Canadian Journal of Rural Medicine

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Introduction: This study seeks to explore influential factors leading to physician turnover in designated Rural Northern Physician Group Agreement (RNPGA) communities in Northern Ontario, as well as physician's perceptions of the RNPGA contract and effects of the Northern Ontario School of Medicine (NOSM) on physician retention in these communities. Methods: Twelve qualitative semi-structured interviews were completed with rural physicians who had RNPGA contracts within the past 5 years but had left their practice community. Data collected from recorded interviews were analysed using a thematic analysis approach in order to identify common themes. Results: A range of factors influencing physician's decisions to leave were identified including lack of partner career prospects, burnout and lack of opportunities and amenities. Common challenges were sometimes also perceived as rewards of rural practice. The concern of lack of flexibility of the RNPGA contract was identified, as well as a perceived lack of presence of NOSM graduates in RNPGA communities. Conclusion: A variety of factors influence physician turnover in RNPGA communities. These may be considered by communities hoping to inform recruitment and retention policy. Renewal of the RNPGA contract may require consideration for availability of part-time positions, increasing the number of physicians funded and incentivising physician wellness. NOSM may consider mandatory postgraduate programme placements in RNPGA communities and further development of infrastructure in these communities to improve learner, graduate and institutional engagement.

Introduction: The purpose of this study was to identify, through self-assessment, how comfortable rural emergency medicine (EM) physicians are in treating critically ill trauma patients, the resources available to treat such patients and their comfort with performing trauma procedures. Methods: An anonymous self-assessment survey was e-mailed to family physicians practising rural EM in Saskatchewan regarding training, hospital resources, demographics and self-reported comfort with rural trauma management. We included physicians who had provided EM care within the past year in Saskatchewan outside of the major trauma centres. Comfort was measured on a Likert scale. Results: One hundred thirteen physicians out of a total of 479 physicians contacted agreed to participate (23.6%). Thirty-nine percent (n = 31) of respondents were comfortable with paediatric trauma, and 46% (n = 37) were comfortable with vascular trauma. Nineteen percent (n = 15) were comfortable with pericardiocentesis and 25% (n = 19) were comfortable with cricothyroidotomy. In the past 12 months, 21% (n = 17) had performed paediatric endotracheal intubation, 1.3% (n = 1) had performed cricothyroidotomy, 28.8% (n = 23) had performed needle thoracentesis and 20% (n = 16) had performed central venous line access. Those who did their residency training outside of Canada were more comfortable with overall trauma care. Those who had taken emergency department echo were generally more comfortable with trauma procedures. Those who had current advanced trauma life support were more comfortable with less frequently encountered aspects of trauma care. Conclusions: This self-assessment helped us identify which aspects of rural trauma medicine are the most challenging for rural practitioners. It gave us an understanding of the procedures related to trauma medicine that are the most difficult, which critical resources are available and where training could be focused to benefit rural emergency physicians.

Introduction: The HEART scoring system codifies the clinical gestalt used by physicians with 0–2 points assigned to 5 criteria (history, electrocardiography, age, risk factors and troponin). This scoring provides a prognostic tool that assists in disposition planning. The use of a truncated HEART score, minus the troponin data (HEAR score), was used for patients presenting with chest pain at one of four outpost nursing stations served by La Ronge Health Centre in northern Saskatchewan. These nursing stations have no onsite physician and no ability to obtain any troponin data. This study set out to determine if there was any utility in conducting point-of-care (PoC) troponins in these nursing outposts. Materials and Methods: A retrospective analysis was conducted using the La Ronge regional electronic medical record by searching for all patients for whom an outpost nurse had called a physician regarding chest pain symptoms between 01 January 2011 and 31 December 2016. The HEAR and HEART score were then calculated for each individual presentation of patients with chest pain that met inclusion and exclusion criteria. Results: By calculating both the patient's HEART score before evacuation from the outposts and after (i.e. with the troponin data), we were able to determine that, in 89.4% of cases (110/123 events), patients would require evacuation regardless of the troponin values due to a HEART score ≥4. In 10.6% (13/124 events) of cases, the patients who were evacuated had a HEART score ≤3, and in only one case did the troponin data increase this score. Conclusions: The majority of patients would continue to be evacuated regardless of the result of their PoC troponin due to an already elevated HEAR score. PoC troponin is unlikely to reduce the rate of evacuation of patients with chest pain from the nursing stations served by the La Ronge Health Centre.

Online since 24^th September 2018.