Langley Division of Family Practice Talent Management Strategy Report 2011 Ryan Williams M.A 12/28/2011
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Table of Contents Executive Summary ....................................................................................................................................... 2
The Situation Analysis ................................................................................................................................... 4
Divisions of Family Practice ....................................................................................................................... 5
Langley Today and Tomorrow .................................................................................................................. 6
Stakeholders ................................................................................................................................................. 9
Health Authority ....................................................................................................................................... 9
The Provincial Government .................................................................................................................... 10
The British Columbia Medical Association (BCMA) ................................................................................ 10
Existing Recruiting Communications Channels ....................................................................................... 11
The Federal Government ........................................................................................................................ 12
The College of Family Physicians of Canada ........................................................................................... 12
College of Physicians and Surgeons of British Columbia ........................................................................ 12
Mature Population .................................................................................................................................. 12
About Canadian Family Physicians .............................................................................................................. 13
Changing demands of practice: .......................................................................................................... 13
Locum support .................................................................................................................................... 14
Summary of Member Feedback .................................................................................................................. 15
The Talent Management Strategy .............................................................................................................. 17
What we know .................................................................................................................................... 18
The Numbers ........................................................................................................................................... 19
Primary Audiences .................................................................................................................................. 20
Key Messages for Recruits ...................................................................................................................... 20
The Pillars ................................................................................................................................................ 21
The Parking Lot ................................................................................................................................... 23
References .................................................................................................................................................. 24
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Langley Division of Family Practice Talent Management Strategy Report 2011
Executive Summary
The shortage
The British Columbia Medical Association (BCMA) estimates that approximately 10% of all British
Columbians (400,000) are without a regular family doctor. Policy papers from the BCMA in combination
with multiple studies from the College of Family Physicians report a shortage of doctors as a Canada-
wide issue. These issues are compounded by an aging workforce. Assuming that the Division of Langley
is consistent with the rest of the province, there would be an estimated 13,000 Langley residents
without a family doctor.
The impact
From the patient’s perspective, the situation is not as dire as the raw numbers suggest. Being without a
regular family physician does not necessarily translate to lack of access to primary health care. Many
patients, especially those without chronic disease, can and do regularly access primary care through
walk-in clinics. In jurisdictions like Surrey this is becoming the norm for families seeking care. This
situation can translate to inconsistencies in care and possibly quality of care issues.
From the physician’s perspective, the disparity has professional, personal and financial implications. The
workload associated with a full medical practice requires the family physician to work long hours.
Family physicians may have the inability to secure replacement locums. This restricts a doctors’ ability to
participate in required continuing education opportunities or to take holidays. The overall result is often
a poor work and life balance. Economically, the long-term financial impact is that medical practices are
worth relatively little since new entrants can simply hang a shingle and have a completely full practice
within a few months or with little commitment provide service at a walk in clinic.
The opportunity
One response to the population aging and growth in combination with physician succession challenges
has been to create the Divisions of Family Practice. The Langley Division of Family Practice (LDFP) was
formed in August 2010. In Langley, the Division’s vision is to bring together physicians, resources and
patients to improve access to and the standard of healthcare.
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The stakeholders
The LDFP represents family physicians in Langley, Fort Langley, and Aldergrove, BC. Together, the
members work to improve patient access to local primary care, increase the influence of local physicians
on health care delivery and policy, and provide professional support for physicians. The Division also
gives local physicians an opportunity to work collaboratively with Fraser Health Authority, the General
Practice Services Committee (GPSC), and the Ministry of Health Services to identify health care needs in
the local community, and develop solutions to meet those needs.
The report and strategy
TWI Surveys is an affiliate of Tekara Organizational Effectiveness Inc., a Vancouver-based organizational
development consultation firm. TWI Surveys has developed strategies for Fraser Health, Vancouver
Coastal Health, The Alberta Medical Association and Johns Hopkins Medicine. The Division tasked TWI
Surveys with helping the Division create a framework for its approach to attracting new physicians into
the Division and achieving an appropriate ratio of doctors to patients.
In this report, TWI Surveys provides recommendations based on literature reviews, interviews,
workshops, and survey responses by a representative sample of Langley physicians. The stakeholders
involved a stratified sample of members, interviews with three Division directors, and requested for
information from Fraser Health and the British Columbia Medical Association. Initial findings were
reported to the Division’s Board on October 10, 2011 and the Board feedback was incorporated in the
final recommendations.
We recommend that the Division adopt a multi-faceted approach, based on four pillars – awareness,
member involvement, recruitment, and building capacity. A draft strategic plan is presented with
specific actions that should be undertaken to support each of these pillars over the short, medium, and
long-terms.
