Leadership in Medicine and Rural Generalism with Dr. Barb Zelek

Join us this month as we sit down and talk with Dr. Barb Zelek, a rural generalist in Marathon, Ontario. Dr. Zelek has worked in Marathon for over 20 years, providing rural generalist care, including emergency medicine work, obstetrical care, and hospitalist work. Outside of her clinical work, Dr. Zelek has been deeply involved in Leadership opportunities at NOSM University and now the College of Physicians and Surgeons of Ontario. Throughout her career, Dr. Zelek has also used her clinical practice and pulse on rural care to guide her research to help improve healthcare in rural communities. Listen in to learn how you can build research and leadership into your future career in medicine!

Transcript

SPEAKER_00 0:16

Hello everyone, and welcome back to the Pathways Podcast produced by Nawsam U Student Council. In this series, we sit down with physicians in Northern Ontario and learn about their journey to medicine, their careers, and their lifestyle. My name is Mackenzie Martel, a third-year medical student at Nossum University.

SPEAKER_01 0:32

And I'm Pascal Ducet, a current fourth-year medical student also at Nossum University.

SPEAKER_00 0:38

And we're excited for today's episode since we have the chance to chat with Dr. Zelik, a rural generalist working in Marathon and beyond. Dr. Zelik is also involved in medical education and leadership at Nossam University, including her role as a professor. And she's very active with research in rural health. So without further ado, thank you, Dr. Zelik, for being here today.

SPEAKER_02 1:00

Thanks so much for having me.

SPEAKER_00 1:03

Awesome. So in preparation for this episode, we did some digging and uh saw that you have an extensive uh resume in leadership roles at Nossum and have been involved in research throughout your career. For our listeners who may not have met you yet, would you be able to introduce yourself, tell us where you're from, give a brief overview of what you do for work at this point in your career?

SPEAKER_02 1:24

For sure. Um, so yeah, so my name is Barb Zelig. I am a rural generalist, family physician, and my home base currently is in Marathon, Ontario, which is part of the traditional unceded territory of the Victagong-Nishnabe First Nations peoples. I actually grew up in Toronto in the West End in a Polish neighborhood uh called Broncesville. My parents were Polish immigrants and had met in Canada. And uh so I grew up in downtown Toronto and then eventually made my way to Marathon. So I've been in Marathon for over 23 years and in practice for over 25. So that's a little bit about uh sort of where I live right now and uh a bit of the path to where I got how I got here. And then the other bits in terms of my career right now. So for uh 22 and a half years, I was a comprehensive rural generalist family physician in the practice here in Marathon, Ontario. And um prior to that, locumed uh for a year and a half. So I've transitioned the clinical part of my practice uh back to being a locum. So I provide locum services in a number of different rural communities, and then have had the great privilege of being involved in both leadership and research at Nossam University. So I currently wear the hat as the Associate Dean Faculty Affairs Clinical Sciences, and I'm also on the physician, uh on the leadership team as a physician for the Dr. Gilles Arcand uh Research Center. That's amazing.

SPEAKER_00 3:05

Now, with that in mind, let's go all the way back to the beginning. When did you realize you first wanted to be a doctor?

SPEAKER_02 3:12

Yeah, I love that question. So I do actually have a really distinct moment that comes to mind. And I was in high school and I was uh visiting my family physician at the time, who was an elder uh gentleman. And I remember having this sort of moment of thinking, uh, there need to be more women in medicine. Uh and so that was sort of the time when I uh realized that I was interested in in medicine, um, and then sort of pursued a path uh from from there.

SPEAKER_00 3:45

Awesome. And can you take us through that journey from discovering you wanted to be a doc and then all the steps that we, you know, all the hoops that we have to jump through to become a physician in uh in Canada?

SPEAKER_02 3:56

Yeah, for sure. So um after finishing high school in Toronto, I did my undergrad degree at McGill University in microbiology and immunology. Uh, and I remember that being just a really sort of a fun time of my academic journey being away from home, as many people do, to go away to university, making some really, some really great friends. Um, and I actually I remember uh on my floor in residence, there was uh another woman who was interested in medicine. And I remember thinking, oh my goodness, she worked so hard. Do I do I have to work it as hard as she does? And so we became good friends. And I think I certainly learned some good work ethic uh from her and did apply to medicine when I was in my third year of university and was actually uh successful in getting into the University of Ottawa. And at that time, I was really lucky to be able to defer my acceptance for a year. So I was able to finish my undergraduate degree at Nigel and um and then had a really fun fourth year of undergraduate education and then went to the University of Ottawa for med school. And uh when I think about my path in medicine and being at the University of Ottawa, again, sort of just felt really lucky to be connected with um just a great group of classmates. There were various opportunities presented for electives both in Ottawa and outside of Ottawa. And I actually remember a very uh formative experience where I had an opportunity in my third year to go to Sioux Lookout. And Sioux Lookout was a really, really popular uh place to do electives uh back in the 90s when I was in in medical school. And and I had an absolutely sort of wonderful experience that without realizing at the time did did shape my eventual path, career path as a clinician. And so it was one of those moments um where the clinical medicine was really interesting. I had some really fantastic preceptors. I was really open to kind of learning and the experience and just uh came away from that experience, uh just really moved by what uh family medicine and rural family medicine could look like. And so certainly would identify that as an important deciding factor around pursuing family medicine in particular. And then I did do my residency at Queen's University, which at that time was one of the medical schools that offered more of a rural experience. Um, and that's something that was shaped by that uh experience in third year at InSue Lookout. And so did my residency at Queens. And that was sort of my educational path to uh in medicine.

