How to attract psychiatrists to P.E.I.

It's no secret that it's been a challenge to recruit psychiatrists to vacant positions in P.E.I. — but what is it that psychiatrists are looking for in a job?

CBC spoke to two psychiatric residents at Dalhousie University's Department of Psychiatry — Dr. Joshua Smalley and Dr. Alexandra Manning — both of whom plan to be looking for work as licensed psychiatrists in a few years.

Smalley, the chief resident in the department, is in his fourth year of his residency, and plans to become a child and adolescent psychiatrist. Manning is the associate chief resident and is in her third year of her residency. She also hopes to be a child and adolescent psychiatrist.

Typically, to become a licensed psychiatrist in Canada, you have to complete an undergraduate degree, a medical degree, and then a five-year residency in psychiatry before writing exams through the Royal College of Physicians and Surgeons of Canada. A sub-specialty in child and adolescent psychiatry, like Smalley and Manning are planning to do, means an extra year before getting licensed.

• Peace of Mind | CBC P.E.I.'s ongoing coverage of mental health services in the province
• What has your experience been with mental health services in P.E.I.? Contact us here.

What P.E.I. needs

P.E.I. recently recruited four new psychiatrists to the Island, bringing the number of filled full-time equivalent positions to 13 out of a complement of 15.

While this is an improvement since the fall, when only 7.5 full-time equivalent positions were filled, P.E.I.'s chief of mental health and addictions Dr. Heather Keizer said the challenges with recruitment remain as some of the province's existing psychiatrists look to retire.

"The reality is this is not something I can let go, because we have to look to the long game," she said. "Even though we're getting a good number now, I also have to be able to plan for some of my colleagues wanting to phase out."

"We can never give up the fight to recruit."

Ups and downs to a small team

Smalley said that when he looks for work, the size of the team, who else is on it, and whether a staffing shortage is temporary or more of a long term issue will likely be a factor.

"One of the things that I'm looking for is to be in a department that's very cohesive and where there's a lot of opportunities for mentorship," he said.

"When you're a recent graduate transitioning from a more academic or supervised setting to independent practice there's still a lot of things you're going to learn, so it's really important to have colleagues that you can draw on for support and consult with."

Manning agreed it is "an easier transition" to move in to a team that's fully staffed, but she said there are also benefits to joining a team that is under complement.

"There's also a lot of opportunity for future development and forward thinking as to where you anticipate the future practice to look like," she said.

Keizer said there are such opportunities in P.E.I.

"One of my personal desires when I went out recruiting was really to recruit people that were smarter than me and who would bring something more to the table and so that we can plan for the future and that more innovation and creativity at the table can really enrich the services that we provide to P.E.I.," she said.

Both Smalley and Manning said it's not just the other psychiatrists they would take into account, but the entire team they would be working with — which includes psychologists, social workers, recreational therapists and outpatient teams.

Location, location

Neither Smalley or Manning know exactly where they'll be looking for work when the time comes — they say it depends on what is available.

"In terms of where I would actually practise in the future, it's hard to say because we actually don't know where the jobs are going to be available," Smalley said.

Smalley said the kind of care he will be able to provide will also be something he takes into account.

"The opportunity to provide patients with the right type of care when they need it — so that's evidence-based psychiatric care, which is something that isn't always easy to do in some systems," he said.

Manning agreed the types of opportunities are also important to her. That would include a position in her sub-specialty, as a child and adolescent psychiatrist.

She said, for her, it would also be an asset to have the option of teaching in the future. She worked in education prior to going to medical school and said she has a strong interest in medical education.

Maritime roots

She grew up in Head of St. Margaret's Bay, N.S., and said she is hoping to stay in the Maritimes.

"I have roots in Nova Scotia," she said. "It's so difficult to predict where the jobs will be at the end of training because we'd be looking sort of three years out now, but my preference would be to stay in the Maritimes, certainly."

She did say that P.E.I. played a role in her decision to become a psychiatrist. As a medical student, she did a rotation with Dr. Keizer in Charlottetown.

"She had such a varied practice in so many different areas of psychiatry that it rekindled, I think, a lot of interest that I had in mental health and wellness and psychiatric illness," Manning said.

Down to dollars

Smalley said for a recent resident, what is being offered in terms of loan repayment can also play a role in recruitment.

"We've invested a lot of time in our academic training and a lot of people have kind of maybe put off some of the things maybe people their own age would have done, like starting families, those kinds of things," he said.

"One of the things that would probably be helpful for recruitment is to have some assistance with student loans."

Smalley said it's not uncommon for a resident to have upwards of $200,000 in debt.

According to the province's website, a newly recruited specialist who accepts a position in rural P.E.I. (outside Charlottetown and Summerside) may be eligible for up a $40,000 return-in-service grant. There is also an allowance for moving expenses —  with limits ranging from $5,000 to $10,000 depending on where the person is relocating from.

Health PEI did not provide specifics about what is offered to psychiatrists. A post on the P.E.I. government website states that psychiatrists are eligible for return in service grants, and that base salaries range from  $205,914 to $238,090.

P.E.I. not alone in search for psychiatrists

The need for psychiatrists isn't unique to P.E.I.

"Recruiting for psychiatry is really a challenge because it's a specialty that is in high, high demand all across the country," said Keizer, who said she has worked closely with P.E.I.'s recruitment and retention secretariat over the past year.

Keizer said she visited a number of medical schools in the fall to meet with psychiatric residents (Smalley was part of the group she met with at Dalhousie).

She said her work has helped secure three senior psychiatry residents to do community electives in P.E.I., all of whom she said are interested in staying on the Island.

In addition, Keizer said P.E.I. has been invited to join the Psychiatry Rounds at Dalhousie, a series at which new research and innovation is discussed, which she said not only provides an opportunity for education, but also creates connections with others specialists in the Maritimes.

"Now, all the hard work is starting to come home and it's wonderful," she said.

This story is part of an ongoing project CBC P.E.I. is doing on mental health services in the province. You can share your experiences with us here.

• MORE P.E.I. NEWS | P.E.I. doctor calls his role in medically assisted death a 'profound experience'
• MORE P.E.I. NEWS | Kinley Dowling an accidental advocate for sexual assault victims