Providing sustainable primary care in the Division of Langley
Awareness Member
involvement
Recruitment Building
Capacity
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The Situation Analysis
A 2011 Ipsos Reid survey indicated that 83% of Canadians have come to believe that the level of health
care has been the same or worse since 2004, when the federal-provincial health accords were signed. In
an ideal situation, the needs of patients, physicians and health authorities would all be met
satisfactorily; however, the path to that ideal solution is impeded by significant challenges, namely:
inflation, layers of change in governments, health authorities and practice models, practitioner
remuneration models, inefficient health models, aging workforce and population, declining student
interest in family medicine, and adopting new technologies.
A drive towards health care renewal represents the need for energy to change the status quo and yet
Canadian physicians, in general, show moderate levels of burnout as they enter into any form of
transformation. This is the culmination of decades of research that conclude that the excessive demands
and the inability to balance work and personal life puts physicians at risk of burnout (Leiter, 2009). The
need to sustain continuing education places an additional demand on already limited time available to
physicians. Physicians are central to overseeing, managing and informing the renewal; however, their
situation is one of little time and diminished energy.
In the search for an ideal solution, there have been evolutions of payment models and structures. One such structural evolution is the formation of Divisions of Family Practice. In Langley, the Division of Family Practice seeks to provide a structured plan to deal with
the issues facing the profession,
liaise with the Fraser Health Authority, and
optimize the level of health care in the community.
One objective is to help family physicians address the multiple risks to providing sustainable primary care to both physicians and patients. In March 2011, the Canadian Medical Association (CMA) sponsored an expert panel that looked at the sustainability of health care in Canada. The report contained recommendations that may inform the role and adoption of policies by the Langley Division of Family Practice (LDFP) in support of their human resources needs. They include:
1. Being open to discussing a range of ways of funding services while acknowledging that no
unanimity on the best way to fund services has been reached. The criteria for funding should
focus on quality, access, efficiency and equality.
2. Supporting methods of physician compensation that support quality care, efficiency and
integration.
3. Advocating for greater accountability of the health care system towards patients who need care
and their families.
4. Supporting the use of electronic health records.
(Report of the Advisory Panel on Resourcing Options for Sustainable Health Care in Canada, July
2011)
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This report will seek to identify the stakeholders in the healthcare system responsible for recruiting and
retaining the right family physicians for the Langley Division. It will describe how the role, needs and
preferences of each of these groups inform the overall need the Division fulfills in the eyes of the
members. This report will also lay out the core elements of a strategic framework intended to guide the
work of the Division over the next five years.
Divisions of Family Practice
An effective primary health care system is one that supports British Columbians to stay healthy, get better, live with disease and cope with end of life. This includes providing first contact access for each new need, long-term person-focused care, comprehensive care for most health needs, and coordinated care when it must be sought elsewhere.
Division was funded as part of a six year allotment provided through GPSC.
The BC Government has mandated that all British Columbians have access to a primary care physician by 2015.
All family physicians in the province have the opportunity to be involved in a Division of Family Practice. As such, Divisions are developing in two ways:
1. Some Divisions include physicians from a number of communities and are known by a regional name, such as Cowichan Valley (which includes the communities of Duncan, Lake Cowichan and Chemainus).
2. Other Divisions include physicians from a single community and are known by that community’s name, such as Chilliwack or Prince George.
Benefits of Membership:
Being a member of a Division offers a number of potential benefits, including:
Enhanced provision of full spectrum primary care as a collective responsibility
Greater impact on the organization of local and regional health services
Improved access to local health authorities
Increased ability to advocate for the needs of patients and for practising physicians
Ongoing professional support from peer networks
Shared efforts for recruitment, retention and locums
More support from colleagues in caring for complex or unattached patients
Reliable assistance with duties historically falling to call groups, e.g. scheduling and meeting
organization
Strong financial and practice support for information technology programs and pilot projects
(Source for Division information: http://www.Divisionsbc.ca/)
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Langley Today and Tomorrow
Langley currently has 133,000 residents and with expected growth of 29% over the next 10 years, and is considered the fastest growing local health area in the province. Much of that growth is expected to come from older persons who may be moving to the area to take advantage of lower property prices. The proportion of youth in the area is expected to decline over the same period. The impact on healthcare provision is potentially significant because the older population typically demands more of the healthcare system than their younger counterparts. These dynamics will put upward pressure on the patient per physician ratio. While there is no ideal ratio or optimum number of physicians to patients (BCMA, 2011), the true objective is reaching the physician complement that adequately addresses the needs of all Langley residents while allowing physicians to achieve their goals of work-life balance, continuing education, and a continuity of care for their patients. The projected population growth and an aging demographic in Langley, along with projected physician retirements will exacerbate the situation in future years. Increasing workloads and the lack of available locums make it difficult for physicians to take time off or to attend necessary on-going educational events.