SPEAKER_00 7:08

Oh, that's great. And I really appreciate the opportunity that you had to defer your acceptance to medical school and continue your finish off your degree. I'm sure that was pretty satisfying to kind of get that behind you, but also takes off a bit of pressure in those fourth year classes, knowing that you're you're uh heading into medical school regardless.

SPEAKER_02 7:27

Yeah, that was awesome. Like I um am so yeah, so grateful for for that opportunity in that year in particular.

SPEAKER_00 7:35

Awesome. So day one of med school, did you know you always wanted to be a real generalist?

SPEAKER_02 7:42

No. I think I I definitely did not know that I wanted to be a real generalist. So my frame of reference had been certainly growing up in Toronto, but I didn't have an idea in terms of what kind of physician I wanted to be. I really sort of went into medicine with a very open mind. And and actually through much of medical school, I was like, oh, you know, I should keep my options open. Uh, I thought about pediatrics, I thought about psychiatry, and I thought about family medicine. Um, and so I think I actually applied to all three and may have interviewed for all three. Um, and when I look back, I I think ultimately family medicine is really what I wanted to do. But it was this sort of, you know, mindset of, oh, let's keep my options open and and see see where things land.

SPEAKER_00 8:29

All right. So pretty undifferentiated and even up to the matching process. Um, were there any other specialties that you had considered outside of pediatrics and psychiatry throughout your time in med school?

SPEAKER_02 8:41

I would say it was those three really, like when I look back, are the ones that I've considered uh not not any others.

SPEAKER_00 8:49

Awesome. Was there anything that, you know, a certain point in time, or a preceptor or mentor that kind of helped you decide the family medicine?

SPEAKER_02 8:57

Or so what I would say is certainly that experience in Sue Lookout probably um started the the grounding in terms of making me think about uh family medicine as probably my primary choice. And you know, if I yeah, if I look back and try to connect to that moment at the time, I think really that was quite transformative in terms of guiding my path ultimately, and then had the opportunity to be exposed uh sort of more broadly to other specialties and family medicine as well. So did, you know, obviously eventually end up on that path.

unknown 9:43

Right.

SPEAKER_00 9:44

And uh would you be willing to share how your residency time was and what uh program you had done and how that kind of set your trajectory as a world generalist after that?

SPEAKER_02 9:56

Yeah, for sure. So at Queens, um, at the time, uh, as I had mentioned, there was an opportunity to do rotations in some more distributed settings. So I actually remember doing an orthopedics rotation in Timmins. Uh, I did some family medicine rotations in Moose Factory and obstetrics in Belleville. And so I was also in a uh at a point where I had the opportunity to travel. I wasn't tied down to needing to be in Kingston for all my rotations. And so chose to go to those other communities and yeah, just really kind of loved all the experiences uh when I look back and being in different centers and the opportunity to get to do so much um by being in some of the smaller centers.

SPEAKER_00 10:48

That's great. Yeah, the opportunity to, you know, stay in Kingston for some of your main uh rotations and then still get that uh that rural uh experience throughout uh other kind of electives and things like that. So that's that's awesome. And through all the training that you've gone through, is there a unique part of your specialty that you found surprising or something that you didn't expect before uh working in it?

SPEAKER_02 11:14

Oh, I love that question. And I and I what I think about really is I don't know that I would have imagined myself as a rural generalist. So I had finished family medicine, had pretty comprehensive training, um, and and then sort of just took that time after graduating to do locums and go to different places. And so I guess one of the things when I look back that I hadn't necessarily planned out, but ended up being just a really great experience was doing a really busy locum being based in Ottawa, where the practice that I was covering, the physician had a very busy obstetrical practice and uh was in a small group and sort of covered her deliveries mostly herself, and then sometimes signed off to one other colleague. So early in my clinical practice as a family physician, I got exposed to a lot of obstetrics uh in a bigger center. So at that time it was the general campus of the Ottawa hospital, and I got to uh attend, it was a large number of births in a small period of time in a really supportive environment. So because I had done medical school in Ottawa and then had gone back to practice there, I knew a lot of the physicians and specialists and so was able to just gain a lot of really great obstetrical experience so that when I did eventually settle in Marathon, where uh obstetrical services continue to be provided without surgical backup in the community, I felt really confident in my skill set. Um and that's not necessarily something that I had planned out, but something that I look back at and am really grateful uh to have experienced, especially in the early stages of my clinical career.

