There is a serious physician workforce crisis looming in Ontario. The physician shortage has been influenced by several important factors that predate COVID-19, but the consequences of the pandemic have exacerbated the situation significantly. Some of the reasons for the physician shortage include:

1. Disruptions for graduating physicians going into independent practice (provisional licenses are in place but time out for delayed exams);
2. Early retirement of some physicians because of COVID-19 or changes in their scope of practice due to workload challenges;
3. Ongoing difficulty in recruitment and retention for rural, northern, Indigenous and Francophone communities, and under-represented populations;
4. Insufficient residency positions in Ontario, causing a net migration of newly-graduated MD’s out of the province; and,
5. Some physicians decreasing the size of their practice to manage effectively the increasing needs of the population—in particular the population with complex, chronic illnesses.

The deficiency of physicians for historically underserviced and vulnerable populations has been an ongoing challenge. The current pandemic has been superimposed on an already fragile system and has exacerbated the concerns of care delivery sustainability. Specific areas of care such as mental health, public health, long-term care, and seniors’ care are particularly affected.

The pandemic has further highlighted for the Council of Ontario Faculties of Medicine (COFM) the urgent need for both a re-evaluation of the workforce pipeline and the comprehensive development of novel ways to achieve better distribution of physicians across the province. The six medical schools agree that we urgently need to reconcile the demographic needs of the province, practice patterns of the contemporary physician, and the future health-care needs of communities.

The current planning model is not sufficiently nimble to adjust to crises and major disruptions like COVID-19. System fragility and instability remains in many communities and is anticipated in others due to an aging/retiring physician workforce, an increased demand for patient care while at the same time having to train NOSM learners across Northern communities to obtain the necessary skills for clinical practice. Thus, COFM has submitted a proposal to expand all medical schools in undergrad and postgrad positions to increase the number of doctors in Ontario. NOSM is a full participant on this proposal.

An unpredictable and fragile Northern physician workforce.

Today, we are facing an unpredictable and fragile Northern physician workforce, with many clinicians on the brink of either retiring (aging physician workforce) or withdrawing from some services including teaching—an essential element of the NOSM distributed model—as clinicians continue to be under-resourced, overwhelmed and only able to focus on immediate patient care needs. This has been exacerbated by the COVID-19 pandemic changes in work commitments for clinicians. Those who remain in the Northern physician workforce are deeply worried and concerned that Northern Ontario is in the same crisis it was in when the original review of need made its recommendations 20 years ago.

Currently, physician shortages/vacancies across Northern Ontario exist as follows:

• > 100 family physicians – mostly rural generalists; and,
• > 100 specialists in the five Northern urban hospitals, but also in large rural communities like Sioux Lookout and Kenora.

Additionally, it is estimated (through work done recently by the Centre for Rural and Northern Health Research) that up to 50% of rural clinicians expect to retire in the next five years.

In relation to individuals in other areas of the province, in the North there is:

• lower life expectancy (by two years on average);
• greater difficulty accessing primary care in a timely way;
• increased burden of complex chronic conditions; and,
• greater burden of mental illness and addictions.

We are on it.

We are focusing on developing the best residency programs. There are new pathways being launched, including the Rural Generalist Pathway (RGP). The RGP is envisioned as a pathway with multiple points of entry from high school through to postgraduate training, culminating in an attractive clinical and academic career in a rural community, well-supported through meaningful contracts and administrative resources and ideally with a faculty designation that acknowledges the breadth of the Rural Generalist role.

The Rural Generalist faculty of NOSM will be supported to be “joined up” in ways that support mentorship, leadership, and resilience of the clinical community of rural Northern Ontario. We are deeply engaged in advocacy for recruitment and retention of physicians with our partner hospitals and Academic Health Science Centers. Our strategic plan focuses on our primary mandate—the strategic direction Transform Health Human Resource Planning means we are working on developing better data to identify the ‘needs of Northern Ontarians’ and the best ways to align the output of physicians to practicing in areas of need. Reforming our admissions process and criteria to curricular reform and improving community engagement are specific projects to increase our success in this regard.

