Does NOSM ever develops new community affiliations

[lwu018]

Does anyone know if NOSM ever develops new community affiliations? If so, I am hoping to get some of your thoughts and criticisms – especially from current students at NOSM – on the following situation. Thank you greatly to anyone who reads over this and can provide feedback as it is a very lengthy post.

 

I ask because the region I am from (i.e. Haliburton County) borders two of NOSMS regions (Muskoka and Nipissing) and, according to a news article back in 2010, was " the second-worst in Ontario in terms of family doctor shortage" (http://www.mindentimes.ca/2010/12/14/countys-doctor-shortage-draws-french-broadcasters-attention) – not certain if their claim is reliable or still valid. Further, a 2010 report by the Rural Institute of Ontario listed Minden Hills (i.e. the county seat of Haliburton) as one of four communities in Ontario with “the worst accounts of poor access to family doctors” (http://www.ruralontarioinstitute.ca/file.aspx?id=ce33d262-b27e-49a1-986d-2da1b9d1c384). From personal knowledge, I am well aware that the area, and specifically Minden Hills, has had a severe persistent shortage of doctors. Prior to 1996, there were six full-time GP/FP's in Minden. From 1996 to 2004, the number dropped to 2 full-time and 2 semi-retired part-time GP/FP's. By 2008, there was only one full-time and one 70+ year old part-time GP battling metastatic cancer. From 2008 to present, there is only one full time GP. I should note, however, that since 2008, MOH LTC funded the Haliburton Highlands Family Health Team to provide comprehensive medical services to all residents of Haliburton county- Minden and Algonquin Highlands included. The team of family phyisicans, nurse practitioners, dietician, occupational therapist and chiropodist alternate between their Haliburton and Minden sites in 3:2 ratio. Currently, one Family Health Team physician comes to Minden one day every other week to supervise patients registered to the nurse practitiioners. Haliburton Highlands Health Services also contracts a group of emergency-physicians from Bracebridge, Barrie, Lindsay and Peterborough to staff the Minden (emergency-dept only) hospital.

 

Whether or not this problem of a severe physician shortage in the area will improve in the future is questionable. One problem that exists, in my mind, is that Haliburton is one of the few counties / districts in Ontario that doesn’t belong to – or is considered an extended region of - one of Ontario’s sub-regions with a medical school. Eastern Ontario has Ottawa and Queens, the Golden Horseshoe has Toronto and Mac, South western Ontario has Western, and Northern Ontario has NOSM. The only sub-region that Haliburton belongs to is Central Ontario, which has no medical school. Consequently, my thought is that few medical students and residents will be apt to do their family medicine rotations or other forms of training in Haliburton County compared to other regions of Ontario. I have heard of a couple medical students who did their rotations in the area from Ottawa, Queens and Toronto, but these occurrences are far and few in between. Considering that engagement in a community during a medical student’s training is an important motivating factor for that student to practice in that community in the future, it would seem to me that the Haliburton County would be at a disadvantage in the future for recruiting and retaining family physicians.

 

NOSM’s social accountability mandate includes “actively involving ..... rural and underserviced communities” and “increasing the number of physicians and health professionals with the leadership, knowledge and skills to practice in Northern Ontario”. Because the communities of Haliburton County are rural, underserviced, and relatively north – they are on similar latitudes as Muskoka District’s communities – I would think that an affiliation between these communities and NOSM would be beneficial for all parties involved. Haliburton County would provide increased rural training opportunities for NOSM’s students and such training opportunities would hopefully lead to increased recruitment and retention of family physicians in the communities of Haliburton County in the future.

Overall, does this seem reasonable or are there major flaws in my thinking. If it is even possible to facilitate an affiliation between the communities of Haliburton County and NOSM, what would be some of the major hurdles and barriers?

 

Thanks again to anyone who can provide feedback / managed to actually read through this without falling asleep

[Real Beef]

NOSM for sure has added communities to the 'NOSM family'. You can simply look at the list of affiliations and the dates at which these affiliations were signed:

 

http://www.nosm.ca/uploadedFiles/2012%2003%2028%20CA-MOU-Site%20Agreements%20Schedule-1.pdf

 

From their website they describe these as:

 

"Affiliation agreements solidify these relationships between NOSM and its extended reach of professional partners. To date, more than seventy have been signed with various centres across the North. This growing number of agreements, in addition to securing associations with hospitals, health centres and communities, enables students, faculty, and staff to become immersed in the culturally diverse region they are serving."

 

Once a health center, hospital, physician group is signed I suspect the 'community' is added to the list of communities.

