Full Transcript: "Good News Stories Should Be Celebrated"

How did a small, homegrown foundation become a leader in provincial physician recruitment? Alyssa Long, Executive Director of The New Brunswick Medical Education Foundation, shares the story - exploring the organization's history, results and impacts across the province.

Below: Read the full talk as presented to PROBUS Saint John members at the club's February 15 meeting.

Full Transcript

Thank you, Paul. Good morning. It is a pleasure to be among such a distinguished group of gentlemen. My name is Alyssa Long, and as Paul noted, I am the Executive Director of The New Brunswick Medical Education Foundation.

Full disclosure – I am not a trained medical professional. Nothing I say over the next 45-minutes should be interpreted as any form of medical or treatment advice – this is for your protection as much as mine.

When I was a teenager, I wanted to be a doctor. This was deeply influenced by the fact that my father and grandfather were both family doctors. Throughout my childhood, they seemed all-knowing and utterly dedicated to their patients at the sacrifice of weekends, holidays, and personal pursuits. It’s intimidating to grow up with someone who routinely saves lives for a living. It tends to put a poor grade or bad day into perspective very quickly.

One of my earliest memories of my dad took place our way home to Saint John from Halifax. I was about four years old. We were first on the scene of a horrific car wreck, and I could see debris all over the road and the two cars sprawled in the median.

Dad pulled over our blue minivan and raced across the highway to the cars. My Mom turned around and tried to keep me, and my younger siblings distracted. Dad was gone for a long time. The first responders arrived soon after, with lights flashing and sirens blaring.

It was the first time I’d seen firefighters in full turnout gear up close. I remember them carrying a strange metal device – now I know it was the jaws of life. At least one person died at the scene, and a helicopter landed nearby soon after to airlift another victim to hospital.

Eventually, Dad came back to the car. What I remember most as he slid into the driver’s seat was the blood staining his hands and clothes. Despite what he must have seen and treated over those long minutes; he calmly responded to my barrage of childish questions drove us all safely home.

He’s been doing things like that my entire life – but that memory cements how I view physicians, their skills, and the role they play in our society. To me, he was and is a hero. I wanted to be just like him.

Now it turns out medicine was not for me. I enrolled in a Bachelor of Science at St. Francis Xavier University. Just like my father and my grandfather. I often joke that degree had one dissection too many.

I did not have the objectivity that a clinician needs, nor did I enjoy the work in a way my classmates did. I needed to find another career path. And thankfully, I did. And I have had a wonderful career journey.

But I will always look to medicine with a sense of awe. Today, I am a communicator and organizational storyteller. In my new role, my story centres on a small, homegrown foundation that has become a leader in identifying and removing barriers to primary care.

The New Brunswick Medical Education Foundation is a private, not-for-profit foundation dedicated to enhancing access to healthcare for all New Brunswickers. We offer a proven solution to physician recruitment by providing return-to-service scholarships to medical students – ensuring a pipeline of future doctors are ready to practice in the province following graduation.

So let me ask you:

• How many in this room have been to a doctor or clinic in the last year?

• How many have a family doctor who is within 5-10 years of retirement age?

Before I share more about the Foundation and our model, it’s important to look at our healthcare system, particularly access to primary care. We know the system is in crisis – every day, we are inundated with new headlines, reports and anecdotes that paint a dire picture. But what are the root causes of problem?

As Steve Jobs said, “If you define the problem correctly, you almost have the solution.”

I. Understanding the Problem

Primary care is defined as a patient’s first point of access. It’s the healthcare provider who follows a patient over the long term. Often a family doctor, the primary care provider functions as a gatekeeper to subsequent health services – such as specialist referrals or diagnostic testing.

On paper, New Brunswick outperforms Canada on access to a primary care provider. In a 2020 Primary Health Survey, 91% of New Brunswickers reported having a family doctor or nurse practitioner, compared to an 86% national benchmark.

It’s important to note, however, that regional access within New Brunswick varies significantly. Our Moncton, Restigouche and Bathurst health zones outperform the national benchmark, but the Saint John, Madawaska and Fredericton zones all fall below the national average.