SPEAKER_01 13:20

That's really interesting to hear about, Dr. Zalek. Um, aside from your main specialty, we'd also love to hear a little bit more about some of the other roles that you've taken on during your training. So you mentioned being involved in leadership and research at Nossum. Would you be able to share with us how you decided to incorporate those into your practice over the years?

SPEAKER_02 13:43

Oh, I would love to do that. So, what I might do is I might start with uh the research part because it does actually go back to medical school and residency and highlights, I think, the importance of mentors uh for us at different stages of our careers. And so uh when I was a medical student, I had an opportunity to be involved with a number of faculty members from schools across Ontario who were at that time really interested in gender issues. And I met a wonderful colleague who is now a friend, Dr. Susan Phillips, who was actually at Queen's University when I was at the University of Ottawa as a medical student, but very involved at that time in research around gender studies and gender studies in medical education. And so through just being interested in uh gender studies, I was invited to participate in this larger group and that sort of sparked this interest in research in a really supportive environment. Um, so Dr. Phillips, I would say, sort of probably held my hand through lots of it. Uh, but uh during that time in uh in medical school, we had an important publication, I would say, that came up uh looking at gender sensitivity and medical curricula. And what I learned from that was how our interests in general can help us ask questions that are important in uh clinical practice or medical education or other areas that can inform pathways around research. And so that's how I sort of started into research. And then when I ended up at Queen's, I had an opportunity to work more with Dr. Phillips and again just had a very had an interest in sort of uh gender differences in healthcare. And so my residency research project looked at physicians and nurses and gender and power. And so again, that research interest continued. And then once I got into clinical practice, that's when sort of I was exposed to sort of some of the questions around um clinical care that could inform research. And so again, at that time, as I had mentioned earlier, we were doing a lot of obstetrics, and marathon was one of the few communities and still is that does provide obstetrical services without C-section backup. And so with one of my colleagues who also had an interest in research, we did some surveys and studies to look at rural obstetrics in particular and women's experiences of delivering in rural communities. And so, so again, it was a question that came up and uh sort of we asked it in a scholarly way and uh have published a couple of papers related to that in particular. And so that also corresponded, I would say, with at a time when I had small kids. So I was doing a bit less research, and as the kids got older, just uh through NASEM, actually in the beautiful web, I would say, of the university and the opportunities to be involved in academia and scholarship, um, just continued to meet folks who've been involved in research and the last few years have had the chance to spend a lot more time um in research and primary care research in particular. So I might sort of stop there because uh thinking about sort of the the research path, there's potentially more, and we can go there if if we choose. I think the question around leadership again is uh is a great one. And again, I attribute uh so many of the opportunities that I've had to our distributed environment at Nassim University and just the opportunities that come up to be involved from a leadership perspective. And so I think lots of folks who end up in medicine end up in medicine because they do have some leadership qualities. And so I think uh when I look back again to the early stages of my career as a rural journalist, you're often called upon to um be involved in committees, whether those are hospital committees or clinic committees. And sometimes you do that just because it's your turn. And so certainly there was some of that. And so was involved with a number of different committees during my clinical practice time in Marathon. And then um again, just through that network of being a smaller university, I think opportunities came up where I was sort of tapped on the shoulder and said, Hey, do you want to consider this leadership opportunity? And so one of those was in the early days of when the Promotions Committee of Nassum University was getting started. I was invited to participate on that committee and then to be the chair. And I remember thinking, oh my goodness, what do I do? Feel like really overwhelmed by that. Um, but they're great and safe places to learn about leadership and administration. Um and so again, that opens doors and that idea of just being open to opportunities that come up is one that has stayed with me, especially in that kind of leadership space. And eventually I was um the vice chair for family medicine at Nossam University, and then the clinical sciences division head, and now the associate dean for faculty affairs clinical sciences. So it's been just this um lovely uh, I guess, progression in leadership opportunities that I really sort of just credit to the web of Nossam University and um and the relationships I think um that we have across Northern Ontario that span those clinical, academic, and for me, also those research spaces.

SPEAKER_01 19:57

Wow, thank you so much for sharing your pathway into both research and leadership. I think it really just speaks to the fact that there's so many opportunities out there beyond clinical work as well. And it's really inspiring to hear about how you can really mesh both your clinical work and interests with both research and leadership. I'm really curious. Like, how do you balance all of these roles? It sounds like you, you know, wear a lot of hats. So I'm just curious, like, how do you balance all of it?

