Through a lengthy Freedom of Information request, this data-driven project uncovered a growing doctor shortage in rural Western Manitoba and provided insight into the continuous problem of doctor retention in small towns. This article ran in The Brandon Sun in April 2016.

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From covering relocation costs to providing free housing to paying for extra training, many Westman municipalities are turning to taxpayer-funded incentive programs to address the high doctor turnover rates in their communities.

The wheel-greasing is, for many communities, necessitated by a growing doctor disparity between urban and rural areas in Prairie Mountain Health.

According to data acquired from PMH through a lengthy freedom of information request, rural communities have lost three times as many doctors as Brandon and Dauphin over the past five years — 75 doctors compared to 21.

During that period, roughly 60 physicians have been hired in both areas.

“As an elected official for a rural municipality, our responsibility is not health care — we deal with roads and bridges and water,” Prairie View Municipality Coun. Roger Wilson said. “One of the functions of an elected official is (also) trying to … get people to move to your community and without stable health care, it’s more challenging.”

Relative to its size, the town of Birtle has one of the highest turnover rates in the health region — losing three doctors since March 2010 while only hiring one.

For the second time in four years, Birtle Health Centre has zero doctors on staff.

While there are two nurse practitioners currently working in the clinic, many residents have been travelling to neighbouring communities for health care. However, with doctor shortages also affecting places like Shoal Lake and Hamiota, Wilson says service is affected across the map.

“Whenever you have a facility that is lacking a doctor … that impacts all of the surrounding communities,” Wilson said. “It’s kind of a domino effect.”

Only three of 26 rural communities that now fall under PMH had no doctor turnover in the last five years. Communities with the highest turnover rates include Deloraine, McCreary, Minnedosa, Carberry and Killarney.

During that same time period, the number of doctors working in Brandon has grown from 95 to 133.

Wilson says the RM has been setting aside money for health-care provider recruitment since Birtle started struggling with physician retention 10 years ago.

Several years ago, the town and the municipality bought a house as an incentive tool, which worked to bring one doctor on board, but subsequent hires have turned down the free lodging.

“Just because you have a house, it doesn’t mean they will want to live there,” Wilson said.

Killarney recently had success hiring two new doctors through a private recruiting firm to the tune of $250,000 in taxpayer dollars.

“If that model is successful, I’m sure everyone else is going to be perking up their ears and jumping on board — ourselves included,” Wilson said.

PMH CEO Penny Gilson says Killarney’s use of a headhunter doesn’t signify a loss of faith in the region’s abilities to recruit physicians, but rather a difference in priorities.

“As a region, we have to have a regional perspective and we have to place physicians in our top-priority locations,” she said. “We’ll work closely with communities, but that is their right to look at other options and to engage with private agencies.”

PMH conducts an exit interview whenever a doctor leaves the region. Gilson cites a host of reasons for the disparity between doctor retention in urban and rural Westman, including workloads, opportunities for spouses, hospital support staff and specialization options.

“They want some quality of life,” Gilson said, adding that international medical graduates often report feeling isolated in rural communities.

PMH also offers incentives to potential doctors in exchange for service commitments.

For example, PMH will pay for an international medical graduate to go through Manitoba’s mandatory licensure assessment or training program — which take three months and one year, respectively, to complete. In return, the graduate will commit to working in a rural community for several years.

While Gilson says the doctor assessment process is necessary, Wade Schott, head of council for the RM of Roblin, says the rules put Manitoba at a disadvantage for attracting talent from elsewhere.

“The requirements are a lot higher here, (doctors) have to work a lot harder to be able to practise here,” Schott said. “I think there should be common requirements right across the country.”

Roblin lost six doctors in five years and only managed to recruit four during the same period. Currently, there are two doctors on staff and the health centre’s emergency room is closed sporadically.

“A lot of times it’s closed because of lack of doctors. In fact, it’s closed right now,” Schott said, adding that the health centre services an area with roughly 3,500 residents.

Not unlike Wilson, Schott says doctor recruitment shouldn’t fall on the shoulders of municipalities, but he understands why it does.

“It should be the work of the health region, and we all should be treated fairly,” he said. “But it’s very tempting for a municipality to offer an incentive because that’s what our job is: to work for our ratepayers and to make sure they’re looked after properly.”

According to a December Probe Research survey of 400 rural Westman residents, 29 per cent of respondents listed health care as one of the top issues plaguing their community.

Kate Basford, head of council for the RM of Mossey River, says health care was a top concern for most of the councillors she talked to at a three-day municipality conference in Brandon last week.

“The hardship is equal for every community,” she said.

Mossey River’s health centre in Winnipegosis is one of PMH’s northern-most facilities and has experienced doctor shortages similar to those in Birtle.

Residents are currently travelling more than an hour away for medical and laboratory services, and Basford says a major issue in attracting doctors to the area has been the health centre’s lack of amenities.

“Until we get a doctor, we were recently told by the government, we will not be putting in an X-ray and have full lab services here,” she said, adding that two doctors recently declined jobs in the village because of the equipment deficit. “It’s like a chicken-and-egg situation.”

Basford says PMH and the province should be working harder to develop smaller health centres, rather than pooling investments in larger areas like Brandon, Dauphin and Swan River.

“Rural Manitoba is not Brandon, is not Dauphin … it is communities that have facilities with smaller numbers,” Basford said. “The whole system is broken … we have to look at this thing as a big picture.”

The Brandon Sun first requested information about doctor turnover from PMH last August. After filing a complaint with the Manitoba Ombudsman in October, the health region provided the documents free-of-charge in January 2016.

Requests for information about doctor turnover rates were also posed to the office of the province’s minister of health and the College of Physicians and Surgeons of Manitoba with no response.