While most New Brunswickers have a primary care provider, where the rubber hits the road is around accessibility and timeliness of care. Only 57% of New Brunswickers reported going to their family doctor most often when they needed care, and only 51% reported they were able to get an appointment with their family doctor within 5 days.

When patients cannot access a primary care provider, they often resort to emergency rooms or after-hours clinics. Both are more costly for taxpayers. ERs, especially, are intended to resolve immediate needs. Unnecessary visits lead to delays and increase the likelihood of adverse health outcomes for our most vulnerable citizens.

Furthermore, they are not designed to function well when over capacitated. Combined with pandemic protocols, staffing shortages, burnout and supply chain disruptions, high demand creates a recipe for disaster. Unfortunately, there are deadly consequences.

So why can’t more people get in to see their doctor? On average, physicians in New Brunswick see between 600-1,200 patients per year. The variation is likely due to the way physicians practice, with some providers working fewer hours or in multiple settings besides their offices. But if we consider that New Brunswick has a ratio of one family doctor to 1,100 citizens – too many people are left behind.

And that doesn’t even consider more than 63,000 New Brunswickers currently on the provincial waiting list for a family doctor. Or, that 35% of our province’s family doctors will reach retirement age within the next 5 years. Unless we can fill those anticipated vacancies, the list will grow even more.

As the Supreme Court of Canada recognized in 2005, “Access to a waiting list is not access to health care.”

Increasing the number of physicians in New Brunswick is therefore vital to increasing access to primary care and reducing strain on our secondary healthcare services.

II. A Founder’s Foresight

Staffing shortages in the healthcare sector are not a novel concept, and there have been many groups working to address the issue for years. These include government bodies, regional health authorities, municipalities, chambers of commerce and grassroots community initiatives. But these efforts have often been siloed, regionally specific and expensive with varied results.

In 2010, Dr. Donald Craig had a new idea. Having worked as a practicing physician for more than four decades, he knew both the vital role family doctors and specialists play in the lives of patients and that we were quickly approaching a critical shortage of providers in our province.

He connected with the Saint John Regional Hospital Foundation and proposed a completely novel concept: rather than working to entice practicing physicians to relocate to New Brunswick, could we engage current medical students to commit to practicing here following graduation?

The timing could not have been better. 2010 was also the year Dalhousie Medicine New Brunswick welcomed its first class; the result of a 2008 partnership between Dalhousie University, the University of New Brunswick and the Government of New Brunswick.

And so, The New Brunswick Medical Education Trust was formed as an entity of the Saint John Regional Hospital Foundation, with Dr. Craig is its founder. Its role was to extend return-to-service scholarships to New Brunswick medical students, ensuring a pipeline of future physicians are ready to begin practice in New Brunswick.

Our model is simple, but completely unique in Canada: we raise funds to support scholarships for current medical students from New Brunswick. In exchange for financial support, these students pledge to practice in the province for a number of years once they have completed their degrees and residency programs.

In 2016, The New Brunswick Medical Education Foundation was established as its own, private entity, separate from The Saint John Regional Hospital Foundation. We moved from offices in the Regional Hospital to the Rothesay Town Hall, and more recently to the Bill McGuire Centre in Renforth.

What was truly visionary about Dr. Craig’s approach was that it was proactive in nature. We are engaging these talented, world-class future physicians early in their training and helping them to envision a future in Saint John, Bathurst, Riverview, St. Stephen, or any number of New Brunswick communities where the need is dire.

Together with our donors, we are investing in tomorrow’s healthcare. It takes years to “grow” a doctor. If they enroll full time, their education entails four years of medical school, followed by a residency program. Depending on whether they pursue a career in family medicine or a specialty, they will have an additional 2-5 years of residency post-graduation. We are still in the early stages of seeing the fruits of our labour. But they are exceptional, and only getting better.

Further, by supporting students from New Brunswick, we are reaching a group of students already far more likely to settle here and providing them with additional financial incentive to do so. Most of these students have strong roots in this province; they have family and friends here. They volunteer here. They want to build a purposeful life here.