SPEAKER_02 20:30

I love that question too. So yeah, the balance has shifted over the years, uh, is what I would say. And so um at a point when my children were younger, I would say certainly I was doing uh less and the clinical work took more of a focus and being a mom and a partner um, you know, were priority. And then as the kids got older, I felt that I had more capacity to take on certainly some of the leadership roles. And then now both my kids are in university. And so again, it's this sort of shift in stage of career and um and that intentionality around the opportunities and thinking about how I want those to look and the balance that those take in my life. So, so again, with having been able to shift to more of a locum-based practice, that means there's been some more space opened up to do leadership and research at this sort of later stage of my career. And I've loved that. And so I think that piece around balance is different for everybody and our callings with respect to sort of clinical, personal, um, other areas of service or time that we need to decompress uh and have alone time. Are there it's different for everyone? And it's looked different for me at the different stages of my career. Um, and I would say probably there's been times when I have been uh less balanced and probably too busy. Um, and other times where I approach my commitments uh yeah, very more intentionally and think about uh sort of yeah, what is it that I need to stay feeling full, feeling joyful, uh while also being to being able to contribute um in the various areas that I'm able to. Amazing.

SPEAKER_01 22:48

I know you spoke a little bit about your role as a researcher, and I'm curious to hear how did this role change over the course of your career? And are you as involved in research now as you were before? And what does that look like?

SPEAKER_02 23:05

Oh, thanks also for that question. So I would say that I'm more involved with research now than I ever have been. Um, and so I think I spoke earlier about sort of the early times of getting involved with research as a medical student and then as a resident, and then in the early stages of my career, uh, looking specifically at obstetrics. And so the point in time when I would say that research took more of a role in my career was actually when I was the family medicine co-chair for Nossam University. And at that time, I was attending provincial and national meetings and learning about something called practice-based research and learning networks, which each of the other medical schools had, these PBRLNs. Um, and just really quickly, what those are is a collection of de-identified patient electronic medical record data that can be used to ask practice-based questions. And so I was approached to see if I would be, if Nossum University would be interested in um working with another university to develop a PBRLN and uh and sort and join their PBRLN. And I guess I'm probably a little bit stubborn. And so I said, well, no, we don't need to join, we'll just have our own. And so I think that was the that was the moment when I would say I got uh more involved with research. And so again, through the support of lots of mentors at Nelson University, uh, we were able to move that initiative forward. And what that did is then opened up a lot of doors around primary care research. And one of the huge gifts has been the opportunity to work with our human and medical sciences faculty at Nelson University who are also involved in research. And shout out to a colleague of mine, Dr. Brianne Wood, who is a PhD epidemiologist, who's an associate scientist with Nelson University and also the Thunder Bay Regional Health Research Institute. So Brianne is a really passionate, brilliant researcher. And so we just happened to kind of meet up at this time of our careers when this path around PBRLNs was opening up and she was really interested. And so, so again, my involvement in research has exploded, I would say, since that time. And so it's been it's been really fun to be involved and then have the opportunity at Nasim University to build some of the structures for our clinical faculty who are also interested in in research. And so, again, just um with the PBRLN has that has shifted to an opportunity to be involved with the Dr. Gilard Khan Center for Health Equity, um, which is a research center, as I had mentioned earlier. And so I continue to be involved with that and that continues to be a really important part of my work currently.

SPEAKER_00 26:17

That's amazing, Dr. Zalek. And it's it's interesting to see how a career as a rural generalist can allow you to have such a good pulse on a community over, you know, decades of your work and from there kind of inform the um research that you want to conduct and kind of make the change that you want to see in the system. So we really appreciate you uh sharing that role. And kind of, you know, we always think about the CAN Med's role in medical school. So it's really cool to see how you're you know embracing those roles and then also sharing, sharing them with us and our listeners. So we appreciate that a lot.

SPEAKER_02 26:55

Yeah, thanks for that reflection. And if I can say the other really great thing has been um seeing students, medical students get involved uh with some of the research uh initiatives. And honestly, that just gives me so much energy. Over the last few years, uh I've had a chance to work with a few of the Nossan University medical students, and it's just so exciting to have kind of your energy and interest kind of help kind of keep me really motivated. So a shout out to to uh sort of both of you, because I think this is in some ways a scholarly endeavor doing these podcasts, as well as some of your um your colleagues uh who, again, I think are just uh sharing their good energy and some of them in that space of research as well.

SPEAKER_00 27:45

Awesome. We appreciate that. And kind of maybe we'll try and bring you back to the days working in Marathon with your comprehensive family practice. Can you tell us, you know, what a typical week might look like for you at that period of your career? And then maybe contrast it with what a typical week might look like for you now.

