Excellent interview, can’t be any clearer.

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Hi Paul,

I am really enjoying your writing and very notably miss your writing in Macleans, which subscription I am cancelling when my subscription runs out in May.

Just listened to Brian Lilley's interview with Ret'd, Lt.Gen Michel Maisonneuve re his Nov. 9 speech when he accepted the VIMY AWARD. A good interview, but I would really like to hear your interview/comments re Maisonneuve's speech and position w.r.t the Canadian state of the military and general leadership of our military right from TRUDEAU ON DOWN THE LINE.

Thanks, John Rempel

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An interesting and informative interview, Paul. Thanks.

Interesting for sure that Alex Munter was saying staff shortages is now the number concern due to retirements, but also young medical staff personnel who have left the profession. We hear more and more these days about staff shortages in different businesses and institutions, and it begs the question where do these young people go?

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December 2, 2022

Mr. Wells, this is a long response to your most recent podcast with Alex Munter, the CEO of CHEO. There was much to think about in that interview.

In the course of the interview, Mr. Munter said, “you just can’t hire (retain?) psychologists in hospitals anymore.”

I am a retired neuropsychologist. I have spent decades in both hospital employ and private practice. In that stretch of time I have thought a lot about why psychologists work in either setting. Some of the thoughts may apply to recruitment and retention in other professions as well.

Mr. Munter’s sense was that one reasons why psychologists left the hospital for private practice was that they could make more money. It is quite true but not the entire truth. Over the years I have heard psychologists give many reasons for leaving hospital work to go into private practice. I have come up with many to rationalize my own decisions. The reasons included not just making more money, but also having more autonomy over what kind of work one did; autonomy over how hard to work; when to take vacations, the ability to go to conferences....many such things. About the money part, though, in reality the net income is not too different.

Okay, so working in a hospital is tough. Psychology is not alone in feeling that strain.

One element is that the practice of psychology, when done well, is very wearing on the practitioner. Emotionally, it is tough work. One day a patient apologized to me about the suffering they had brought to the appointment. All I could say was, “We do not see happy people in this line of work.” So far, that is true for any one in health care. The practice of psychology seems take a different type of toll. Our work takes a long time to have beneficial effect, if there is any at all. It is never certain if what we do will make life better for the patient. Even though the training of a psychologist includes ways to keep an emotional distance from the patient, to achieve a work / life balance, to take care of one’s own self, it is still a type of job that, when done properly, requires empathy and compassion. The use of these attributes exacts a price from the practitioner, and there is no guarantee that the work one does will balance out somehow with a good outcome.

All clinicians need to balance out the sheer toughness of health care. Some believe the balance might be found in nicer vacations, more time for conferences, some measure of recognition beyond a paycheque for a job well done. It is clear that front line workers of all professions know without verbalizing it directly that they must find ways to repair themselves from the grinding effects of the work.

Hospitals simply do not allow for that kind of mechanism. Private practice holds out the promise that it does.

There is a trade off when a psychologist leaves the public sector for the private sector, and that is the range of patients they see. The difference lies in which pocket the money for the services is to be found. In neuropsychology it is particularly the case that, as a colleague explained, the hospital is where one sees real clinical cases; the most unusual and challenging cases. Neuropsychology, and many forms of psychology, is expensive. In private practice one sees patients with access, often through auto insurance or litigation, to the kind of funds that pay for twenty to thirty hours of professional time, plus costs, expenses and rents. As a consequence, in private practice one sees a very limited range of patients and clinical presentations and after a while, the work is not challenging or interesting. It is a well paid but boring job. Hospital work, in contrast, is more challenging but it wears one down far faster.

I do not have specific answers for a hospital CEO that wants to retain psychologists on staff. This is a time when all staff in all areas are struggling. It might be simplistic to say that psychologists leave because they can. It is not too different from nurses leaving for agency work. It is possible to make a good living privately. Many of us, at least in neuropsychology, would have liked to stay in hospital work, but these are tough places to work.

I have worked, since graduating with a PhD, in a variety of hospitals. Personally, I found the drain comes not from the patient load or the types of clinical presentations. What makes hospitals such challenging workplaces for psychologists is probably the same set of forces that make it hard for others. When the work is so emotionally demanding, clinicians need more than a paycheque.

I suspect this underlies why so many other professions open free standing services, why nurses sign up for agency work. These options provide some hope for autonomy, some breathing space to make decisions to take or refuse work, to manage the stressors in a way that makes health care livable. Making more money in private work is seen as a means to achieving that autonomy.

One might conclude that the necessity of taking a business model into account in managing a hospital is in direct conflict with the clinical work of tending to ill people. Ill people bring a greater range of needs with them than a predetermined set of investigations and treatments. There is only so much money to go around, and it must be managed carefully. Unfortunately, there are only so many psychologists, nurses and other professionals around, and they too require careful management.

I keep coming back to individual autonomy as key to retention. This too might also be simplistic.

I will leave my thoughts there, with apologies for the length of this response.

Kind regards,

Lorraine McFadden PhD

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