Marathon works. How to thrive in rural practice.

PROBLEM BEING ADDRESSED Medical care in rural Canada has long been hampered by insufficient numbers of physicians. How can a rural community's physicians change the local medical culture and create a new approach to sustaining their practice?

OBJECTIVE OF PROGRAM To create a sustainable, collegial family practice group and address one rural community's chronically underserviced health care needs.

PROGRAM DESCRIPTION Elements important to physicians'well-being were incorporated into the health care group's functioning to enhance retention and recruitment. The intentional development of a consensus-based approach to decision making has created a supportive team of physicians. Ongoing communication is kept up through regular meetings, retreats, and a Web-based discussion board. Individual physicians retain control of their hours worked each year and their schedules. A novel obstetric call system was introduced to help make schedules more predictable. An internal governance agreement on an alternative payment plan supports varied work schedules, recognizes and funds non-clinical medical work, and pays group members for undertaking health-related projects.

CONCLUSION This approach has helped maintain a stable number of physicians in Marathon, Ont, and has increased the number of health care services delivered to the community.