SPEAKER_02 28:08

Yeah, um, so a typical week for probably, you know, a good two decades of my clinical career um would in in marathon. So this is sort of the the frame of reference, would be usually I would do one 24-hour emergency medicine shift. And during the emergency medicine shifts, uh, the way things had been set up here is we would often do procedures on those days. So those would be lumps and bumps, IUD insertions, endometro biopsies, joint injections. So we tended to do those during our emergency medicine shifts. So that would be 24 hours. Some of those nights we would get to sleep. Other nights we would be, we would be up. And then other nights, sometimes we would just get phone calls. So that would be part of it. And then when we had patients who were admitted into the hospital, if we were the doc working in eMERGE, we would be the ones responsible for admitting any patients. And then once those patients are admitted, they would be transferred over to their family physician for rounding during the week. So though that would depend um whether I would have patients admitted or not. But usually if I did, we would round in the mornings, um, typically between eight and nine o'clock. And then probably two to three days a week, I would have clinics uh that were at the family health team. So working in an interprofessional uh care environment. So seeing patients um in the clinic setting, providing continuity of care. And so again, a mix of sometimes sort of more same-day urgent type appointments with chronic disease management and everything else that falls into the family medicine sphere. One of the really fun things that I think about from the clinic perspective just was the gift of working in an interprofessional team environment. So we were one of the first communities to hire a physician assistant. And one of my colleagues did a lot of work in terms of working through the delegation details uh for physicians, uh physician assistants. Um, and so part of the work we did in the clinical setting was be an interprofessional care resource person uh that was designated per half-day clinic. So if our PA or nurse practitioner um or at in the past, we have had a dietitian had questions, they would have a physician that was designated that they could speak to. So that's one of the sort of really, I would say I feel like marathon is a is a really nice model of a high functioning interprofessional team in primary care. And so, so that was part of what those weeks would look like on the days that I was in clinic. And then in the early days of covering obstetrics in marathon, what we did is we would be on call for a month at a time for obstetrics. Our volumes were low, so it was doable. Um, and we had a number of people. So you would take kind of obstetrics call for a month. So if something was due, you'd get called if and they came in in labor, you would get called in to see them. Um, and so that changed in the later stages of my career doing obstetrics to a week at a time. The month sort of felt a little bit too much, and then the numbers of obstetrical providers did decrease. So it's just made more sense from going back to your sort of lifestyle and balance question to do a week at a time. So um, so, so some clinics, uh, 24 hours of call. And then typically on Wednesday mornings, our team would have that time set aside for meetings. So we just spent a lot of time uh sort of on committee work and just also thinking how we functioned as a team and how we made decisions and really intentionally dedicating time to those types, uh, types of meetings. And then thrown in there would be taking kids to various sort of sports practices. So when the kids were younger, um, there was gymnastics and hockey. Um, so being a parent. Um, and again, what I love about a small town is it doesn't take long to get to places. So you could zip out a clinic and get a kid to an activity uh and then uh and then get back home uh if necessary. So so hopefully that answers the the question around what a typical week would look like uh through most of my clinical career. And then more recently, I think was the the second part of that question, which is um uh I usually do a few days of locoming at a time. And the locoming will be emergency medicine as well as clinic. And then my other time is dedicated to my Nelson University leadership role in research. And so that involves a lot of virtual meetings and a lot of emails.

SPEAKER_00 33:22

No, that's fantastic. And as someone who just uh completed their uh community clerkship in third year, it's really interesting to see how you know rural medicine can look like and how physicians structure it and how the days just fly by and the weeks, I'm sure, and I'm sure the years eventually fly by as well. And I'd like to just ask one of my favorite questions, which is if you have a procedure or a patient presentation that you like to treat, like your favorite procedure or patient presentation that comes in the merge, or the clinic that is your favorite to manage or take care of.

SPEAKER_02 33:59

That's a really fun question. So what I would say like the stuff that kind of gets me excited actually is some of the undifferentiated cases. So I love the challenging clinical presentations and diagnostic skills. And so, so yeah, so it's not necessarily answering what's my favorite kind of presentation or procedure or something to do. It's really, I think, these interesting cases where folks are coming in and we have the opportunity. So either if we know the person to have some of sort of their know a little bit about them, both from a medical history and perhaps a personal perspective, and then that opportunity to kind of piece together, okay, what's been happening in the uh in the primary care environment, what are they coming in with now? What does our physical exam show us? So I love kind of that's a really still important core teaching for me is going back to what is our physical exam telling us? Um, both vital signs and what we're actually finding. And how does that fit with uh what the symptoms the patient is coming in with, and then whatever sort of diagnostic tests we might have access to, and then trying to think through what that could be and being comfortable knowing that sometimes we don't know the answer. Uh yeah, and my colleagues will I think we'll probably agree that uh uh that this is the kind of stuff that gets me excited is some of this undifferentiated stuff that uh sometimes you do need to sort of consult with your colleagues or specialist colleagues. Um, but that chance to kind of piece things together I I find really, really interesting.