In 2009 in BC, the average doctor-patient ratio was 1:472. It should be noted that this ratio was calculated solely on the basis of total headcount and does not consider the effect of regionalization, or of physicians who have opted to restrict their preferred practice area.
An acceptable level of primary care for a growing and aging population demands that solutions be cost-effective, efficient and sustainable. The goal of the Division will be twofold:
1) Reduce costs of operating, and 2) Improve the quality of care
Population Health Profile Langley (Provided by Fraser Health)
To date, approximately 70 of all Langley general practitioners have joined the Division. The board has assigned two members to operate as a steering committee for organizational development activities.
To achieve an effective primary health care system, physicians should be an integral part of the solutions that support health care needs of the community. Based on TWI Surveys’ many years of studying and member interviews the working environments of physicians some general statements can be made:
Currently, the total number of physicians residing in the Langley Division of Family Practice is 108
90 are private practice general practitioners
18 are primarily hospital based
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In general, physicians
Have a high desire for participation in health care renewal
Maintain the leadership position in the community when commenting on health care issues
Are small business people who manage investments, human resources and patient care
For most physicians, regular activities include:
Seeing patients
Improving professional skills
Serving in the profession
Serving in their communities
Running their practices
Currently, 94% of member respondents report being satisfied with Langley as a location to practice. They are less likely to agree that the Division is effective in supporting their needs. With the early evolution of the Division’s programs and services most respondents are parking their opinion in the ‘Not sure’ category. Over the next year, it will be important to gain member support to enable the implementation of the talent management strategy.
Current members chose Langley for the following reasons:
Grew up in the area
Had a colleague already practicing in the area
Trained in Langley
Had family in the area
Had a locum experience
Moved to the area to balance professional and family needs
The following table provides an overview of the current state in Langley:
Currently: 108 Family Physicians
in the Division
If we do not add physicians, in ten years that would increase to:
% Physicians who Reported being in
practice more than 20 years:
# Physicians who Reported they expect to retire in the next
four years
1230 people for every family physician
1590 people for every family physician
68% of member respondents
Approx. 15 physicians expect to retire in the near future
In the last five years three new family physicians have entered the Division
Approx. 25% or 27 are likely to retire in the next 5 - nine years
(More numbers can be found in the talent management strategy section.)
Questions Mean0 20 40 60 80100
Category Percentages
Strongly disagree
Disagree Not sure AgreeStrongly
agreeCount
4.44 0.0% 0.0% 5.9% 44.1% 50.0% 343. As a location for your practice, I am satisfied with Langley
3.39 0.0% 3.0% 54.5% 42.4% 0.0% 335. I believe the Division will be effective in supporting my needs
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While the previous table represents the hard numbers, the true picture may be somewhat different.
Typically, physicians reduce their workload as they approach the end of their practice, and the 15
physicians who plan to retire in the near future may already have reduced their patient load. A 2010
BCMA survey reports that physicians work between 48 and 59 hours per week, with younger doctors
opting for shorter work weeks in an attempt to achieve greater work-life balance.
In addition, it is possible that now, or at any time in the future, some physicians may restrict their
practices to include or exclude specific practice areas, e.g. obstetrics, geriatrics, sports medicine, etc.
The result is that the true availability of patient services may be quite different from the picture that the
numbers suggest.
The 2011 BCMA study provides some very basic data on physician workforce supply—numbers per
100,000 patients, number of physicians over age 55, and work hours broken out by age group. While
these data may appear interesting at first glance, their value is less informative as the data does little
more than provide a possible basis for general comparison. The good news is that it should be relatively
easy to replicate similar data for Langley family physicians because the sample size is only 108.
Most members report not having acute work life balance issues today. Almost one third of respondents
to a member survey did report that they were not sure if their current balance was sustainable.
The management of demands in Langley will likely become more challenging with the increased
turnover of physicians. Currently, a large majority of physicians have practiced in Langley for more than
20 years. The attributes of a physicians in this circumstances is to have well developed relationships,
processes and methods for managing their practices.
Questions Mean0 20 40 60 80100
Category Percentages
Strongly disagree
Disagree Not sure AgreeStrongly
agreeCount
3.80 72.7% 0.0% 13.6% 13.6% 52.3% 20.5% 441. In the past 12 months, I have taken steps to improve the balance between my professional life and my personal life.
3.73 65.9% 0.0% 6.8% 27.3% 52.3% 13.6% 442. My balance between my professional life and personal life is sustainable.
4. How many years have you been in practice?Response Frequency Percent 0 20 40 60 80 100
Less than 2 years 1 2.3%2 - 5 years 3 6.8%6 - 10 years 1 2.3%11 - 20 years 9 20.5%More than 20 years 30 68.2%
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Stakeholders
Health Authority
Healthcare delivery in Langley is the responsibility of the Fraser Health Authority (FHA). Facilities
include hospitals, clinics, community health care centres, residential care and assisted living homes.
