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.