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Nearly half of NOSM-educated docs are practising in the North

Dr. Sarita Verma, the head of Northern Ontario's medical school, says the university places a 'huge emphasis' on family medicine
NOSM University 3

THUNDER BAY  — On the first anniversary of its re-birth as a stand-alone degree-granting institution, the head of the Northern Ontario School of Medicine University said she's "extremely satisfied" with the number of NOSM-trained doctors who are now practising in the region.

Dr. Sarita Verma said NOSM U has one of the highest recruitment and retention rates among Canada's 17 medical schools.

According to data provided to TBnewswatch, 1,011 physicians have completed their medical degree and/or residency at the former Northern Ontario School of Medicine since it accepted its first cohort in 2005.

Of these, 467 doctors — 46 per cent — have stayed to practise in the North.

These include 161 doctors practising in Northwestern Ontario, of whom 50 are practising in rural in communities.

Those 161 in the Northwest include 123 family medicine practitioners and 38 specialists.

"When you think about the fact that almost half of them actually stay here, that means we are filling our residency programs with people who are from NOSM," Verma said this week in an interview. 

A residency is a period of training that all medical program graduates are required to take after university.

"The linear relationship that you expect between people being admitted to medical school and when they go into practice is still a work in progress," Verma said. "NOSM actually just started offering residency programs less than 10 years ago, and we have only offered nine of the 130-plus residency programs that people can undertake. So most of the graduates have to go somewhere else to do their residency."

Verma that some of these individuals are still enrolled in five-year or eight-year residency programs. 

"So we have yet to see the outcomes of this," she said. "It's too early in the game."

NOSM University is implementing a significant expansion of enrolment in stages, resulting in a 32 per cent increase in the number of admitted students by 2025.

Verma said she's very pleased with NOSM U's retention record to date, but expects its contribution to filling the doctor shortage across the North will improve further in the coming years.

"We're going to almost be doubling the size of the MD program. We're also looking to open up many — almost 20 — residency programs," she said. "If you want to be a cardiologist, you can't train here, you have to go somewhere else. What we're going to do over the next few years is see that change. In the natural history of a medical school, it takes about three decades before you actually see the direct output from the input."

But a significant challenge remains across Northern Ontario and across Canada in finding more family medicine practitioners.

In Thunder Bay alone, between 10,000 and 20,000 residents are not currently rostered to a family doctor.

Verma said although there's been a decline in interest in family medicine across the country, NOSM U has won awards for 13 straight years for having the highest proportion of students choose family medicine and go into rural family practice.

"We're tracking all of our data. It's too early for us to show all of it because it's a longitudinal process, but 50 per cent or more of our graduating class chooses family medicine. So there's a huge emphasis at our institution on family medicine. You would compare that to between 20 and 29 per cent of the graduating classes in the rest of the country." 

She called that outcome "remarkable," but said there's an urgent need to get family doctors to serve the approximately two million Ontarians and seven million Canadians who don't have one.

Health care 'grinds to a halt' without access to a family doctor

"Without access to a family doctor, it grinds your health care to a halt. Sustainability for critical care is a critical function for not just NOSM University but for the entire system. One of the biggest problems is that we can bring people in and educate and train them, but it's actually up to the community, the municipality, the city, to then recruit and retain them."

Verma called models of remuneration for family practitioners in Northern Ontario not as effective as "much more seductive" models of remuneration elsewhere, such as turnkey office operations that allow doctors to immediately walk in and open up a practice.

But she also stressed that burnout from heavy workloads — exacerbated by the pandemic — and the administrative burden from having to do paperwork and toil seven days a week "with a take-home that's 20 per cent of what you earn" is not the way to attract more people to family medicine.

Verma said it's "mostly" up to the federal and Ontario governments to resolve this issue. 

In Thunder Bay, the Community Economic Development Commission works to recruit health care professionals, with a focus on family doctors.

It has tracked 15 family physicians who have started practice in a primary care setting in the city since 2018, and was involved in the recruitment of at least nine of them.

Community health sciences recruiter Lexie Penko said most municipalities in Canada have similar programs, and "it is a highly competitive environment."

Penko said that although there are aspects specific to Thunder Bay that affect recruitment, the larger problem is that fewer doctors are interested in family medicine and primary care.

"There are specialist areas of medicine that appear to offer more attractive career and practice opportunities," she stated in an email to TBnewswatch.

Penko also noted that even though new doctors have come to Thunder Bay, there have also been a number of retirements involving doctors leaving behind larger patient loads than most new physicians are willing to take on.

She estimates that the city needs 16 to 20 family doctors, assuming each would roster between 1,000 and 1,200 patients.

The CEDC hosts and partners on events and initiatives that allow Penko to promote local practice and lifestyle opportunities to prospective recruits.

It also administers grants and scholarships targeted to medical learners.

"I am constantly promoting local practice opportunities in family medicine as well as family medicine as a career choice," Penko said.

Her office coordinates site visits with family physicians and family medicine residents to connect them directly with primary care clinics.

The CEDC also maintains a strong online presence that provides comprehensive information on practice opportunities, incentives, and other particulars.

Penko said she believes "NOSM U is doing amazing things for the region," noting that of the 15 family doctors recruited to primary care in the city since 2018, all but one trained with NOSM.

She said the CEDC expects the medical university it will continue to play a crucially important role in producing physicians who work in Thunder Bay.


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Gary Rinne

About the Author: Gary Rinne

Born and raised in Thunder Bay, Gary started part-time at Tbnewswatch in 2016 after retiring from the CBC
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