It is significant that the FHA also oversees health care delivery in Surrey and Abbotsford. The
geographical proximity of Surrey and Abbotsford, with their larger populations, to Langley will likely
affect the services that will be supported in Langley and, consequently, could become a factor in the
Division’s ability to attract prospective new physicians to the area.
For example, the Surrey Division reported that currently they are short approximately 200 physicians
and within the Division and they represent the largest amount of growth in walk in clinics per capita in
the province.
In Surrey, a new community hospital is opening and acting as a shared delivery model that will impact
many of the practices and attraction to the community.
Abbotsford also has a new hospital and learning opportunities for residents.
The FHA has well developed formal communication programs where stakeholders will inform
themselves about the region. It will be an opportunity to partner with their communication programs
around the needs of Langley and participate in the conversations on their social channels like their
Facebook page and Twitter accounts.
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The Provincial Government
One service which the Government of British Columbia provides through the BCMA is Health Match BC,
a free health professional recruitment service. Since 1999, the province has successfully recruited
thousands of Canadian and
internationally educated health care
professionals to BC. Health Match BC
is a principal resource for health care
professionals seeking employment in
BC.
The Langley Division relies heavily on
Health Match BC as a primary
recruitment source. This is the single
space to post and connect with
physicians looking for placements. The
challenge is to differentiate in the
Health Match BC space. To be effective
other communication channels need to
support the reputation of Langley
Division and its value proposition for
potential physician recruits.
http://www.healthmatchbc.org/About-Us
The British Columbia Medical Association (BCMA)
The BCMA is the representative body that negotiates on behalf of physicians with the government and
distributes resources back to physicians. Within the BCMA, the GPSC recognizes the challenges facing BC
physicians today and supports British Columbia’s doctors through developing and implementing
programs that improve job satisfaction for family physicians (FPs) and primary health care for patients.
The GPSC was formed in 2002 as a partnership between the British Columbia Ministry of Health Services
(MoHS) and the BCMA. Its key role is to “encourage and enhance” Full Service Family Practice to the
benefit of patients and it is funded through an allotment of approximately $800 M over six years.
It also offers an expanded role for BC doctors in determining the future direction of health care through
mutually identified initiatives around quality patient care and system-wide improvements.
http://www.gpscbc.ca/
The GPSC was formed under the 2004 Agreement between BC's doctors and the provincial government.
The GPSC is comprised of eight representatives: four from the BCMA and four from the BC Ministry of
Health.
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Its role is to develop and implement strategies that allow for optimum use of the cumulative total of
$382 million designated within the 2004/2005 agreement to support improvements in primary care.
https://www.bcma.org/popular-topics/gpsc-overview
Existing Recruiting Communications Channels
These are examples of other
Health Match BC
communications channels that
the Langley Division could
participate in. The Division
website can act as a blog or
landing page for additional
information but it is most
effective and efficient to go to
where the recruits are and link
them back to your
communication channels. With
those links create multiple
opportunities for calls to action
from asking a question, filling in a
survey or initiating a phone call
to learn more.
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The Federal Government
Health Canada is responsible for helping Canadians maintain and improve their health. To carry out this
responsibility, Health Canada supports activities that:
Preserve and modernize Canada's health care system
Enhance and protect the health of Canadians
Work in partnership with others
Communicate health promotion and disease prevention
http://www.hc-sc.gc.ca/ahc-asc/activit/index-eng.php
In the area of physician recruiting from outside of Canada the website directs candidates to explore their
qualifications with these two organizations.
1. Canadian Information Centre for International Credentials (CICIC)
2. Royal College of Physicians and Surgeons of Canada
The College of Family Physicians of Canada
The college will encourage collaborative models of practice and the training to support family physicians
working together with other health professionals.
The college will also develop programs and messages that promote family medicine as a highly desirable
career choice for medical students.
Source: Strategic Plan for The College of Family Physicians of Canada 2007-2011
College of Physicians and Surgeons of British Columbia
The College is the governing body for the standards and qualifications for physicians in the province. The
College is supporting the licensing of physicians for other jurisdictions. Partnering with the college will
enable clear understanding and insights to recruiting international physicians to support their
qualifications to practice in British Columbia.
https://www.cpsbc.ca/
Mature Population
With a mature population, Langley follows the national trend with the fastest growing demographic
being that of those over 80 years of age. To compound the challenge there is a shortage of geriatric
specialists in Canada. The aging population is living longer and they are continuing to be active. The
BCMA reported in a policy paper 2011 that per capita spending on healthcare doubles with every 10-
year age bracket during the final one-third of the life cycle. The implications for Langley are potentially
significant if the anticipated influx of elderly residents from other communities becomes a reality.
