Dr Anette Fosse - Norwegian Centre for Rural Medicine

Dr Anette Fosse is a rural GP and researcher at the Arctic University of Norway.  She is also the director of the Norwegian national center for rural medicine.

Episode summary:

00.45  Anette tells us about her professional background and how she developed her interest in rural health and research

04.00  How is the healthcare system organized in rural Norway?

06.05  Who are the members of the wider primary care team?

09.30  Do the medical secretaries receive specific training?

10.45  What are the characteristics of arctic populations? 

14.30  Are clinicians trained to deal with more extreme conditions and isolation?

16.00  What is the Norwegian center for rural medicine?

17.55  What kind of research has been done by the Norwegian Center for Rural Medicine?

20.45  What were the insights that came from the research on medical education for rural areas?

26.30  Have there been challenges to find mentors or clinicians to supervise students?

28.05  Are there support networks for clinicians in rural areas?

29.30  What has caused the increase in the use of locum doctors and what were the findings of the research? 

34.42  What are rotational positions for doctors and how are these being used by municipalities?

40.00  What other research is planned at the Norwegian Center for Rural Medicine?

44.15  What are you top three tips for people thinking about going into a rural health career?

 

Key Messages:

Primary care is organized by the municipalities, the general practitioners are contracted by the municipality.  In rural areas there is not a market for running your own general practices so the practice is run by the municipality which employs GPs.

All GPs with a contract with the municipality have a duty to participate in out of hours services.   

Every citizen in Norway is entitled to have a named GP, the average list is 1000 patients.  In rural areas the GPs have fewer patients on their list, however they perform other duties such as out of hours, monitoring care homes, and child preventative care.

Average practice does not have nurses or other allied health practices, there are health secretaries which take phone calls, then can do ECGs, wound dressing, things which may be done by nurses in other countries.  Norway is starting to introduce nurses into general practice.

Medical secretaries receive 2 years of training.  They are not trained to the level of nurses.  

Weather can affect travel significantly for patients, some communities can be cut off and isolated.   

There is no standard training for rural practitioners in Norway.  There is a good system for specialist training for family medicine, they all take an emergency medicine course and collaboration sessions with local ambulance services.  

The Norwegian Center for Rural Medicine is a national center focused on improving recruitment and retention, research and education.  It has been supported by the government since 2007.  They aim to bridge health, academia and policy to work together to address challenges.  

“Making it Work” - a research project looking at recruitment and retention. 

Systematic review on educational intervention to ensure provision of doctors in rural areas trying to find the answer to what medical education needs to provide to help students choose rural practice. 

Last year they did research on the use of locums as the use of locums is exploding in rural areas.  

Project on primary healthcare teams looking at how to include nurses into general practice.  

University of Tromso was one of the first medical schools to be located in a rural area due the need for doctors and other healthcare workers in the region.  It was established in the 1970s.

The things that have been found to increase amount of students choosing rural practice are:

• Preferential admission from rural areas.

• Curriculum relevant to rural medicine.

• Decentralized or distributed medical education based in rural areas.

• Practice oriented learning in rural areas. 

All of the medical schools in Norway have started to apply distributed medical education, sending students to smaller towns.  

It is not difficult to get GPs to supervise students in their practice, what has been more difficult is to get rural GPs to teach at the University in Tromso.  

All trainees have to join a mentor group with other specialist candidates and a supervisor, those groups will often be located within the same regions and they can share experiences.  

When the crisis reaches the cities that means that there has been a crisis in rural areas for a long time.  The authorities often only start addressing the issue once it is visible in rural areas.  

From 2016 to 2022 the number of locum contracts in GP surgeries increased 446% in all of Norway.  In rural areas the increase was 659%.

In rural areas locums were covering positions for a shorter duration of time than in urban areas as they would need to cover 100% of a position, while locums in urban areas might be there for longer by often covering part-time.

Locums are expensive with locum agencies earning large sums.  GPs can earn triple what they would earn if they were salaried and they can work more flexibly.  

Rotational positions are a way of organizing general practice in areas that have been dependent on locums for a long time.  It is inspired by the off-shore positions in the North sea.  Doctors work 3 weeks on and then 3 weeks off.  Three doctors would then cover one full time position. 

The municipalities have noticed that there are no applications for the normal salaried positions when they are advertised but when they advertise a rotational position they get 20 or more applicants.  

Top tips:

• Seek a well functioning practice and a mentor

• Seek clinical courage,  curiosity and flexibility

• Potato ethics - doing things outside of your comfort zone because you are the only one that can do this

• Be involved in the local community, get to know where you live and work.

 

Norwegian Centre for Rural Medicine: https://www.nsdm.no/english/ 

Contact: https://en.uit.no/ansatte/anette.fosse

 

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