Six physicians reflect on working in rural and Northern Manitoba
by B.R. Hartle
A medical career in rural or Northern Manitoba offers a unique experience that can’t be found in a large urban centre, like Winnipeg.
We spoke with six rural physicians about their practices, why they chose rural Manitoba, and what it takes to make a career as a physician in Manitoba’s Northern and rural communities.
Dr. Ganesan Abbu
In 1998, Dr. Ganesan Abbu moved his young family from South Africa to Winkler, Manitoba. He had lived his entire life in South Africa. Born at the dawn of Apartheid, he took part in the struggles against it until the end, but became disillusioned with the level of violence and crime in his country. He asked himself what kind of society he wanted for his children, then 4 and 5 years old. He wanted something quieter — no more big, bustling cities of millions of people — and believed he would be able to give more to his family medicine practice in rural Canada.
“I wanted to explore my full potential as a physician,” he said, from his home in Winkler. “And the community and medical community has been greatly supportive.”
As an example of that community support, after settling in Winkler and mainly focusing on family medicine, he chose to go back to study anesthesia.
“I had to give up my family practice for a year and go back to Winnipeg to do a residency in anesthesia, but my family still lived in Winkler. People from the community would shovel my driveway of snow, mow my lawn. Sometimes unknown people, sometimes neighbours. It’s small things, but overall that encouragement helped to put me on the right path to achieve the things I wanted to achieve.”
Since then, he’s seen the community step up and do the same to support other physicians, be it someone pursuing geriatric care, palliative care or obstetrics. “It’s not just me. It’s a whole list of people here who have been supported by our community and our physician group, helping people achieve a more diverse practice.”
Another benefit he sees in rural medicine is the freedom he has to innovate. For example, he was struck by how much money was wasted on unnecessary pre-op testing. When he looked at a pre-op chart, he felt it was too complicated and it forced people to order costly, unnecessary tests, and he thought he could fix this problem. He set to work, first ascribing a qualitative value on the most common tests, mainly chest x‑rays, urine, and EKGs. Then, he worked out an algorithm on paper for a more streamlined and effective way to think through pre-op testing. He got linked up with a graphic artist and application developer, then took his new pre-op app invention to Manitoba Health. After doing their own due diligence, Manitoba Health agreed to help develop his app and and it’s now used across the province.
“In 30 seconds you can figure out how to use it and what testing a patient needs. I never would have had that kind of opportunity in South Africa. It’s all because I had the freedom to think and be innovative, which my physician group and community greatly support.”
The culture of support he felt makes him want to help others achieve those goals now, too, especially other International Medical Graduates (IMGs).
“One of the areas we fail in is supporting IMGs,” he said. “They normally go to remote areas of Manitoba and too often they are left alone to return their service and then they leave.”
For Dr. Abbu, one key way to keep people in rural and remote areas is to build a network of support, as he found in Winkler.
“Sometimes certain practice styles can be different and IMGs need mentorship in their practice, but equally important is support for their families. If you can keep the spouse happy and help them feel part of the community, you’re likely to keep the doctor in the community.”
For Dr. Abbu, family and community are essential.
Recently, his son moved back to Winkler to work as a family doctor and when asked if this was another way of Dr. Abbu doing his part to recruit doctors to Winkler, he chuckled and said, “No, no. This is his home. He chose to practice here because he loves it here.”
Dr. Jade Young
Growing up in Eriksdale, Manitoba, Dr. Jade Young’s mother was adamant she learn her family’s Métis roots.
“She taught me that we are Métis people and about what has been done to, and continues to be done to, Indigenous people in Canada. Because of my upbringing, I wanted to have a focus on Rural, Remote, and Indigenous health.”
Today, as a Métis physician, she divides her time between her home community of Eriksdale and rotations in Lake Manitoba First Nation and Garden Hill First Nation. In Eriksdale, she works in the clinic, ER, hospital and the Personal Care Home. She does a clinic one day a week at the Lake Manitoba First Nation and flies into Garden Hill one week a month at the nursing station, where she consults, sees emergency cases, and helps however she can.
“At Garden Hill, I fly in on Monday and out on Friday. They have a residence where I stay and I’m on-call for 24 hours every other day. Even if I’m not on-call, if the station is becoming overwhelmed, everyone comes to help.”
Addressing the gaps in Indigenous healthcare is important to Dr. Young. Being in Garden Hill and Lake Manitoba First Nations allows her to do something tangible to help our communities and, she said, “that feels good.” She plans to spend her career in Eriksdale and northern Manitoba, describing herself as well suited to living in the country.
In her 3rd year of medical school, Dr. Young participated in the Home for the Summer program in Eriksdale. She enjoyed the variety of the work, found the staff welcoming and approachable, and generally felt supported in wanting to provide outreach to other communities.
In her last year of residency, she did a fly-in rotation in St. Theresa Point and enjoyed the collaboration between health disciplines in the nursing station. Dr. Young said she “was humbled to work with the patients and providers all working with limited resources towards improving health in their community.”
In many ways, the practice she built for herself is the practice of her dreams. Still, she feels that the work she does is incomplete.