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Access to physicians with care for the elderly (COE) training is rare. There are fewer than 200 of these
physicians in Canada. Funding models can directly limit effective care for the aging population. The
passion for serving this demographic is related to the “intellectual challenges of geriatric care, the
pleasure of working in teams, and the satisfaction of improving function or quality of life for older
person.” (Frank, 2010)
About Canadian Family Physicians
The foundations of the role of family physicians are continuity of care and patient advocacy. The
impression of residents is that family medicine is flexible and conducive to balancing professional and
life goals. Residents are core audiences for recruitment. When they are determining their career path it
is helpful to highlight the potential intrinsic value created in family practice. Langley provides continuity
of care opportunities, in combination with autonomy and is balanced with the support of specialists and
larger centers nearby.
Three dominant themes emerge to motivate the decision to join general practice:
The relationships built over time,
the capacity to solve a variety of problems at the primary care level, and
the integration and coordination of the patient’s care.
The perceived barriers:
The ability to keep up
The diversity of needs
Ability to balance family and work
Overhead start-up costs
(Beaulieu, 2009)
Changing demands of practice:
Chronic disease treatment consumes 80% of healthcare spending and is expected to rise 58% over the
next 25 years. (2011 BCMA Policy Paper)
Three factors that influence students to choose family medicine:
Length of residencies
Involvement in public health
Flexible work hours
Family practice is different because it defines itself in terms of relationships. (Pimlott, 2011)
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Locum support
Locum service providers are health care providers that serve as substitutes or temporary relief. One
widely used strategy to attract physicians into an area is to first recruit physicians as locum providers.
This is a flexible way for physicians to try out a practice, a community and still have the flexibility to
change their mind.
Key messages to attract locums:
Not tied to overhead
Don’t need to worry about the business
Life style flexibility
Learn from other doctors on how they run the business
Learn about the community both professionally and personally
Locum practice:
Seen as the ability to learn about a practice or area
Opportunity to learn about how others run their practices
Seen as flexible
Young and female family physicians were more likely to practice as locum tenens. The average length of
placement was 9.1 months.
Deterrents to locum tenens:
Negotiating locum contracts
Low patient volumes
Patient continuity
Difficult staff
Most family medicine graduates arranged their own locum placements and they tend to make
placement decisions in the second year of residency. (Myhre, 2010)
Factors affecting student’s choice of family medicine as a career include:
High quality clinical experiences
Positive reinforcement by current family physicians
Early and accurate information on family medicine training and career options (Scott, 2007)
Langley members reported limited use of Locums. With a long term and stable group of physicians they
are sharing support. This practice will be challenged as the need to attract new physicians to the area
increases.
New physicians will need to identify locums
To attract new physicians, locum terms are helpful
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More than a third of respondents to a member survey reported not having coverage when they are not
working.
Summary of Member Feedback
Members enjoy Langley as a place that is close to the urban center but has the benefits of a small town
community. The community offers opportunities to provide continuity of care to families and they enjoy
the support of the medical community.
Program ideas
o Division needs to do meaningful and practical things
o New physicians need to – join practices, have access to specialists, access to hospital
o Need to welcome potential physicians by showing them the community, introducing them to
colleagues and the hospital and making it easy to locate
o Langley could brand as a center for excellence in family practice to align with the structure of
the health authorities and the provincial hospital strategy
o Have a program with students some need effort and more advanced reduce workload – both
gain experience in the area and make it more likely to set up in Langley
o Maintain a locum pool
Challenges
o Will the government provide the continuity required to change systems?
o One member graduated with 20 colleges and of them three are in practice the rest are locums
and walk in clinics
o Keeping people involved in hospital care is challenging – should work with hospital to welcome
new physicians
o Access to specialists
Recruiting
o Teaching and residents an important time for exposure and choosing practicums or locums
o Some members have not heard about opportunities for teaching and report an interested in
teaching
o The blended practices in combination with residencies can act as a communication channel for
those making the decision to locate to consider Langley
Advocacy
o No consensus on if Division should advocate for a blended practice model – should support
member choice in model and that includes blended models
o Some believe that the Division should champion the blended model as an answer to
physician/patient ratio
6. Do you have in office coverage when you are not working?Response Frequency Percent 0 20 40 60 80 100
Yes 29 65.9%No 15 34.1%
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o Langley has been on the front of the curve with blended model practices
o Value of the blended model - how do I keep patients healthy they stay out of the office
o Need better measurement to track and tell the story of different practice models
Communication
o Email is the preferred method of communication for members – they don’t look at
attachments, suggest to provide links and to consolidate messages
o Short surveys were welcomed as opportunities to have representation and involvement
o Examples of other communication channels: CMA website, Medscape, and Journals
o Sees training and resident focused conferences as best opportunity to attract
o Creating community - community was found in the centralizing place of the rounds at the
hospital and that diminished over time. Core was a place to meet after the rounds – the quality
of the cafeteria made it sticky for the physicians to meet.