SPEAKER_00 35:42

Yeah, definitely the patient who presents with weakness or busyness definitely requires some detective work. So I can appreciate how that uh can be stimulating, definitely. I'd like to try and see what your opinion is on what the bread and butter is of family medicine, but more specifically, family medicine in a rural community. What would you say is kind of the things that you see every day, the pathology that you see, and how that might compare to what's seen in more urban centers?

SPEAKER_02 36:14

So what I would say is, yeah, I mean, I think there's probably some common answers that people might uh give to that. But when I think about sort of my clinical reality of living in a northern, more rural and isolated setting, certainly what I would say there uh is a lot of chronic disease, and specifically thinking about diabetes, uh, coronary artery disease as two prominent ones that come to mind in terms of diagnoses that patients would have. I feel that over the years, and certainly since COVID, that there's been a lot more presentations related to mental health. And I'm just gonna segue a little bit just because it's the chance to talk about. So, one of the uh recent areas of interest from a research perspective has been youth mental health. And part of that has been shaped by the fact that I have seen an increase in presentations in youth mental health and mental health in general in primary care. So I would say um that's another large sort of part of um what people are presenting with. I have an interest in preventive care as well. So I think when I when people come in for some of the chronic diseases or mental health, or whether it's sort of an acute illness that might uh might have come up, I often do take the opportunity to ask questions about preventive care services. Cause again, I think those are really important from a um a disease prevention perspective. Um, and so I think generally with rural medicine, we see all of those things. And then also have the gift of um, again, I think it's a small community where everybody accesses care in the same centers. You do get to know families and generations of families. Um and there's uh there's certainly a beauty, and I think a gift of of getting to know people and hear their stories, making some of the connections and being able to then, I think oftentimes have a better context and therefore understanding maybe of some of the presentations that they're coming in with.

SPEAKER_00 38:33

That's amazing. And uh I appreciate you sharing the uh work with uh youth mental health, and I think that's a really important work, and we definitely appreciate you being on the forefront of that. You you mentioned earlier uh locum work, and for our listeners who, you know, may be in high school or just starting medical school, could you kind of explain what the role of a locum physician is and what that might look like in someone's practice and perhaps how you've incorporated it into your practice, and as well as maybe uh a rapid fire of some of the communities you've been able to locum for?

SPEAKER_02 39:12

Sure. So maybe I'll start with the definition. And I think for uh for folks who aren't in medicine and they hear the word locum for the first time, it's kind of like the equivalent would be like a supply teacher. So you're a supply doctor uh going to various communities to provide um locum services. And so depending on someone's training and their level of comfort, sometimes for as a family physician, you could be a locum and work exclusively in the clinic setting, providing uh clinical primary care appointments. Um, or as a rural generalist who's had exposure to emergency medicine, as a locum, you might go and cover the emergency department in um in smaller communities. So that's certainly what I've done. Um certainly there's also specialists who uh may provide locum services. So there may be locum radiologists or surgeons that come in and typically cover for another physician. So if a physician is um uh off on vacation, they would ideally find a locum to cover for them. Sometimes um there certainly are communities I think that have been uh struggling with physician human resources. And so in those communities, sometimes locums um are not necessarily providing vacation coverage, but they're working to keep emergency departments open. So that's sort of a quick um overview of locums. But as a rural generalist locum physician, what I do now is often we'll cover in emergency departments. So usually those are 24-hour shifts. And again, you see the folks that come in. If people need to be admitted, you get to admit people into the hospital and oftentimes also are rounding on the patients who who are admitted and then um providing clinic services uh as well. And so that's kind of the the, I would say kind of the high-level overview in terms of what a locum does. And then since I've shifted from my regular clinical practice um about two years ago, I have had the opportunity to be a locum in Marathon, Terrace Bay, and Nippigan. So I've stayed relatively close to home until just September. I still still had kids who were were home and in university. And so uh so it's been great actually to sort of just be able to provide the services along kind of this north shore of Lake Superior Highway. Uh and then I'm hoping in the next year to sort of expand a little bit beyond that because I'm really, really interested in rural primary care and the delivery of rural primary care and just sort of seeing some of the best practices in different communities. So, so in a few months, I'm hoping maybe to go to some other communities. But that's that's where I have welcome to up to now.

SPEAKER_01 42:04

Incredible. Thank you for sharing that. Once again, I feel like it's it's really amazing to hear about the opportunities of being able to shift your practice as a rural generalist and family physician to meet your interests and personal life as well. So it's it's really great to hear about that. Um, we're really also curious to hear about whether you're still taking call and like in general, how often do you take call, let's say like on a weekly basis and and what does that look like?

