The rural recruitment model getting a second look

Three small-town emergency rooms that spent 2023 posting closure notices spent the past year fully staffed, and the experiment that did it — contracting a physician team collectively rather than recruiting doctors one posting at a time — is now on the health ministry's desk for provincial adoption.

The model's insight is social rather than financial. Rural recruitment fails, its designers argue, because it asks one physician at a time to accept professional isolation. The team contract hires four to six doctors as a group, guarantees the schedule that makes coverage shared rather than heroic, and lets the group govern its own rotation. Two of the three pilot teams recruited themselves — colleagues recruiting colleagues — which no incentive payment has ever managed.

The costs are real: team contracts price above the sum of the positions they replace, and the doctors' own association is split between members who want the model everywhere and members who read it as the end of fee-for-service by instalments.

The ministry's evaluation, due mid-winter, will decide whether three towns were an anomaly or a template. The forty-odd communities currently running their ERs on locums and luck have already decided, and are lining up to be next.