Today, our leadership team is comprised of a 15-member volunteer Board of Directors, including Co-Chairs, Dr. Michael Simon, and Carol Chapman. We were founded by physicians and continue to be led by physicians, with 4 practicing doctors now sitting on our board. In addition, we have a team of two – a Foundation Coordinator, Natalie Boyce, and myself – who oversee day-to-day operations.

III. Data Well Presented

During my time with J.D. Irving, Limited, I was fortunate to work with several key senior leaders and had access to a great deal of institutional wisdom. One of my key takeaways was a quote from Mr. J.K. Irving, former CEO of the company. He once remarked: “Data well presented tells a story.” Isn’t that beautiful?

When I look at The New Brunswick Medical Education Foundation and what differentiates us from other recruitment initiatives and charities, it is the strength of our data. We have a proven solution to physician recruitment that is unique to our province, our country and that seems to be flying completely under the radar.

In our first year of existence, in 2010, the Foundation awarded three scholarships totalling $25,000. In the fall of 2022, we awarded 66 return-to-service scholarships, totaling $455,000 in funding. Because each award is tied to at least a one-year return-to-service agreement, in 2022 alone, we secured 66 years of service – or the lifetime careers of two-family physicians.

We have grown exponentially in a very short time and have supported 223 individual students through 413 distinct awards. All funds have been paid directly to the students’ universities and we have supported New Brunswick students across French and English language programs.

Today, we have 36 program alumni practicing in the province. This includes:

• 15 in the Greater Saint John region

• 6 in Moncton and Dieppe

• 7 in Fredericton

• 5 in Northern NB Communities

• 2 in rural NB communities of Nackawic and Waterville

And, we have 179 scholarship recipients at various stages in their medical education who have pledged to practice in New Brunswick following graduation.

75% of our alumni have fulfilled the requirements of their return to service agreements, and those that have left the province prior to their terms being fulfilled are contacted by the Foundation to repay their awards. This ensures we can continue to fulfill our mission – to recruit and retain physicians for New Brunswick – and protect the interests of our donors.

To put this in perspective, according to Trevor Holder, Minister of post-secondary education, training, and labour, roughly 40% of New Brunswick medical students trained outside the province return to New Brunswick to work, while 60% of those trained in the province will stay. We can, and are, doing better.

For us, the tagline “A proven solution” isn’t just a pretty phrase. It’s our story and backed by strong data and evidence. So, with a model that works, we can now focus on growth and scalability.

While we have grown our capacity to support more than 66 awards annually, we receive an average of 120 applications for financial aid each year. My foremost priority as Executive Director is to grow the Foundation to a point where we can support all eligible New Brunswick medical students who are willing to commit to this province.

IV. Societal, Economic & Generational Implications

This will not be an easy effort, but necessary if we want to create a healthier New Brunswick before it’s too late for too many. Creating opportunities for physicians to train, settle and thrive in this province will have a profound impact – with social, economic, and generational implications.

I’d like to take a few minutes to dig into the economic implications.

For the first time in recent history, access to healthcare is being viewed as a business issue. In surveys conducted by both the Fredericton and Moncton Chambers of Commerce, members reported that their greatest concern or challenge was access to healthcare.

If businesses want to grow, they need to attract and retain talent. That means as a province, we need to have the capability to provide newcomers with housing and access to reliable primary care. Otherwise, they will not stay.

In recent months we have seen hugely expanded efforts on the part of chambers and businesses to engage physicians and residents and provide resources to help them establish and grow practices. They understand that improving access to primary care is essential if we want to position our province for continued growth and outcompete the rest of the country.

Healthcare is a vital public service and barriers to it will restrain the province’s economic growth potential. It is also the largest economic sector in New Brunswick (GDP contribution) and the largest employment sector in the province with 44,000 workers (excluding social assistance).

One of the most common questions I see from members of the public, business and community leaders is: “Why should I get involved? Isn’t recruitment the government’s problem?”

And yes, healthcare is a cost to the taxpayer. But our healthcare system and communities are in crisis. If we don’t act as a community, our friends, families, and neighbours will suffer for it. I believe The New Brunswick Medical Education Foundation has the ability and the resources to make a significant impact in a far shorter time than the government.