SPEAKER_02 42:37

Yeah, so I still am doing um sort of call, and I'm I would say from a I guess a language perspective, I would almost wrap it up into the locum, uh, locum bit. So for example, this week, um I had a uh colleague who had to sort of go away unexpectedly for family issues. So I took a 12-hour overnight shift uh on Tuesday, and then I'm gonna do a 24-hour call shift on Friday and 12 hours on Sunday. Uh that's here in Marathon, so it's it's great because I I get to be home. Other times what I do, what I'll do is serve sort of stack four days and um we'll maybe do uh like a 24-hour call and then a clinic, a 24-hour call and then a clinic is sort of what my sort of locum and call days are looking like uh right now for the most part.

SPEAKER_01 43:29

Okay, that's really great to hear. Um and in general, do you find you work many night shifts or like it sounds like you're working some 24-hour call days here and there? Um, but in general, would you say you also work overnight quite a bit?

SPEAKER_02 43:46

Um, so what I would say is sort of when I'm on call and doing the 24 hour shifts is usually when I do the the night shift part of things. So um I'm finding that I'm still able to do that. So that is uh that is a Good thing as I get into the later stages, stages of my career. And again, the way in lots of these rural communities is some of those overnight shifts, um, you do get to sleep and sleep some of the night, other times most of the night. So knock on wood. Hopefully, that pattern of things, uh, things continues. But uh certainly am still incorporating uh overnight work in my in the clinical parts of my practice.

SPEAKER_01 44:27

Awesome. Okay, yes, that makes sense. And it sounds like there might be some variability here, but how many hours would you say you work clinically per week?

SPEAKER_02 44:40

Um so yeah, there is a lot of variability right now. I would say probably again, averaging things out over a month with the balance of doing the research and the NASAMU leadership, I would say probably 20 hours a week averaged out, which would include some of those overnight shifts.

SPEAKER_01 45:00

Awesome. Okay, thank you for sharing that. Um I'm also curious to hear, are there specific specialties that you find you often work closely with? Or more in general, are there any like um non-physician healthcare professionals that you often are working alongside?

SPEAKER_02 45:18

Oh, yeah, great questions. So I'll start maybe with the specialists. Um, and so again, as a rural family physician, oftentimes if we have um sort of more complicated patients that we're either needing another sort of um someone else to kind of review things with, we'll often call our tertiary care center. Uh, so for me, for uh up to this point, it's been Thunder Bay and talk to colleagues there. So, what I would say in terms of the specialists that I'm most in touch with, where again I will need help because I might be thinking of transferring a patient, would be cardiology. So, shout out to the cardiology colleagues, and then probably general surgery would be the two that I consult with most frequently. Um, orthopedics for sure, when there are some more complex fractures that I'm dealing with. So, those would be probably the specialists. I also would say that uh it's really nice to connect with radiologists sometimes. So while I feel pretty confident reading x-rays, sometimes having a second set of eyes. And again, because of having a centralized diagnostic imaging system. So specialists in Thunder Bay, the radiologists, are able to look at images. So radiologists for sure. And again, in the communities that I've worked, none of those have CT scanners. So if there is someone where either an X-ray or an ultrasound may not give us the information that we need, or we feel that someone needs a CT scan, we're often again consulting with our uh radiology colleagues who are the ones that would approve those CT scans, especially if they're needed on an urgent basis. So those would be the specialists. And then in terms of interprofessional colleagues, um, so certainly nurses are probably the ones that I would work most closely with in the emergency departments. I have worked also in different places. Some places have nurse practitioners that are either hospital or clinic based. Um, dietitians are another uh group of specialists that I would say have really supported some of the primary care and in particular around diabetes management as well as other lifestyle-related um uh uh health issues. Um, and then also social workers. I think social workers are a really great resource to rural generous and primary care physicians, and so have seen the benefits both in emergency department settings as well as in the clinical primary care setting of getting to work closely with social, uh, with social workers.

SPEAKER_01 48:01

Great. I think that really underlines the importance of having those really strong collaboration skills to provide the best quality of care for patients. And I'm sure Mackenzie and I can both really attest to you know, seeing that, especially in those northern and rural areas where sometimes you have those limited resources. So thank you for sharing that. I also wanted to ask you, in your opinion, what makes a good rural generalist physician?

