “If specialists are spending a lot of time doing work that could be done by a family physician, they will go elsewhere,” says Dr. Hendricks. “How do we create an attractive job description for rural specialists, so they are truly using their expertise, not just filling gaps for missing primary care, ER or other inpatient resources?”

2. Value inpatient care
Dr. Hendricks sees a growing divide between procedural and non-procedural care. Procedural care is when a doctor performs a procedure or interprets a test, while non-procedural care is looking after patients while they stay in hospital.

“Procedural care is remunerated quite well and the other is remunerated quite poorly,” said Dr. Hendricks. “For example, when I’m reading echocardiograms, I’m paid nearly 10 times as much as when I’m seeing patients face-to-face on the ward,” says Dr. Hendricks. “There is a real disparity. We need to value clinical care much more, if we’re going to hold on to specialists in the non-procedural disciplines.”

3. Build a community of support
Building camaraderie among doctors, and valuing their input and expertise, can help bond physicians to a community and to a hospital.

The tight-knit, supportive environment she enjoys at St. Martha’s Hospital gives Dr. Hendricks hope. There, physicians meet weekly for educational sessions. “We eat together and learn from our local experts,” says Dr. Hendricks. “The sessions have no drug company sponsorship and are accredited, so we can meet many of our educational credit needs without leaving our site for lots of extra conferences.”

Family physicians also work shoulder-to-shoulder with specialists. “Family physicians see the hospital as their hospital – it’s not just the territory of the specialists. They’re the experts in their patients, and sometimes, we’re the experts in the disease process.”

Dr. Hendricks says that physicians owe it to each other, and to their patients, to create this type of work environment that makes new recruits feel like the community has their back and wants them to succeed. It’s the kind of place where physicians want to practise, put down roots, raise their family and serve their community.

Outcome: Improved patient care
For Dr. Hendricks, a strong physician culture means better patient care. “It can’t be artificially constructed, bought or legislated, but it can be broken,” she says. “I truly believe that a positive culture is our secret sauce for flow and for keeping patients out of the ER corridors. I wish we could bottle this, so it can be replicated elsewhere.”

The recipe for effective physician retention and recruitment is complex, and requires the commitment of physicians, health authorities and government. It must also be flexible and based on the needs of a community, the position and speciality being recruited, and the service gaps in the area.

For Dr. Hendricks, retaining specialists in rural Nova Scotia means offering physicians a full scope of practice, fair compensation for their work and a positive professional culture. It’s about everyone working together to create a thriving physician workforce that meets the health-care needs of all Nova Scotians.

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