As a government strategy, NOSM has been a success and has obviously had an impact in Northern Ontario. But we can do better and at NOSM we are poised to do so. Check out our new strategic plan at strategicplan.nosm.ca.

Thank you, miigwetch, merci to all.

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Please continue to follow my journey on Twitter @ddsv3 using #WhereisDrVerma.

I welcome input on this blog and other issues you want to bring to my attention by email to dean@nosm.ca.

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Did you know?

Canada has among the lowest number of practicing physicians per thousand population compared to other OECD countries, ranking 29^th out of 33, with a ratio of 2.74/1000 compared to the world average of 3.5/1000. Within Canada, Ontario ranks 8^th out of 12 provinces/territories in physician to population ratio. At present, more than 1.3 million Ontarians still do not have regular access to primary care (Stats Canada, 2016).

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Did you know?  

Dr. Sarah McIsaac, NOSM’s Medical Director, Faculty Development, has partnered with the School on a Crazy Socks for Docs initiative. By making a gift of $20 or more, you will receive a pair of Crazy Socks for NOSM Docs and help us develop programming and support specifically for faculty at NOSM. These past few months have been challenging for everyone, and Dr. McIsaac believes it is important that we create a network of support and inclusivity.

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Did you know?   

If you are searching for a family doctor, here are a few tips:
Learn how to find a family doctor, nurse practitioner or specialist and details about the Health Care Connect program.

1. Register with Health Care Connect and have a nurse find a doctor or nurse practitioner for you.
2. Use The College of Physicians and Surgeons of Ontario’s Find a Doctor search. And choose “Advanced Search” to find a doctor near you (by city/town or postal code).

Also, a resource titled We’re Your Family Doctors is recommended by Dr. Sarah Newbery (NOSM’s Assistant Dean, Physician Workforce Strategy and former President of the Ontario College of Family Physicians) is a tool for understanding how to ensure you access your own family doctor if you have one, and how to find other ways to access care if you do not have one yet.

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Did you know?

A virtual panel event is being hosted to discuss the benefits of hiring a Physician Assistant to help support your practice and how you can become a clinical partner and offer placements for the PA Program. In the era of COVID-19, and with health system resources being stretched thin, the panel will include those who have supervised student PAs and subsequently hired them. Never has there been a better time to add such a valuable resource to your team.

Wednesday, December 2, 2020
5:00 – 6:00 p.m. EST
RSVP here.
For more information, visit nosm.ca/pa.

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SPECIAL EDITION

Hello, Aanin, Boozhoo, Bonjour,

Today marks another historic day at the Northern Ontario School of Medicine (NOSM). I am very proud to share The NOSM Challenge 2025, the School’s third strategic plan. The theme reflects the need to challenge ourselves, our communities, our ideas, and our commitment to social accountability in order to drive change and improve access to quality health care in Northern Ontario.

The five-year plan sets out the School’s goals, aspirations and outcomes by 2025. With an updated mission statement “to improve the health of Northern Ontarians by being socially accountable in its education and research programs and by advocating for health equity,” we have identified four strategic directions:

1. Transform Health Human Resource Planning
2. Advance Social Accountability
3. Innovate Health Professions Education
4. Strengthen Research Capacity in Northern Ontario

As well, to ensure the successful implementation of its plan, The NOSM Challenge 2025 identifies the following four strategic enablers:

1. Valuing Our People
2. Managing Our Resources
3. Investing in Our Infrastructure
4. Sustaining Our Resilience

NOSM listened to you. Our plan is grounded in input from nearly 2,000 stakeholders including learners, staff, faculty, partner organizations, and community members from across Northern Ontario. NOSM will train health-care professionals of the future to work in an increasingly uncertain and volatile world.

NOSM will promote innovation, discovery, and academic and clinical excellence while building a culture of diversity, inclusion, respect, equity, and empowerment.

How can we formulate strategy in the face of uncertainty?

That’s the fundamental question leaders in today’s rapidly shifting environment must ask as they prepare for the future. And in the midst of a global pandemic, answering it has never felt more urgent.

