If training doctors locally and encouraging them to stay to set up practice in northern B.C. is the gauge of the success of the Northern Medical Program (NMP), then family doctor Heather Smith is convinced the system is working.
Smith says she knows of at least eight of her NMP classmates from the original class of 23 graduates in 2008 who have hung out their shingles to set up practices in Prince George or rural communities north of the 53rd parallel and that trend is continuing with newer graduates as they complete their residency programs.
"It is happening the way we'd hoped," said Smith, whose NMP colleagues are now working in Prince George, Mackenzie, Fraser Lake, Fort St. John, Grande Prairie or Fort McMurray. "This program was set up to provide doctors for rural areas. I don't know what more we could ask for."
Prince George has always been home for Brian Hillhouse, and he took it as a personal insult when CBC TV News in Vancouver took a shot at the NMP, claiming less than 25 per cent of the 2008 grad class set up family practices in northern B.C. What that CBC report didn't take into account, Hillhouse said, was the number of NMP graduates working as locums to relieve family doctors and those still training as residents in hospitals to become specialists.
"They missed the biggest success of our program," said Hillhouse. "In my year particularly, about 75 per cent of my class matched into a family [residency] program of some sort, most of them rural. If you look across the country at any medical school, that's a far anomaly. Toronto had a few per cent go into family medicine and UBC, in general, has 20 per cent. Our Prince George residency program had only seven seats and they filled them all. It was jam-packed with Prince George graduates."
Hillhouse is part of the family residency teaching program at UHNBC and also works in emergency, internal medicine and at the walk-in clinic. He was in Vancouver studying botany when UNBC was first getting established. His parents attended the "Condition Critical" health rally of June 22, 2000 that brought a crowd of 7,000 to the Prince George Multiplex, now known as CN Centre, which led to the birth of the NMP in 2004.
"That said so much about our town and the can-do attitude," said Hillhouse. "If there's a problem, we'll fix it. Getting the program was quite an achievement."
Doctors need a minimum of two years of residency after graduation from medical school before they are allowed to set up their own practices, while those who chose to specialize face a minimum of five years in residency.
The original class of 24 had 23 graduates (one graduated the following year) and 16 of that group are now eligible to begin practices. The rest are still involved in residency programs. Twelve of the graduates became family physicians, with five currently working in northern B.C., and three serving as locums or in short-term training positions in the region. Two of the 2008 graduates are working in Alberta, one has a family practice in Trail, one moved to Vancouver to follow her husband, who is training to be a psychiatrist, and another is in Kingston, Ont., to fulfill his military requirement. At least one other has taken a career break to go on maternity leave.
NMP graduate Kathleen O'Malley, 31, comes from a medical background. Her father Michael and uncle Peter are both family physicians in Prince George, where she was born and raised, and she's followed in their footsteps. In June 2010, six years after she enrolled in medical school, she took over a practice started by two family doctors who have since left the city.
"I always wanted to go to UBC and it obviously made it more interesting that it was going to be in Prince George," said Kathleen O'Malley. "I was amazed how quickly they put the program together.
"It was such a nice welcome to the city, that was overwhelming. Everybody felt that this was an idea that came from the community, it wasn't enforced on anybody. All the physicians were all very welcoming to having students, which is a huge amount of work to ask, but they did it enthusiastically.
"I think that's probably a huge factor as to why some people stayed up north," she said. "They just felt so welcomed by the community. I really enjoyed the NMP program and I was happy I was in it."
Smith, 35, one of three Prince George born-and-bred doctors in original class, works for Central Interior Native Health as an outreach doctor to provide mental health services. She also works at the Prince George Correctional Centre and the College of New Caledonia health clinic and as a women's health provider.
Smith was one of the original UNBC students when the campus opened in 1994. From high school at PGSS, she jumped to undergraduate and masters studies in anthropology and community health at UNBC, right into medical school. She liked the small class sizes at UNBC, but even better was the doctor-to-student ratio she encountered while gaining hands-on experience in a hospital working with specialists at UHNBC.
"In Vancouver, there might be five other residents if you go into the operating room, whereas here, you'd go into the operating room and it might just be you," Smith said. "You got to be right up there and the surgeon or whoever was doing the teaching had time to teach you because it was only you or two other people with you. They wanted to teach us, they weren't burnt out on medical students, they saw the value of it.
"The rally showed people wanted a medical school here and they were willing to support it. And when the medical students showed up, all the doctors, nurses, all the staff and everyone in the hospital who makes community health run, they all supported us. Everywhere in the north, patients were excited we were here and were willing to let us try our new skills on them."
Prince George is one of three B.C. cities outside of Vancouver that provide medical student training, all operating as branches of the UBC program. Since 2003, the province has doubled the number seats available to first-year medical students for a total of 233, including 32 in Prince George, 32 at the Southern Medical Program in Kelowna and 32 at the Island Medical Program in Victoria. Competition for those seats is fierce. The year the NMP started, 1,700 students applied for 24 seats.
One of those 24 was Dan Crompton, who spent two years as a resident in rural practice near Red Deer, Alta., and worked as a resident in emergency rooms in Saskatoon, Regina and Calgary. Crompton likes the adrenaline-charged atmosphere and it was a natural choice for him to return to UHNBC's emergency ward in September, which gives him a chance to teach medical students.
"It's always challenging and there's always something new," said Crompton, who grew up in Kelowna. "It's a very broad field and your knowledge base has to be big. But I still like rural family medicine and doing emergency could equip me to be a better rural family doctor, because a lot of times, those are the guys that have the least amount of support.
"I know the group here and they're very good and I knew that they were very willing to teach and help someone who is just starting out. It's small enough that everybody knows each other. I don't think the medical community [in other cities] gets along like we do here."
Crompton, a former rugby and soccer player, loves to ski, and he and his wife, a speech therapist, are attracted to the outdoors lifestyle Prince George has to offer. The services and facilities available in the city and relatively low cost of housing compared to other medium-sized cities in Canada are also considerations for medical students setting up shop, most of whom have had at least 10 years of post-secondary education and are paying off six-digit student loans.
"Prince George is a good place to live, there are tons of outdoor activities to do, like the Iceman," said Crompton. "It seems like a lot of people that do well in the Iceman are doctors."
NMP graduate Joanna MacLean and her husband Evan Roll, who met while MacLean was a first-year resident in the Kelowna rural program, were locums for a year at several B.C. locations, then took over an existing family practice at the Fraser Lake Community Health Centre two months ago.
For MacLean and Roll, one of the attractions of working in the diagnostic clinic in Fraser Lake was that it allows them to work daytime shifts, Monday to Friday, aside from one 48-hour shift per month at Vanderhoof hospital, which they split equally. The tradeoff is medical staff shortages are typical in small towns and with only three doctors in the area MacLean makes good use of her broad base of practical training.
"I went through the rural resident's program, which has more emphasis on emergency medicine than some other programs do and that's been part of my practice here," said MacLean, a native of Vancouver. "I appreciate the challenge of it. It's definitely not boring."
