News at Medicine - July 2014 - Memorial University family medicine graduates take up practice

Memorial University family medicine graduates take up practice
July 4, 2014
After a two-year family medicine residency at Memorial University, 31 newly-qualified family doctors are busy planning their future. At the same time, 32 new MD graduates are entering the family medicine residency at MUN.
 “I have loved my journey through family medicine at Memorial University’s Family Medicine Residency program,” said Dr. Raie Lene Kirby, who has just completed her residency. “The two years have given me so much exposure through rotations both in the city as well as rural and remote parts of the province and beyond – including Nunavut for maternal health/obstetrics.“ 

Dr. Laura Edwards, who is originally from Lawn, said Memorial’s Family Medicine Program provided her with the opportunity to go home to the Burin Peninsula and complete her second year of family medicine training. “It was an amazing and very rewarding experience to work at home in both the clinic and emergency room settings. The experience enabled me to follow patients over time and develop strong and trusting doctor patient relationships. Burin is a very warm environment and the doctors, including my preceptors Drs. Lyn Power, Stacey Saunders and Dr. William Moulton, as well as the specialists, are very supportive.”
Because of her positive experience in Burin, Dr. Edwards has chosen to start practice for at least a year, as a fee-for-service family practitioner based out of the community hospital in St. Lawrence, located just 10 minutes from her home town of Lawn. The practice will include clinic, emergency room coverage as well as long term care responsibilities.
“I love rural Newfoundland and I wanted to start off my career by giving back to my community,” said Dr. Edwards. “I look forward to living close to my family and the challenges that lie ahead. I feel that the residency program has prepared me well as I set out on my own. One of the biggest challenges for rural Newfoundland and Labrador is recruitment and retention of family physicians. I hope that the provincial government continues to provide support to rural areas and that my colleagues see the potential of what rural communities in the province have to offer, which is a very rewarding career.”
Dr. Danielle O’Keefe, program director for the Family Medicine Residency Program, said 16 of the new family medicine graduates are staying in Newfoundland and Labrador, eight will be starting practice in other parts of Canada, while seven will be completing additional training. Of the 16 staying in the province, many will be providing locum coverage – replacing a regular physician for short periods of time – while others will be setting up their own practices. 
“After six years of medical training, the residents are ready to embark upon their professional careers and we wish them all the best of luck,” said Dr. O’Keefe. “Our incoming residents join 36 colleagues who have just started their second year of family medicine training.”
Dr. Kirby, who spent the last 10 months of her program in Botwood, is one of the new graduates who will be doing locums to get more experience in a variety of practices and see what she wants her eventual future practice to look like. She is currently scheduled to be in Botwood for the summer, doing family practice plus emergency room coverage. “I have subsequently lined up another locum for the fall in Portugal Cove with plans on becoming involved with the general practice low-risk obstetrics group in St. John's.”
Dr. Cathy MacLean, chair of the Discipline of Family Medicine, said residents provide an invaluable service doing locums by filling in for family doctors who often work in emergency, long-term care and nursing homes, as well as their regular practices. “They feel best when they can go and have a holiday and know the practice is in good hands,” she said. “Our residents provide many family doctors with this break and their patients with good care while their usual doctor is on holidays. Locums are also a wonderful way that residents gain more practice experience – it is a normal and very common means that residents use to transition into practice.  It also helps them pay off debt before assuming any new debt settling into a practice of their own.”
Dr. MacLean noted the seven new graduates completing additional training will be studying in areas of need such as palliative care, care of the elderly and developmental disabilities. “Our Family Medicine Program offers an enhanced skills program in emergency medicine to meet needs here in Newfoundland and Labrador – usually about one quarter of residents in family medicine do additional training, with the largest program being in emergency medicine. We try to encourage those residents who do enhanced skills training in specific areas to continue to do some family medicine when they finish as well.”
Dr. MacLean said Memorial’s Family Medicine Residency Program is succeeding in its mission to prepare more doctors for practice in Newfoundland and Labrador, especially in rural areas. “A study last year showed there were 300 of our graduates practicing in the province. That’s a lot of family doctors, all trained by here for here. This year we have added 16 more well-trained family physicians who are going to places all over the province, including Happy Valley-Goose Bay in Labrador.”
The Family Medicine Program is changing its training model to streams so more residents can train in regions of the province for their entire two years “This is to enhance recruitment,” said Dr. MacLean. “We are also working to get more postgraduate residency seats at Memorial. And we are working with government, the Newfoundland and Labrador Medical Association, and the NL chapter of the College of Family Physicians of Canada to help improve the primary care system here. We can train residents but we also have to create a primary care model, like the Patients Medical Home, to make it so they want to stay and practice in Newfoundland and Labrador.“
Dr. MacLean said the province needs more group practices and more team members to work with family doctors around the province including family practice nurses, pharmacists, social workers and psychologists. “This team approach in group practices that have an Electronic Medical Record system is something graduates are looking for. Once Newfoundland and Labrador puts this model in place, we will retain more of our trainees.”
Dr. Robert Power, another new family medicine graduate, said the program gave him great exposure to medical practice in rural and remote areas. “As advertised, the program here has a strong rural focus. Residents can choose from a variety of rural sites, some more rural than others. I spent time in Placentia, Springdale, Grand Falls-Windsor, Gander and Corner Brook as well as St. John's.”
Dr. Power, who grew up in rural Newfoundland, said he was already open to the idea of working in a rural area.  “When I saw first-hand the diversity of practice afforded to family doctors in rural areas, I knew that this was the right set up for me. My immediate goals are to establish myself in Placentia, get some experience and continue to develop my skills as a rural family doctor.  Long-term plan remains to be seen, but it will certainly involve practicing somewhere in this great province”
Dr. Brie Quinton is also a new family medicine graduate, planning to do locums until the right permanent practice opportunity presents itself. “Throughout my residency, I practiced medicine in numerous rural areas including Grand Falls-Windsor, Springdale, Gander and Miramichi, NB. Each area offered their own challenges and provided fulfilling experiences.”
Dr. Kirby added that family practice in Newfoundland and Labrador is extremely rewarding.  ”It is a practice full of wonderfully interesting and enjoyable patients, complicated and exciting medicine with the opportunity to be involved in the many facets of primary care including the emergency room, obstetrics, palliative care and others depending on the location.”
Dr. MacLean commented that the Family Medicine Residency Program provides solid training. “We are trying to reach out to communities that need family physicians and we are encouraging the regions to start recruiting for primary care in the community not just in regional health authority-run primary care clinics. This is new and every step will help. We also think communities would do better if they recruit groups of graduates – cohorts of two to four residents at the same time for a specific location. This is a strategy that has worked elsewhere and we want to build this type of success for communities here.”