“There is so much to do and nowhere near the resources. Having lived here and knowing the people, understanding rural life, even though it’s incomplete work, it’s still important work. It’s important to provide people care where they are. Many of these people can’t travel for care, or they need timely emergency services, or to be close to their social supports. I believe it’s profoundly meaningful to provide people care in their home community.”
Her advice to anyone considering rural medicine is to go and see where you’ll work and experience the broader community you’ll be in. To help make it easier for physicians to get a sense of rural life, she and her sisters started their own Instagram account called @Lifebetweenthelakes. The idea was to share what they love about living in their community, so students and residents can learn about life in the area.
“Overall, the best we can do is to do our work, what we’re able to do, and continue to support and advocate for one another.”
Dr. Selena Papetti
Born and raised in Winnipeg, Dr. Papetti has spent the last decade practicing in Lac du Bonnet, Manitoba.
“I was a different person when I started, coming to work in expensive outfits with 6‑inch heels,” she says from her home in Seven Sisters Falls. “It made people uncomfortable. Now I’m the hot-mess-mom who roles into work with my Doctors Manitoba t‑shirt, and people like that. They feel like I’m really part of their community. People like that you’re real and down to earth.”
Dr. Papetti always wanted to be a rural family doctor. While she was putting herself through school, she worked at the lodge at Big White Shell Lake where she taught swimming. For five years, she would travel around the Whiteshell, teaching kids to swim and watching them grow.
“Some of the two-year-olds I used to teach are now adults and are my patients, along with their parents and grandparents, and one of them is even a nurse locally. It makes me feel extremely old, but it’s also so cool!”
The experience of living her summers at the lake with a tight-knit community made her want to find a way to live by a lake for good. Together with her partner, they found a community that works for them both.
Over her time practicing in the area, she’s found that recruiting doctors isn’t as big of a challenge as getting them to stay.
“There needs to be more balance for people to make it sustainable, especially for women who have different demands on their time,” she said.
“The best advice I’ve ever gotten about physician retention is to remember you are in charge of your own retention. The system will allow you to work 24/7 until there is nothing left of you. How do you figure out what’s right for you?”
“For me, I realized early on that I can work a little less, and do that for longer. You can have me 7 days a week for 5 years or 4 days for 30 years.” Dr. Papetti has 3 children, including toddler twins.
For Dr. Papetti, the issue of retention is critical. Recruiting doctors is less than half the battle, she says. Helping them stay requires a supportive approach that recognizes each physician’s individual professional goals and personal needs.
Dr. Papetti’s good humour helps to carry her through, and she is grateful for the team she has around her and the informal atmosphere they have built to welcome patients
“I recently turned 40 and the office threw a huge party with balloons and streamers. There’d be people laying down for tests and balloons floating by. So we have fun and can be more informal, which people like. And you will never have a funny experience like that in the city. It’s so much more fun in the country. I’m part of a great community. That’s the joy of it.”
The relationships with her patients make rural medicine that much more rewarding for Dr. Papetti. After the passing of one of her patients, Dr. Papetti joked with his widow about buying and wearing a fanny pack and naming it after her late husband, in his honour. He wore a fanny pack everywhere, “long before it was cool (again).” Recently, the family gifted Dr. Papetti with his well-loved and well-used fanny pack. It was accompanied by a beautifully written card confirming that her work continues to make a measurable impact on her community.
“I was never much of a city kid,” said Sydney McLaughlin from her home in Neepawa. “As a medical learner, not a doctor yet, there are lots of opportunities in rural areas and people don’t realize it.”
Coming from Neepawa, she’s always loved rural life and doesn’t want her fellow medical students to close the door on rural medicine.
“There are preconceptions people have about rural medicine. Sure, there aren’t always the same advanced resources, and, yes, doctors in rural areas have to be more self-sufficient, but there are networks of support.”
She has heard specifically from her fellow medical learners that they’re put off by the idea that they would be going to a rural community and be more or less alone, without a team for help.
“But that’s not the case,” she says. “There are so many opportunities, including to specialize if that’s what you really want and do things like surgery. The community you build is so tight-knit. My best memories growing up are being part of my community and I really want people to give it a chance.”
“Getting people more exposure to rural areas and opportunities would help people consider rural areas,” she said.
Recently, medical students from the University of Manitoba had their Rural Week, where everyone in first-year medicine goes out to a rural community and practices. The communities are located across the province, and Sydney placed in Morden. She arrived Sunday evening and left the following Friday. Over that week, she had the opportunity to shadow different doctors and work alongside them.
“It was a wonderful experience in Morden, which is a bigger regional hospital than what I’m used to in Neepawa, and it was great to see the resources they had. Hearing from my classmates afterward, they enjoyed their placements and I think it made people consider rural medicine in a different way. People got to see that there’s lots to do outside the city and that’s important — you need exposure to it to really see if you want to do it.”
She’s doing her part to get more students interested in rural medicine. With another classmate, they are co-presidents of the Rural Interest Group, which focuses on helping other students experience rural Manitoba.