o The most trusted source of information is the BCMA
o No one is buying practices any more
o Physician’s value: continuity of care, positive impact on patients, lifestyle balance
o People are choosing lifestyle options
o Cooperative working community
o Small town feel with big city support
o Family area with nature, access and great schools
o While members may be the most effective messengers to recruits, they do not yet see
themselves in that role, but they acknowledge that their social network would be a primary
source to add to their practice
2. What is your preferred source(s) of communications about the Division?Response Frequency Percent 0 20 40 60 80 100
Email 32 94.1%Website 3 8.8%Paper Mail 1 2.9%Social Media 0 0.0%Fax 1 2.9%No Response 1 2.9%
4. What are your most trusted sources of information about the needs of physicians and the changes in the BC health care systemResponse Frequency Percent 0 20 40 60 80 100
BCMA 27 79.4%College of Family Physicians 14 41.2%The Government 0 0.0%The Health Authority 0 0.0%The Media 3 8.8%Physician Journals 2 5.9%Other 5 14.7%No Response 0 0.0%
Questions Mean0 20 40 60 80100
Category Percentages
Strongly disagree
Disagree Not sure AgreeStrongly
agreeCount
2.56 47.1% 41.2% 11.8% 35.3% 41.2% 8.8% 2.9% 343. I would likely share information about opportunities in our Division with colleges, friends and family
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Informed by profiling potential recruits, understanding family practices and the variety of stakeholders
the following strategy is proposed.
The Talent Management Strategy
The following schematic illustrates our recommended approach framework.
As for any undertaking, the path to success begins with understanding the needs to be met or the issues to be resolved. This was the purpose of the survey and member interviews we conducted. The information we compiled not only defined the overall need, but also where members need support.
Armed with an understanding of the needs, it becomes possible to articulate the desired outcomes that will meet those needs. It is usually helpful to describe the objectives and the required set of actions along a timeline - 12 months (short term), 24 months (medium term), and 5 years (long term).
5. Where would you primarily go to find a physician to add to your practice?Response Frequency Percent 0 20 40 60 80 100
Health Match 4 11.8%The Division Website 5 14.7%The Health Authority 1 2.9%The BCMA 7 20.6%Your Social Network 14 41.2%Other 10 29.4%No Response 1 2.9%
Bring together
physicians, resources
and patients to improve
their health care
journey
Situation Analysis
Strategic Objectives
Awareness Member
Involvement Recruitment
Building Capacity
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As a backdrop to the process described above, the creation of a member driven strategy should provide meaningful opportunities for physicians to participate and direct activities; however, these need to be efficient and convenient opportunities. Meetings, feedback opportunities and involvement need to be:
Flexible, Results focused, and Accessible to physicians.
The Division will enable the community to manage the needs of the physicians and seek to balance those with the needs of the community. To achieve that balance, a talent management strategy provides access to the appropriate physicians for the community. That strategy must balance:
Family physicians’ needs Collaboration with Fraser Health Authority and the BCMA Tenure – as physicians approach retirement and decrease workloads, there should be a
replenishment strategy in place Locums – availability to allow physicians the opportunity for continuing education or time
off work
Sub groups of physicians to be considered as key stakeholders
Specialists- the appropriate complement available to address community needs Hospitalists Emergency room physicians
This strategy will factor in the demographics of both the physicians and the community.
Plans must match what members would like to happen with their current behaviours. A plan considers a change program to address the needs and preferences.
What we know
Divisions are new and the programming for all Division is in a toddler phase of complexity and experience
Langley will compete for attention with larger neighbours of Surrey and Abbotsford Langley is known for being a family community close to Vancouver Family physicians value the continuity of care offered by practicing in Langley There is not a natural education rotation in Langley which means Langley may have to connect
with recruits in other environments o Potential recruits are new physicians, rural physicians, international physicians and
those looking to transition from locum/clinics into a practice Langley members report a high quality of life and a congenial work environment where they are
supported – 94% of respondent members report to being satisfied with their practices in Langley
The Division has the opportunity to tell the story of practicing in Langley Priority audiences would be physicians early in their residency and those in remote locations
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The Numbers
In the next 10 years:
Up to 42 physicians of the current 108 may retire 31 physicians would have to be added to maintain the current 1230:1 patient to physician ratio
with the projected growth in population
Up to 73 physicians may need to be added over the next 10 years to maintain the current delivery model with the current ratio of patient to physician.