If our actions today can ease the strain on our primary and emergency care centres tomorrow, it may free some of that tax revenue to invest in systemic changes, infrastructure and equipment upgrades that will lead us to a more sustainable future.

New Brunswick is competing with an entire country to address our physician shortage. Our government leaders must leverage every tool in their physician recruitment toolbox. We are one of the sharpest tools at their disposal.

V. Removing Barriers On Three Fronts (Education, Primary Care, Retention)

Earlier in this talk, I alluded to the role the Foundation plays in removing barriers to healthcare. In fact, we are removing barriers on three distinct fronts: we work to enhance access to education, to primary care, and to improve physician retention.

Let’s start with education:

• According to MD Financial Management, the median debt load for medical school graduates is $80,000, with 32% of graduates reporting more than $120,000 in student debt.

• Our scholarships are lifechanging for recipients, who are faced with climbing tuition costs, living expenses and student debt. Relieving some of this financial burden allows them the freedom and peace of mind to focus more intently on their studies, extracurricular activities, and volunteerism. They become more involved and invested in the communities in which they plan to live and work.

• In addition, there are historically marginalized groups that face additional barriers to education. These include Black and Indigenous people of colour, members of the LGBTQ+ community, newcomers to Canada, and people from low socioeconomic or rural backgrounds. Among the 67+ scholarships we will be awarding in 2023 are several scholarships specifically designated for members of these underrepresented groups.

Now, let’s talk about primary care:

• As our capacity to award scholarships grows, we will continue to see an increasing number of medical school graduates return to New Brunswick and build their careers here.

• This influx of physicians comes at a lower cost to New Brunswickers than many provincial recruitment initiatives. It will increase the number of patients seen and reduce wait times for those seeking primary care.

• Many New Brunswick medical students continue to specialize, which means we are also strengthening secondary care across the province, which may contribute to reduced wait times for surgeries, diagnostic testing, and consultations.

And finally, I believe we have a role to play in physician retention as well.

• According to a 2022 publication by the Canadian Federation of Medical Students’ Atlantic Task Force, the primary factors driving physicians to leave the province are workload and community integration. The New Brunswick Medical Education Foundation already plays a role in mitigating these two challenges.

• We proactively secure physicians for the province, which will ultimately lessen the pressures and strain our current physicians face every day.

• And, we connect with our network of students and alumni regularly to help maintain a sense of common purpose and belonging. Increasingly, we are working with partners – like Dalhousie Medicine New Brunswick, our chambers and our regional health authorities – to provide access to events, contacts and resources that will help young physicians become more involved in their communities. And this is just the beginning.

I have so much to learn about the system and where as a Foundation we can use our voice to advocate for improvements and investments that will create a healthier New Brunswick. We aim to create a future where all New Brunswickers can access the quality healthcare services they need, when they need them most.

VI. Conclusion

So why am I here today? It boils down to three key points:

First, I believe good news stories should be celebrated. Our small foundation has built an innovative, province-wide physician recruitment program that is experiencing unprecedented success.

Second, with the challenges our healthcare system is facing, I believe it takes a community to raise a doctor. We cannot rely on government alone to solve this crisis. It’s going to take collaboration, dedication and – most of all – New Brunswickers helping New Brunswickers.

And third, I’m here because I believe in the scalability of this approach as a model for physician recruitment. What we are lacking is awareness at a regional, provincial, and national level.

When I first learned about The New Brunswick Medical Education Foundation, I was fascinated with the notion of a not-for-profit that served all New Brunswickers, regardless of socioeconomic status, demographic characteristics, or geographic location. Having come from a corporate background, I could see the business case for investing in tomorrow’s healthcare providers. It made sense then and it makes sense now.

Healthcare and education are cornerstone virtues of our society. I implore you to protect and preserve them. Every one of us in this room will require the services of a family doctor or specialist many times over. There is no separation between what we are trying to do at The New Brunswick Medical Education Foundation and what will benefit each of us, our families, friends, and neighbours.

I look at this room and see a wealth of experience, wisdom, and intelligence. My inner opportunist sees a thinktank. With that in mind, I invite you to learn more about our organization and share your questions and insights. How can we raise our profile and enhance our impact?

Thank you for your time and attention.