 

However I feel that NOSM is not a Napoleonic organization, trying to extend its territory more southerly but rather adding additional communities within its pre-existing boundaries. Again pure speculation but there are plenty of communities within the current lines that could be added. It would be interesting to see what would happen if Minden Hills FHT approached the Dean of Community Engagement requesting a formal affiliation with the school. But I doubt NOSM would approach them but if local physicians did it might fly ... not sure. But if Minden Hills Physicians havent approached NOSM since 2005 then likely they wont at this point.

 

Beef

[lwu018]

Interesting document, thanks Beef I wasn't aware that NOSM is continually developing new affiliations with community health centers / health teams / hospitals. In fact, it seems several of their collaborative agreements were signed less than a year ago. This type of information helps significantly.

 

I agree though that it is far more appropriate for NOSM to seek out developing new affiliations with communities within their borders. Nonetheless, I am curious to see what NOSM would say if they were approached by HHFHT requesting a formal affiliation. I can't speak for the HHFHT as a whole, but I can guarantee Minden Hill's family physician would be very interested in taking on NOSM's students as part of their ICE or CCC training. I guess the question then is why HHFHT has not yet approached NOSM or, if they have, why did it not go through the first time? Time to do some investigating.

[Real Beef]

Report back if you find something interesting.

 

Interesting document, thanks Beef I wasn't aware that NOSM is continually developing new affiliations with community health centers / health teams / hospitals. In fact, it seems several of their collaborative agreements were signed less than a year ago. This type of information helps significantly.

 

I agree though that it is far more appropriate for NOSM to seek out developing new affiliations with communities within their borders. Nonetheless, I am curious to see what NOSM would say if they were approached by HHFHT requesting a formal affiliation. I can't speak for the HHFHT as a whole, but I can guarantee Minden Hill's family physician would be very interested in taking on NOSM's students as part of their ICE or CCC training. I guess the question then is why HHFHT has not yet approached NOSM or, if they have, why did it not go through the first time? Time to do some investigating.

[lwu018]

Report back if you find something interesting.

 

Certainly will do. In the midst of writing up a letter to the lead physician of HHFHT and the CEO President and CEO of the Haliburton Highlands Health Services to get their thoughts on approaching NOSM for an affiliation. Thanks again Beef!

[Anne]

In terms of having community partnerships there are many that extend outside the "NOSM" region which is defined by the Northeast and Northwest LHIN- and to some extent the North Simcoe Muskoka LHIN at least for third year CCC. There are NOSM preceptors in areas that are part of other LHINs. I am on a clinical NOSM placement right now in a rural area typically covered by the ROMP framework. The only reason for the overlap is that sometimes preceptors go on vacations or need some well deserved time off teaching and ROMP covers NOSM students for placements that are in the more northern parts of bordering LHINs. However, if a student wanted to do an elective in Haliburton they would go through ROMP and that is unlikely to ever change even if from time to time students started going there for required clinical experiences. Haliburton is already covered by ROMP http://www.romponline.com/community/community.cfm for student education partnerships. Haliburton is part of the central east local health integration network and LHINs are what really direct everything (funding, geographic associations, academic associations). For example, and a bone of contention for some, even though at my current placement there are NOSM preceptors if someone applies to NOSM from this region they are not considered "northern" on their application only "rural" because they are not from one of the communities in NOSM LHINs. I actually think it is a blessing in disguise to be partnered with ROMP - ROMP is the main rural program for UofT and is also heavily utilized by Western. You will get way more students coming through your community with ROMP designation than a NOSM one.

[lwu018]

Thanks once again Anne for your time and sharing this valuable information. You make some excellent points regarding the importance of ROMP for Haliburton County and the low likelihood of changing Haliburton's affiliation with the ROMP program. I was wondering though why you think a ROMP designation, as compared to NOSM one, would get way more students coming through Haliburton. I realize that ROMP is the main rural program for UofT and is also heavily utilized by Western -- hence it has far more participants compared to NOSM's CCC and ICE -- but I wonder if this would necessarily translate out to ROMP providing a greater number of medical trainees to the Haliburton area over the next 5-10 years compared to what NOSM would provide. For example, if the ROMP program, compared to NOSM, has a much larger number of spots for their participants to go for training experiences, say because of a greater number of participating communities (hypothetical, don't know if this is true), then it seems possible Haliburton could receive less trainees per year compared to what NOSM could provide. Of course, this is purely speculative. On that note, do you know where I can find stats on the number of ROMP participants who have undertaken training in the Haliburton area over the past 5 - 10 years?

Thanks again Anne for your insight

[Anne]

Ask ROMP for the stats, they probably have them. I think to get people to come back and practice they just have to have a great experience. Where I was is all staffed by recent U of T, Western, and Mac grads who all went there through ROMP as students or residents and loved it, then returned to practice. I think people's choices to practice seems to have to do with their experience in the community, the preceptor they have, and other things related to the work environment.