If we were to assume that half the population growth was to occur over the next five years, the Division will need to increase its capacity to replace physicians as they retire in the near term.
In the next five years, 14% of members surveyed report the desire to retire. If we generalize that number to the 108 physicians in Langley the target replacement numbers look like this:
If all those physicians did retire and the population increased to half of 10 year target we project, the number of physicians needed to recruit would be 31.
These numbers may be on the high side for a couple of reasons:
Assumption one: most people do not retire when they report they are likely to retire. This still indicates a significant increase in the likely challenge and does indicate the likelihood of decreased capacity.
Assumption two: emerging delivery models may enable higher levels of patient to physician ratio.
Assumption three: these numbers do not factor in the mandate of the government to identify a family physician for every resident.
While the actual numbers may vary, these numbers allows for a scope of the need to be assessed. The solution should seek to build the capacity and ability to identify, attract and integrate physicians over the next few years. This starts by creating capacity and then setting actual recruiting targets based on yearly assessment of ability, access and need.
The external number to keep in mind is the supply of all new physicians entering medical school in British Columbia by 2015 is 288 for all classifications of physicians.
Langley Division Need Statement:
To find effective means to promote opportunities that are attractive to family
physicians to locate in Langley that will serve the need to support current Division
members and patient needs
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Primary Audiences
Members
o 68% have been in practice for more than 20 years
o 94% are satisfied with Langley as a location to practice
o 94% prefer email communication
o 41% are ‘Not Sure’ if they would want to share information about Langley and the
opportunity to practice
Physicians looking to relocate
o Remote physicians have incentive based contracts that when they expire regularly look
to move to locations with more support
o Family Physicians in their second year of residency make a number of decisions that will
impact where they practice medicine
Connecting partners that support match making
o Other Divisions are experimenting with their role ex. acting as connecting body with
members, advocating for practice models etc.
o The BCMA is charged with advocating for physicians
o The government has mandated for every citizen to have access to a family physician
The role of the Division will be to amplify the voice of Langley family physicians to support the demands
on the primary care system. This voice will connect the right fit physicians to opportunities in Langley
and support the increasing of capacity to recruit and integrate those physicians.
Key Messages for Recruits
1. Good place to bring up a family
a. Recreation
b. Education
2. Professional, respectful and congenial colleagues
3. We have the best of rural and urban practice
a. Access to the large centers of excellence
b. Autonomy and continuity of care
4. Diverse practices
a. Cradle to grave practices with a diversity of needs
5. Mentors and a community hospital
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The Pillars
This section lays out activities that cumulatively will support addressing the need. This section can also
set measures and targets. The targets should include activity, participation and numbers of recruits
converted. The target can also address efficiency by attaching a budget to each activity.
Sharing the value and opportunity to practice medicine in Langley
Awareness
12 months 24 months 5 years Confirm key messages Evaluate
communication effectiveness
Measure the awareness of Langley value proposition
Build communication collateral
Build process for consistent messaging
Have effective networks for sharing the opportunities in Langley
Participate in trade fairs Enable members to share messages
Have members and community members sharing your key messages and news
Move into health match and Fraser Health social media conversations
Refine trade fair participation
Have a reputation among Divisions for building an effective brand
Ensure website is SEO Tell stories of members who are having success (media and new media introduced)
Have advocates in the medical schools and involvement in the residency programs
Meeting members’ needs through support and involvement
Member Involvement
12 months 24 months 5 years Identify members who have talent needs
Build a dashboard to track emerging and current needs
Members are able to proactively access services
Connect members with resources
Have a frequently asked question section on the website
Members are an active source of strategic information
Monitor how effective member searches are
Visit with 20% of members each quarter in their practices
The Division is an effective service provider
Track member opinions on retention and succession planning
Evolve the AGM into a member engagement event
The Division is an effective advocate to meet supply needs
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Identifying, engaging, introducing and welcoming new physicians to Langley
Recruitment
12 months 24 months 5 years Capture the requests of this Division for information
Actively seek physicians to connect with local needs
Have residents and rural physicians visiting Langley
Create opportunities for target audiences to request information
Call and send target audiences information
Have well developed network to promote local opportunities
Match candidates with local physicians to ask questions
Data base potential recruits
Have a local pool of physicians to act as community ambassadors
Build a visit program Offer local mentorship and expand Locum outreach opportunities
Have a welcome program that integrates new physicians into the community
Having the tools, resources and partners to execute the Division’s plans
Building Capacity
12 months 24 months 5 years Build the process and procedures to support physician supply
Implement and refined process and procedures
Have effective methods to support the work of the Division
Identify technology needs to support document management and customer relationship management software
Acquire relevant tools Have the diagnostic tools to support effective engagements
Build volunteer model to support staff functions
Populate the volunteer model
Champion and recognized your leaders
Have board confirm direction and sponsorship role
Team and skill development work
Perform at a high level
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The Parking Lot
When planning ideas surface that are captured to be incorporated in tactical planning. These lists are
examples of tactics that may help the implementation of the strategic plan.
