Rourke goes on to discuss his recommendations for increasing the number of rural sourced students to medical training programs, the most important of which is changing the admissions one that more adequately recruits rural candidates:
Changes to admissions process
• to admit a fair and equitable number of students of rural original to medical school
• Include rural physicians and rural community members on admissions policy and process committees
• Include rural physicians and rural community members as interviewers
• Ensure that students of rural origin are not disadvantaged by the admissions process
• Apply a rural adjustment factor to grade point averages and MCAT scores
• Set targets for rural enrolment (Rourke, 2005)
All of these strategies to increase enrollment of rural candidates in medical training programs seem logical as the need to recruit people that have ties to rural communities and are presumably committed to returning to their rural roots is significant. People from a given region are more likely than others to be aware of the specific cultural and social systems already in play in any given community and are more aware of what might need to be changed in any given system. (Rourke, 2005) the U.S. has had some success in recruitment and retention programs similar to the recommended actions of the Calgary example above and utilizing some of the recommendations of Rourke and others regarding recruitment from rural areas and retention through support and incentive, but again like Canada progress is short and limited. (Rabinowitz, Diamond, Markham, & Hazelwood, 1999) Rabinowitz, Diamond, Markham, & Hazelwood actually offer a significant model example of a recruitment program at a university in Pennsylvania, where they have slowly but surely been able to influence the numbers or recruited and retained family physicians in the immediate surrounding rural area to the university program. (1999)
Yet, all this marginal success begs the question that the recommended idea of recruiting already practicing physicians with experience and confidence is also not a viable solution. It is clear that every complicated problem requires multiple solutions. In the Calgary residency program, mentioned above even those individuals recruited from and doing practicum in rural areas often chose not to settle in urban areas in the short and long run as they perceived medical support as limited in those areas and sought greater skill set learning opportunities and then often chose to stay for family and financial reasons. (Lu, Hakes, Bai, Tolhurst, & Dickinson, 2008) the institutions that are seeking to help solve these problems with recruitment might consider that the population they might be successful with is the existing physician population, rather than new recruits. The recruitment might be more challenging, as these are not students present at clinical every day, but it might also be pointed out that physicians who have been practicing longer might have more resources to relocate, might have more fundamental desire to make a lifestyle change and most importantly may feel as if they are supported by experience and the already strong network they have developed as physicians in urban areas. This paradigm shift might make the possibility of solving this problem, in part more logical as one of the biggest reasons new physicians site for not choosing rural practice is perceived lack of medical support. Whereas older physicians may feel confident in their practicum skills and feel comfortable using remote or tele-networking to obtain advice and treatment support from already established colleagues. (Grumbach, Vranizan, & Bindman, 1997)
The development of and strengthening of programs associated with improving the recruitment and retention of physicians in rural Canada is absolutely essential to the development of a system that has an ideal more in line with its reality. The recommendations that are found within the literature and are supported by experiential data within it offer a host of recommendations that could go a long way in improving the situation of health care access in rural Canada. Given that 20-38% of the population resides in rural areas the need to provide equitable care according to the intent of the Canada Health Act is absolutely fundamental to the success of the health care system overall.
The proposed solutions in the literature include but are not limited to recruitment of medical school candidates from rural areas, who will presumably return to such areas when in practice, and improved medical school curriculum that will have the duel effect of focusing on rural practicum issues and most importantly provide greater orientation to advanced procedural skills that students may feel they will miss out on if they practice in a rural area and may feel they need to feel confident in doing so. In addition I added a secondary recruitment strategy that will allow recruitment of already practicing physicians who may be at an advantage financially, socially and practically to enter into a contracted engagement in a rural area. Like many of the authors here the use of strategies that both improve the situation on the educational level and improve the recruitment strategies private recruiters might use to bring care providers to rural areas are important to a long-term solution for this enduring problem.
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