Recruiting and Retaining Rural Doctors

Headhunters hired to solve our physician shortage? Give me a break!

In 2019, The Canadian Journal of Rural Medicine published a ” systematic review of recruitment and retention of healthcare professionals in rural Canada.” The review explored “a pertinent issue for healthcare professionals and recruiters alike: which factors are most important in the recruitment and retention of these professionals in rural practice in Canada.” Five themes emerged:

  • Personal/family matters
  • Community factors
  • Professional practice factors
  • Professional education factors
  • Economic factors

Twenty years ago, the Society of Rural Physicians of Canada published the factors that are important for recruiting and retaining physicians in rural Canada. The top three, in order of importance, were:

  1. Collegial environment – group practice versus solo
  2. Life partner contentment
  3. Life style

We are short of physicians and nurses because government recruiters failed to grasp the significance of these factors. Do you really believe private sector headhunters will?


A few months ago, the government heaped praise on the efforts of the recruitment committee of the Nova Scotia Health Authority, claiming great success in their efforts to bring more physicians to Nova Scotia. They also claimed they could have done better had it not been for the pandemic. As the main election campaign issue became more focused on healthcare and the depressing realization that 70,000+ people are waiting for a physician, a new strategy emerged and the idea of recruiting professional headhunters was dropped on the table, throwing the NSHA physician recruitment committee under the bus in the process.

Eight years ago, Nova Scotians were promised a physician for every person. A reflective person would have recognized that no jurisdiction in the Western world has achieved this and yet, up until recently, the government stuck to that messaging.

Headhunters may work when you are looking for a president of a university, a CEO of a company or a chair of a board but they will not work to solve our healthcare human resource issues which are structural, historic and complex. To date there has been little transparency around how we got to this point where we cannot staff emergency departments either because we do not have nurses or because we do not have physicians.

Long-term-care facilities are stretched to the breaking point for similar reasons. When was it determined that it was to be official government policy to off-load our medical personnel training costs to the developing world? How is it morally acceptable for headhunters or anyone else to poach medical and nursing resources from jurisdictions that badly need them, quite aside from the resources they spent training them?


If we are going to dig ourselves out of this mess, we cannot spend any time reinventing the wheel. It is time to upset the paradigm and accept that not every citizen needs a physician to address each of their health concerns. It is time to re-think how we train healthcare human resources and how we match available resources to needs.

This does not mean that we should accept a lower standard of care. Some argue that we could achieve a better standard of care if we were to move to a model where interdisciplinary teams are the providers rather than a hodgepodge of caregivers each doing their own thing, barely aware of what other professionals are doing. Jurisdictions such as the Netherlands and the United Kingdom have already proved that grouping health disciplines and assigning cases based on the appropriate fit permits more efficient use of resources, is less expensive and delivers better health outcomes.

Clearly, leveraging virtual care and other technologies will enable a new model to function better but it is foolhardy and dangerous to try to support what we know does not work.

Changing the paradigm is a monumental undertaking that will take inspired leadership, money, patience, goodwill and trust but we are at the wall with no place to go. Now is the time to be honest with Nova Scotians and lay out the challenges such as they are. In the last election, a cabinet minister told me, “You will never get us to admit that healthcare is in crisis.” Too bad they wasted four years ignoring what every front-line health worker knows to be a fact: we have arrived at a time of intense difficulty, trouble or danger — the definition of a crisis.


Dr. Robert Martel



Bob Martel is a physician living in Arichat