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'Tremendous progress' in the hunt for GPs

RIH program one of 17 around province
By Mike Youds
August 11, 2015 4:00 A.M.
Dr. Harpreet Ghuman is among the first UBC medical graduates in a family practice residency program at Royal Inland Hospital.

In her final year in residency at Royal Inland Hospital, Dr. Harpreet Ghuman has no hesitation saying where she would like to practise medicine, even though her mother would prefer to hear otherwise.

“Actually, I’m quite comfortable saying I don’t want to live in Vancouver or Surrey,” said Ghuman, one of a dozen young UBC medical grads enrolled in the UBC Family Medicine Residency Program at RIH. 

“My mother cringes, every time I talk to her, that I’m not any more convinced to move to the Lower Mainland,” she added.

Originally from Surrey, Ghuman has her sights set on setting up practice in a city the size of Kamloops or even a smaller, rural community, many of which are experiencing ongoing GP shortages.

Having this confirmed must be music to the ears of UBC's Faculty of Medicine and to the Thompson Division of Family Practice. A nonprofit organization of family physicians, the division has been working steadily behind the scenes in concerted fashion to see more general practitioners settle in the B.C. Interior. This has been a considerable challenge, partly because so many GPs have retired or are approaching retirement years, but it’s far more complex than the aging demographic.

Ghuman is among the first intake of six graduates in the UBC program at RIH in 2014, joined by another six last month. They spend part of their time gaining exposure to specialties such as obstetrics and neurology while also working alongside GPs in their clinical practices. The program itself represents one of the more substantial means of remedying a longstanding GP shortage that still has thousands of residents without a family doctor.

“I’m just attracted to the smaller places,” Ghuman said. “I love my family and I have no regrets of growing up in Surrey, but all of my adult life has been spent in Prince George or smaller.”

Spending part of her undergraduate training in Prince George is partly what convinced her to apply for a residency at RIH. The cities are of similar size in population, but more to the point, family doctors there are well respected by their specialist peers, she said.

“That’s kind of what attracted me to Kamloops in the first place — good relationships.”

For years it seemed that young medical graduates were turning their backs on general practice, preferring to become specialists. The system didn’t seem to be churning out enough GPs to keep up with the attrition rate, but there are convincing signs that a change is underway. Now, fully half of medical graduates are choosing family practice over specialities.

“I think, from my experience, the reason why I ended up choosing family medicine is because I love the breadth of knowledge that you’re trained to know. You actually get to do a lot. I am passionate about obstetrics and in family medicine you get to do low-risk OB. I want to be involved in the hospital still and I am able to do that in family medicine. The biggest thing is the continuity of care and being able to follow up with your patients, having that relationship, a stronger connection with your patients.”

Dr. Selena Lawrie

Ten to 15 years ago, there was a sense of almost despair in family medicine, said Dr. Selena Lawrie, site co-ordinator of the RIH residency program. Part of that had to do with the GP fee guide, how doctors were remunerated for their services. The inequitable structure made it more rewarding for clinics and created a shift away from continuity of care toward more episodic care in the clinics, Lawrie said. 

With changes, GPs have seen a structure that pays for more complex and chronic conditions that they’re inclined to see with an aging population. Around the same time period, medical school capacities were doubled. Lawrie is greatly reassured that the health-care system is on the cusp of seeing the benefits of those changes.

“Why I get excited about Kamloops is that I actually think Kamloops has all of the building blocks to have very exciting family medicine that morphs into excellent primary care,” she said. “We can actually, I think, build a really robust relationship between primary care and tertiary care at Royal Inland. We can have an excellent health-care system in the entire Thompson region.”

The residency program and a black bag of other potential remedies for the GP shortage represent what Lawrie describes as “social accountability.” It’s a far cry from when she graduated 20 years ago, when the sole residency program in the province was in Vancouver.

“We now have a distributive undergrad program,” which includes half a dozen undergrad students in addition to the dozen graduates. There are 17 distributive facilities across B.C. “It’s training our family physicians in the communities where they will work in the future.”

A year into the UBC residency program, there have been spinoff benefits that the division of family practice may not have anticipated.

“I see tremendous progress and it’s not just me telling you that. I actually think the family residency program has rejuvenated some in our physician community.” 

Some doctors with established family practices have opted to remain engaged. That’s partly through sense of hope that successors are in the wings through the residency program, but also due to the availability of locums who have arrived to support them with their busy caseloads.

“And we need them to teach,” she added of practising physicians. “There may be a spinoff effect here that is helping with the burnout aspect. It’s because it’s something to pull us together as a community and show them support.”

The network generates its own word-of-mouth interest, she noted.

“Some of these young physicians could never even have heard of Kamloops before,” she said. “Suddenly we’ve got a vibe right across the country now that Kamloops is a cool place to live and work.

“What we’re going to get first is the locums coming to check out Kamloops. Is it a community they can see themselves living in and, secondarily, is the work fun?”

While the program has only been in place for a little over a year and it is too early to tell if it meets expectations, she sees positive signs.

“Three years ago, it was harder to get a doctor here. What we’re starting to see now is an influx of physicians coming into the community and having a share in filling in the void.”

Ghuman jokes about being a guinea pig in a brand-new program, one who is there partly to provide feedback so that the program can be more fully developed and deliver on the purpose for which it was created.

“When you sign up for a new program, you know that. I think the six of us who chose Kamloops as a site were aware that it would mean being involved in the process of developing the program and I think we were all excited to be the first cohort of students and excited to help shape the program.”

Can a doctor from one of the most beautiful cities in the world find satisfaction amid the sagebrush and snowy winters of the Interior? Ghuman knows what she likes.

“I think, actually I know Kamloops is an incredible place to live. The last year has been amazing. I’ve taken up mountain biking, which I really enjoy. Sun Peaks is right there. You’ve got the lakes. I can visit family. I can go to Vancouver for the weekend. We have friends in Revelstoke, friends in Princeton. I can’t imagine a better place to be.”

Willa Henry says:
August 11, 2015 11:23am

As Program Director of the UBC Family Medicine Residency Program, I have been astounded by the energy and enthusiasm of the medical community in Kamloops. With both new undergraduate and postgraduate medical programs, the ask is significant in terms of teaching and supporting these learners. Our hope is that the reward will be the learners embracing the community, remembering the generosity, and becoming future preceptors and excellent doctors themselves. Selena Lawrie and her faculty and administrative team have done this with enthusiasm and a "can do" attitude. The community will benefit in the long run, as will the existing family medicine community.


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