Physician-Community Integration: A Case Study of Practitioner Experiences and Retention Challenges on British Columbia's Haida Gwaii/Queen Charlotte Islands
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Social life, and particularly health care delivery, in a small isolated community is more complex and nuanced than has been reflected in much of the literature on physician retention, which has never extended the notion of the “workload” past the physician’s formal role in the health care setting. Despite having been acknowledged by provincial and national government policies, few of what Anderson and Rosenberg (1990) describe as “unidimensional solutions” have resolved the “multidimensional issues” of physician retention in northern Canada. This thesis employs a qualitative framework to investigate the practice and lifestyle experiences of general practitioners on the Queen Charlotte Islands (Haida Gwaii) to provide a local analysis of physician retention problems experienced by isolated communities. By including both physicians and community members as key informants, the project attempts to determine whether a difference exists between physicians’ perceptions of place and their roles and the voiced expectations of the communities they serve. The research uses a combination of in-depth interviews and questionnaires with physicians (n=6) and community members (n=12) to determine the various roles played by a physician in a small community. It queries whether the community in question expects physician to take up roles outside of the medical space, whether physicians are influenced by these expectations and whether these may contribute to the cessation of practice in remote communities. This thesis examines not only health care-related factors involved in medical practice, but also the informal settings of the community at large, including the general interactions that are incorporated into a physician’s character in a close-knit and isolated place. The findings of the thesis demonstrate that there are significant gaps between what community members and physicians believe is reasonable behaviour and the reality of physicians’ experiences in their respective island communities. The lack of boundaries perceived by physicians in their communities often leads to social isolation, which has the opposite intended effect of respite, instead leading to further disengagement from the local community, finally resulting in a decision to locate elsewhere.