Since its formation in 1992, the Alberta Rural Physician Action Plan (RPAP) has endeavoured to address the professional and lifestyle issues confronting physicians in rural practice, as well as those of physicians contemplating rural practice. The common thread over the intervening years has been innovation and adaptive change as circumstances at many levels have evolved.
Over the past 20 years, the focus of our success has centred on proven core programs, including the rural locum program, rural clinical placements for medical students and resident physicians, skills enrichment, and Continuing Medical Education (CME) offerings for practicing physicians.
Much has evolved for the RPAP and its partners, especially in the last 10 years. We have seen the creation in 2000 of the Alberta Rural Family Medicine Network (ARFMN), a unique RPAP - U of A/U of C departments of family medicine partnership with Rural Alberta North (RAN) and Rural Alberta South (RAS) branches. In 2013, we celebrated the 10th anniversary of the graduation of the first class of rural-trained family physicians from these programs.
There has been significant increase in medical school capacity with subsequent new demands placed on the RPAP. Despite that, the RPAP and the two faculties of medicine have positively worked together to establish associate dean and rural/regional positions to advance the rural agenda, including rural medical education distributed learning.
As a result of chronic difficulties in physician availability in many rural and remote communities in Alberta, in February 1990 a working group of Alberta Health’s External Advisory Committee on Physician Manpower was established to develop a comprehensive action plan for the recruitment and retention of rural physicians. This plan—“Proposed Action Plan for Addressing Rural Physician Recruitment and Retention Issues”—was approved by the External Advisory Committee in March 1990, and was approved by Cabinet in December 1990.
Developed on the basis of influencing physicians’ decisions about moving to and remaining in a rural Alberta community, the Rural Physician Action Plan, or RPAP as it became known, was originally composed of 16 initiatives, focused on three distinct target groups and was fully operational by 1992.
RPAP recognized that recruitment efforts alone would not provide long-term solutions to the rural physician shortage in the province and, therefore, it was necessary to reform its education and training initiatives. Beginning in 2000, the RPAP implemented enhancements to its Enrichment Training Program, which included the introduction of the skills broker role, dedicated to arranging CME and other training opportunities for practicing rural physicians.
Physicians who had trained in urban centres, even with the RPAP rural rotations program, were not as interested or necessarily prepared to meet the broad demands of rural practice. In response to this need, the RPAP worked closely with the University of Alberta and the University of Calgary to develop the Alberta Rural Family Medicine Network (ARFMN), a dedicated rural-based, family medicine residency program. In July 2001, the ARFMN accepted its first class of rural family medicine residents.
After focusing its attention on the development of physician recruitment and education initiatives for its first decade, the RPAP identified that physician retention was another important area requiring attention. Initiatives were developed, beginning with a new multi-year retention work plan in 2001, to support and encourage physicians to continue to maintain their interest and commitment to rural practice. This included the development of a rural physician consultant role—to support and encourage the development of recruitment and retention initiatives by physicians, rural communities and the then-Regional Health Authorities. It also included strengthening the Rural Physician Spousal Network (RPSN).
In 2003, the RPAP completed a review of its rural undergraduate medical education initiatives with an aim to increasing the number of rural origin students in medical school and to better support early careerists. A number of new initiatives were created and implemented, beginning in 2004–2005.
Externally evaluated many times since its creation, the RPAP has consistently demonstrated that, on balance, “[it] has been effective in stabilizing the overall level of physicians in rural Alberta since 1991 in the face of major and ongoing changes to the Alberta Health System.”.
Today, RPAP continues to serve rural Alberta communites, and be active in other areas as well:
- A school outreach initiative to encourage more rural-origin student applications to medical school
- A community engagement campaign to develop community attraction and retention committees throughout rural Alberta
- The APLJobs.ca website and related marketing of Alberta has become the entry point for provincial physician recruitment—metro and non-metro, PCNs, FCCs, and academic posts
- A support initiative to assist new Alberta rural family-medicine graduates to stay in the province and successfully transition into rural practice
- Community attraction and retention conference/video-conferences, and physician recruiter workshops
- Skills brokers and community physician recruitment consultants have effectively contributed to physician attraction and retention