Even before the COVID-19 crisis, we were witnessing the worsening health inequities, rapid technological changes, growing economic interdependence, and mounting political instability that conspired to make the future increasingly murky. Uncertainty was so all-encompassing that to fully capture the depth and complexity of the issues we were facing, researchers had devised elaborate acronyms such as VUCA—volatility, uncertainty, complexity, and ambiguity and TUNA—turbulent, uncertain, novel, and ambiguous.

When the pandemic hit, the sense of uncertainty was so pervasive that many medical schools doubled down on efficiency at the expense of innovation; favouring the present at the expense of the future.

Although we at NOSM were adjusting to the ‘new normal’ we were also pivoting toward preparing for the future in virtual health education and population-based research.

We were already, and still are, ahead of the curve. While a lot of schools have focused solely on surviving immediate threats, at NOSM we rose to the Challenge immediately working on creating new ways to address the issues of the day.

We recognized that the decisions we were making in those moments would have ramifications for years—or even decades. And we recognized that we had to manage our way through the crisis and find a way to link current workloads to future outcomes.

Strategic foresight—offers a way forward.

This strategic plan, The NOSM Challenge 2025, imagines multiple futures in creative ways that heighten our ability to sense, shape, and adapt to what Northern Ontario’s health, education and research reality will look like in the years ahead. Strategic foresight helps us figure out how to innovatively think about the future.

This was no small challenge. In order to survive and thrive over time, we plan to leverage our existing resources and explore new ones. We expect to be flexible and ambidextrous, with an eye to the future. We will confront curricular renewal, new admissions criteria, new pathways, innovation in research and new collaborations and partnerships, while ensuring that health human resources stay in the North. And we will always have a focus on our graduates, who remain committed to our values of social accountability, inclusiveness and respect. Strategic foresight in this plan doesn’t just help us figure out what to think about the future. It helps us figure out how to innovatively think about it.

In The NOSM Challenge 2025, we are imagining a plausible, but a dramatically different future. This can be the most difficult part of the implementation of the plan, particularly for those used to more pragmatic modes of thinking. What we’re doing here is asking every individual in the NOSM community and beyond to push yourself to imagine what the future will look like in five, 10, or even 20 years. I challenge you to prime your imagination and push the envelope of inventiveness.

Between now and 2025, through this Plan, let’s inhabit that future, let’s influence it and let’s make an impact! As the pandemic has made it clear that needs and assumptions can change quickly and unpredictably, preparing for the future demands constant reappraisal, swift ability to pivot, and significant resiliency and perseverance.

This plan, this Challenge, this NOSM, has great potential and provides real opportunities for the School to gain competitive advantage through strategy.

This is our collective call to action. Join us in The NOSM Challenge 2025.

 

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Please continue to follow my journey on Twitter @ddsv3 using #WhereisDrVerma.

I welcome input on this blog and other issues you want to bring to my attention by email to dean@nosm.ca.

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So you think you know about health care in Northern Ontario?

Take the NOSM Trivia Challenge. The game will inform and engage you with what unites us all in The NOSM Challenge 2025. Earn ballots for your chance to win $1,000 and when you register, select a Northern Ontario community that you want to play for and help them win $10,000 for a hospital or health centre in their community. Thank you to TD Insurance for sponsoring the NOSM trivia challenge.

To test your knowledge about Northern Ontario and NOSM—and for a chance to win—visit thenosmchallenge.ca. The game is open now until January 12, 2021 at 11:59 p.m. EST.

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Tomorrow is Remembrance Day

Remember the service of our veterans and service providers in the armed forces. You’re your poppies, pause for silence or participate in a memorial.

In Flanders Fields the poppies blow
Between the crosses, row on row,
That mark our place; and in the sky
The larks, still bravely singing, fly
Scarce heard amid the guns below.

We are the Dead. Short days ago
We lived, felt dawn, saw sunset glow,
Loved and were loved, and now we lie,
In Flanders fields.

Take up our quarrel with the foe:
To you from failing hands we throw
The torch; be yours to hold it high.
If ye break faith with us who die
We shall not sleep, though poppies grow
In Flanders fields.

John McCrae