Nunavut joins European Union study to address high turnover of doctors

A new $2.9-million international study will test solutions to an issue that has long plagued northern communities — the high turnover of medical professionals.

In Nunavut, it's unusual to have a family doctor, who you see year after year. The territory has struggled to retain physicians and nurses since its inception — holding the title of fewest doctors per capita in Canada. The hospital in Iqaluit relies heavily on locums — temporary doctors who are flown in — and many community health centres are run by nurses, who also have a high turnover rate.

"It's challenging for us as community members when we're constantly seeing different professionals," said Gwen Healey, the executive and scientific director of the Qaujigiartiit Health Research Centre in Iqaluit.

"We are capable of finding solutions to help mitigate some of those challenges."

Healey is also an assistant professor at the Northern Ontario School of Medicine (NOSM), which is partnering on the "Recruit and Retain Project."

The European Union project has been going on for three years and has already identified 29 ideas for tackling the issue of attracting and keeping doctors in rural communities.

Some are as simple as meeting new recruits at the airport or helping new doctors find childcare.

Regular doctor makes 'massive difference'

Dr. Madeleine Cole, a family physician in Iqaluit, said she thinks having a regular doctor "makes a massive difference to people."

Cole first came to Nunavut in 2000 for her family resident training and returned after five years to settle permanently in Iqaluit.  

"Continuity of care and the ability to see the same physician over and over is actually what is supposed to happen," she said.

"And most people in Nunavut don't really realize that because they've never experienced it."

Cole, who recently wrote about practising in a remote region for the new book The Surprising Lives of Small Town-Doctors, said being a Nunavut doctor means being a generalist and adapting to uncertain conditions.

"We get really good support from specialists down south because they know there isn't anyone else up here able to troubleshoot."

Getting health care professionals to come to rural and remote communities is an "ongoing challenge," the Northern Ontario School of Medicine said in a news release.

It says both northern Ontario and Nunavut — the two Canadian regions chosen for the research — "have historically faced shortages."

Community solutions

Healey says people who live in the North are in the best position to come up with solutions to keep doctors and nurses, because they understand the challenges, like isolation, and the benefits, like a connection with the land.

"That's really where we're excited to try and dig into the issue," Healey says.

"What are community solutions to some of these challenges? What do people feel can help make a positive contribution? And then how can we test those? And how can we build on them and apply them in our work?"

Being rooted in a northern community, says Cole, means "exciting, fun, meaningful work" for doctors.

For those who choose to stay, it also means providing more nuanced care, since doctors who know the history and context of Nunavut will be better able to understand and diagnose issues.

Canada is the only country outside the European Union to take part in the project. The study is also looking at doctor retention in Sweden, Iceland, Norway and the Scottish Highlands.