Health MatchBC has invested in creating conversations around physician identification and
placement. Langley should monitor and enter into conversations that help support physicians
looking for placement and when appropriate direct them to information about Langley. These
channels include: Twitter, Facebook and LinkedIn. Video is one of the most sharable and effective communication channels for telling stories.
o Host them on Youtube and imbed them in your website, share them on Health Match
BC social channels
o Don’t use high definition
o Make sure they are under two minutes in length
o Capture the key messages in video images and dialogue
o They do not have to be high quality productions if done in video blog style
o Have physicians tell their story to an interviewer beside the camera to maintain a
natural delivery
Your members are the most credible recruiters you have
o Reduce barriers to them connecting with their network for the ideal match
o Enable the community at large to share your messages online
o Link back to your website and contact information
o Build in call to action on your website ex. Ask questions, sign up for newsletter, request
an interview, visit or tour
Face to face communication is still the most powerful opportunity to influence. While many of
the tactics will support the awareness of Langley Division and practice opportunities, it will be
important to remember that decisions are most often made when the experience moves from
virtual to actual. Tactics that will remain important:
o Personal referrals
o Follow up phone calls
o Visiting a recruit in person
o Having recruits visit the Division
o Provide a person to answer questions and support the decision
Conclusion
The Division has an important role in supporting member physician supply needs. There is the
opportunity to create a general awareness about Langley with recruits, build platforms for recruits to
connect with the Division and prepare members to transition with the on boarding of physicians in the
near future. Planning will enable proactive activities to support predictable changes. The plan will also
have to adapt as the situation changes. This report provides a foundation of information to evolve that
plan as resources, stakeholders and patients’ needs change.
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References
Notes from Member Interview Summer/Fall 2011
Notes from Division Director Interviews Fall 2011
Board of Directors Langley Division Workshop Fall 2011
Population Health Profile Langley 2010 (Provided by Fraser Health)
Strategic Plan for The College of Family Physicians of Canada 2007-2011
“What does it mean to be a family physician?” Marie-Dominique Beaulieu, Valerie Dory, Dominique
Pestiaux, Denis Pouchian, Marc Rioux, Guy Rocher, Bernard Gay, Laurier Boucher; Canadian Family
Physician, August 2009.
“Locum practice by recent family medicine graduates” Douglas Myhre, Jill Konkin, Wayne Woloshchuck,
Olga Szafran, Chantal Hansen, Rodney Crutcher; Canadian Family Physician, May 2010.
“Challenges and achievements in caring for the elderly” Christopher Frank; Canadian Family Physician,
November 2010.
“Who wants to be a family physician?” Nicholas Pimlott; Canadian Faimly Physician, June 2010.
“Improving measurement of primary care system performance” Williams Hogg, Elizabeth Dyke;
Canadian Family Physician, July 2011.
“Health practices of Canadian physician” Erica Frank, Carolina Segura; Canadian Family Physician, August
2009.
“Mental health, job satisfaction and intention to relocate” H.V. Thomasen, Marcel Lavanchy, Ian
Connelly, Jonathan Berkowitz, Stefan Grzybowski; Canadian Family Physician, April 2001.
“Rewards and challenges of family practice” Donna Manca, Stanley Varnhagen, Pamela Brett-MacLean,
Michael Allen, Olga Szafran, Allen Ausford, Carol Rowntree, Ismael Rumzan, Diana Turner; Canadian
Family Physician, February 2007.
“The aging of family medicine” Nicholas Pimlott; Canadian Family Physician, July 2011.
“Women in medicine – The challenge of finding balance” Sophia Mobilos, Melissa Chan, Judith Belle
Brown; Canadian Family Physician, September 2008.
Report of the Advisory Panel on Resourcing Options for Sustainable Health Care in Canada to the
Canadian Medical Association, July 2011.
“Why would I choose a career in family medicine?” Ian Scott, Bruce Wright, Fraser Brenneis, Pamela
Brett-MacLean, Laurie McCaffrey; Canadian Family Physician, November 2007.
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“Demands, values, and burnout – Relevance for physicians” Michael Leiter, Erica Frank, Timothy
Matheson; Canadian Family Physician, December 2009.
11th Annual National Report Card on Health Care; Ipsos Reid, August 2011.
B.C. A Leader in Primary Health Care, Report Shows, News Release – Ministry of Health Services and BC
Medical Association, Nov 2010.