“We are hoping to run trips out to Boundary Trails, Brandon, Neepawa, and potentially even a Northern trip this year. We also run a mock interview for students at Brandon University to help prepare them for their medical interviews, as there are a lot of rural students there and we’re hoping to increase rural representation in medicine.”
Overall, she wants to help make rural medicine in Manitoba more equitable, stable and better for patients, and that’s what motivates her to stay.
“I’m open to practicing anywhere in Manitoba, but it has to be a smaller town.”
Dr. Trina Mathison
Dr. Trina Mathison has been a physician in Dauphin for the past 21 years. Rural Manitoba is where she’s from and it’s the only place she has ever wanted to work, joking that her years of school in Winnipeg were “not her thing.”
Her practice is largely with the elderly in the area, working in cancer care and palliative care when she isn’t in the clinic or the ER.
To her, the diversity of her work is one of the unique benefits of rural medicine. Growing up in the town of Hamiota, Manitoba, she saw the local physicians as generalists, doing everything. “When I first started medical school, I didn’t even know about the idea of specialists,” she said.
She did her residency in Dauphin and chose to stay. At the time, she had one child and another on the way. Dauphin made sense for their young family. Her husband is from Winnipeg, and Dauphin was a better compromise than moving to a really small town. She was close to her parents in Hamiota and, after spending time in the community, she could see lots of room for sub-specialization. Importantly, too, she saw the ability to build a great life.
“For anyone considering rural or Northern medicine, make sure it’s a good fit for you and your family. Find your thing, what you care about, and what you’re passionate about. It’ll help you to enjoy your work and have some diversity. Because I have an interest in working with the elderly and palliative care, I was able to tailor my practice in that area.”
The benefits of rural practice are personal too, she points out.
“It’s important to enjoy your work, and also to do things outside of medicine. I’ve enjoyed coaching and the arts. One of my colleagues is involved with the community theatre here in Dauphin. It’s important to have those things outside of medicine that nourish you, too.”
The flip-side of immersing yourself in the local community is the need to establish boundaries. Dr. Mathison coaches, so people have her personal phone number, or they are connected with her on social media and can reach out that way.
“It’s always a challenge when patients are friends and acquaintances, and in general people are much more familiar in rural areas than in other places, so you have to make sure you have a good policy to respond or a set statement.”
And yet, she doesn’t blame people for being frustrated with the state of rural medicine. In her area, the Ste. Rose ER will no longer provide overnight care and Grandview’s ER will be closed evenings and weekends, sending more patients to Dauphin. Travel times are difficult for many patients and families, and people are too often asked to go to the city for follow-up care that should be delivered closer to their homes. The ambulance shortage also strains the system and sometimes forces people who need help travelling to use a Handy Transit Van at their own cost. Care home beds are closed because of staffing, which means people can’t be at the home that’s closest to their loved ones.
These strains on the system are hard on families, and it’s being there to care for her community that keeps her going.
Dr. Nathan Coleman
Dr. Nathan Coleman has worked in Thompson, Manitoba, for nearly 6 years. His practice is a mix of time in Thompson, where he does comprehensive clinical care and a smattering of other things, including ER, hospice, and a medical residency program. He also does fly-in medicine in Shamattawa First Nation one to two weeks per month, a community he thinks of as his home away from home.
Over his time in both communities, he’s become attune to what it takes to make a career in the North.
“Lots of people get interested in rural medicine because of the broad skills they can work with,” he said, “but over time what people usually find is that the community builds you into what it needs you to be.”
As an example of how the community shapes a physician, he recalled a moment during the pandemic when there were issues of people who were addicted to alcohol but couldn’t get access, so the community needed to develop a managed alcohol program. This was new work for him, so he coordinated with community leaders and they pulled a program together.
“It’s what the community needed. There are supportive people who you work alongside and they turn you into what they need.”
Much of what he’s learned about medicine has been taught to him by patients. “People with high needs or from vulnerable populations, they end up being the best teachers and have taught me the most. Their lived experiences are crucial.”
To him, the ability to connect with people is one of the best parts of living and working in smaller communities.
“Sure, it can present challenges. Say you’re at the restaurant and people come and ask about their medical conditions. At the same time, in difficult situations, people in the community know you and see you as a human being. If you look at physician burnout, the dehumanizing of doctors is a big part of that. Small towns make people human again in a way that a bustling urban centre doesn’t.”
He’s taken this approach to building connections with the community and made sure his whole family is able to take part. Twice a year, he would take his kids with him to Shamattawa.
“The kids love being together as a family and knowing where I spend that time, which helps to make them feel connected to me. And the community has been so welcoming, always asking how they’re doing. We went raspberry picking and to watch the bears at the dump sitting on couches. One time, the caribou had come through and some of the hunters brought the kids out and showed them how to prepare it. You have to see it.”
When it comes to the challenge of physician retention in the North, his sense is that it’s not that people are leaving the North because they necessarily want to, but because they need to, usually family demands. This presents an opportunity about how to better support the physician and their family.
“The idea that physicians are human first has to be central. We don’t want people who are looking for easy work because the work will never be easy. What we want is people who are committed and care about people, and who can keep working that way in an ongoing, sustainable way.”