An award-winning family doctor is leaving Prince George because her husband has been denied a residency in the region despite being a Northern Medical Program graduate.
Dr. Cecila Siegling, who received the My Family Doctor award from the B.C. College of Family Physicians in 2017, and husband Rudi will be moving to the Saskatoon area in the hope a residency in a family practice will be available there.
This comes after Rudi tried twice to land a residency, first this region, then in this province, so that he could stay close to his family for the two years it would take. The couple have three children ages 7 to 11 years old.
Although they are leaving reluctantly, Rudi said they have come accept their situation. However, he said the process for placing graduates in residencies has left him concerned for the local community and whether those selected will simply move on once their times are up.
Launched in 2004, the Northern Medical Program was established in answer to a shortage of physicians practicing in northern B.C. The idea is to give students a sense of what it's like to live and work in rural and remote communities and consider careers in those places.
But the residency process runs counter to that idea in Rudi's opinion.
"I'm sure it's amazing applicants that they select, but are they going to stay in the north if they've got no ties to the north?," he said in an interview.
The news has not sat well with at least one of Siegling's patients.
"Many doctors choose to start their careers in the North to get their foot in the door then move on after their initial contract is up. We hear all the time how hard it is to retain doctors in the North," said Bill Leslie in a letter to the Citizen. "This is a case of professionals wanting to stay in the North but are forced to leave in order to secure their careers."
The Association of Faculties of Medicine of Canada (AFMC) administers the process, called the Canadian Resident Matching Service (CaRMS). It works on a nationwide basis and while candidates are welcome to seek residencies within a specific geographic area, they are encouraged to consider openings from across the country.
The process relies on a computer-based algorithm to match students with residencies.
"The match algorithm compares applicant and program rank order lists and matches applicants to programs based on both parties' stated preferences," AFMC CEO Dr. Geneviève Moineau said in an email.
The algorithm is "applicant-proposing," she also said, "meaning it looks at the applicant's highest ranked program, then checks to see if that program has ranked the applicant and if a training position is available.
"If these conditions are not met, the algorithm moves on to the next rank on an applicant's rank order list and continues the process. The algorithm provides applicants with their best possible outcome based on the rank order list submitted. This process is national in scope."
Dr. Paul Winwood, UNBC's associate vice president for the Northern Medical Program, said the method used to match graduates to residencies is not ideal.
"The one thing we can't do that we'd like to do actually is to just have a pipeline from the Northern Medical Program through to a residency program here but we're not allowed to do that," Winwood said.
However, every medical school in Canada is obligated under contract to be a part of the CaRMS, he also noted.
Despite the shortcoming, Winwood said the NMP has produced positive results. He said there are more than 100 physicians who graduated from NMP UBC medical training programs working in Prince George the North "at last count."
Of the NMP graduates who completed residency programs in the North, more than 70 per cent are currently working in Northern B.C. and more than 100 physicians who are currently working in the region have been trained in University of British Columbia programs in the North. Nearly two thirds of NMP grads who are established in family practice are working in northern and rural communities in B.C.
"I've looked at this more than a year ago, so there will be more now," he said, and added about 60 per cent of NMP graduates go into rural and northern practices.
"It could always be better but it's pretty good and I think it's realistically as good as we're going to get actually," Winwood said.
He also said about 60 per cent of NMP graduates go into family medicine, compared to 40 per cent nationally, and the rest work to become specialists.
"We are higher than the norm for family practice which actually makes sense because we want family doctors in northern B.C. and we want generalists," Winwood said.
That some NMP graduates move on to practice in larger centres has its pluses, he added.
"I often said to people that if one of our graduates ends up being a cardiac surgeon in Vancouver, that's got go be a good thing because when people from Prince George go to have cardiac surgery in Vancouver, they're encountering a physician who has some understanding of what it takes for that patient to get down there and what they're going through," he said.
To the extent that there is a move to improve the system, it is a call to increase the number of residencies.
Under the rallying cry of "no doctors left behind," the University of British Columbia Medical Undergraduate Society said there were 14 unmatched graduates from that school in 2018 due to a lack of residency positions.
And the AFMC said 98 graduates were left without matches while 52 residencies were left unfilled following the latest round. It is calling on provincial governments, including B.C., to provide 110 positions for each 100 graduates.
In Prince George, there are 15 residencies for family practice and two for psychiatry. Fort St. John is home to four family medicine residencies and Terrace is home to two. About a quarter of those residencies are held by NMP graduates.
Of the NMP graduates who completed residency programs in the North, more than 70 are currently working in Northern B.C. and more than 100 physicians who are currently working in the region have been trained in University of British Columbia programs in the North. Nearly two thirds of NMP grads who are established in family practice are working in northern and rural communities in B.C.
"Recognizing CaRMS is a highly competitive process, our Office of Student Affairs runs a career planning program which provides services to help students plan their future careers in medicine and prepare them for applying to residency programs," NMP spokesperson Sonya Kruger said.
NMP provides support to those who remain unmatched, she also said, including a new course that gives graduates the opportunity to engage in clinical activities to develop skills and to gain experience to help strengthen their residency application for the next year.
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