SPEAKER_02 48:36

Oh, so many great questions. Um, so what makes a really great general rural generalist clinician? What I would say is a good rural generalist clinician needs to be someone who is pretty resilient. Um, and someone who's also okay not always having an answer. So I think there uh is a lot of sort of rural generalism where we don't necessarily have the answers and and there does need to be, you do need to be okay with that. So, and you're not necessarily going to get an answer right away. So kind of resilience, um not being good with not necessarily having an answer in undifferentiated cases, which I talked about really liking. Um, and someone I think who is okay to be known. So I, having grown up in Toronto, was used to sort of, you know, you go about your your business and you most of the time when you're out and about, you don't see anyone you know. When you're living in a small town, you pretty much eventually, if you've been around long enough, get to know everyone. And so I think you have to be okay with that. And so being recognized in the grocery store or the post office or wherever that might be. So I think there is an element of being known and being comfortable and truly finding, I think, a joy in the community that you choose to have your home. So I think the rural generalists who have, I think, remain rooted in communities are those people who can really connect to that sense of community and become involved in that community. I think about I have lots of colleagues who are vol um who volunteer, so uh uh volunteer coaching sports at schools. I managed hockey teams locally for uh a number of years. And so that ability to really kind of see yourself as part of the community, I think is a really, really important skill of a rural generalist, especially in some of our smaller communities.

SPEAKER_00 50:46

I really like that. I think it's such an important thing that you're right, like you might not think about until you're actually working the communities, you know, the ability to be known and things like that. So I think that's a really important skill that uh I think our listeners will appreciate if they're considering a career in, you know, rural generalism or family medicine in a smaller community. And just to move away from medicine for a moment, how do you spend your time outside of work and outside of your research and things like that?

SPEAKER_02 51:16

I love to be outside. And so, again, probably the uh the gift of having chosen to live and work in marathon for so long. So um I do like to cross-country ski. I used to be a runner, so I think there was a theme of running amongst some of your other podcast uh people that you've interviewed, but I had a really bad ankle injury, so I don't run anymore. Uh, I will cycle in the summertime and certainly like getting out for walks with friends. So, really, I think that's the stuff that grounds me is sort of if uh if I need some downtime or sort of uh need to kind of feel uh downregulated, I guess, uh is I try to get outside and like to be physically active. I am also very grateful for uh for my family. So um, I think I'd mentioned I have two young adult kids now and my husband. Um, so again, we have a camp that's not far from town. So getting out there when we can is also really fun.

SPEAKER_00 52:16

I think a lot of our listeners can appreciate and share the same sentiment of finding time outdoors to really ground yourself and kind of relieve all that stress uh is super important. And I think it's something that Pascal and I have learned throughout our time in medical school is, you know, having some sort of outlet. And maybe that's why we talk about running so much on the podcast. But it's a great way to clear your mind and start uh, you know, avoid thinking of all the different mechanisms and pathophysiology and stuff like that. So I appreciate uh uh you sharing what hobbies you find time for and uh your uh work-life balance with your family. And just as a follow-up question, I wonder if you could shed some light on how you think a community can best support their physicians in this pursuit of work-life balance or perhaps work-life integration.

SPEAKER_02 53:10

Oh, yeah, I I think I just love that you're you're thinking about that and asking those types of questions. I mean, so much is going to depend, I think, on individuals and what they feel they need for work-life balance. Because work-life balance or work-life fluidity, I think is just so different for different people. Uh, and so, and again, different people are um are going to have different boundaries around kind of how involved or maybe less involved they might want to be. Um, but I think what we're seeing is from thinking about rural communities and kind of recruitment needs and and those types of things, I think some of the things that have worked are so there are communities if they have um that will provide passes for things like uh outdoor activities, so like cross-country skiing or the local gym. Um uh so, so those things, I think if someone is moving newly to a community, can go a long way in terms of that sense of appreciation and welcome. Um, marathon's been really fortunate to have a really excellent uh and engaged physician recruiter. And his position is shared between the physician group, the hospital, and the municipality. Um, and I think if we think about all those partners and their sort of contributions, um, just generally around making sure people feel welcome and are aware of what if physician needs might be. And so some of those things might actually also include things like childcare, uh, and so having those proactive conversations. And I think one of the other things that comes up in some of the studies around kind of recruitment and and welcoming physicians into communities is also opportunities for spouses. Um, so I think sort of just really addressing those things proactively is probably some of the stuff that communities can do.

SPEAKER_01 55:19

It's really inspiring to hear how your community has, you know, supported you and helped you to get involved while also making you feel valued because that's really important. And on the same wavelength, is there a specific, like favorite aspect that you have of working in Northern Ontario specifically?

SPEAKER_02 55:41

Um so yeah, so it's fun. Like what I what I like is so having grown up in Toronto, as I had mentioned, you know, to when people don't have a context of kind of where marathon is, so I love that question now. It's like, well, where's marathon? And then I can say, well, it's 1100 kilometers away from Toronto. Um, so so what I uh love is that now that I've actually lived here longer than I did in Toronto, so being able to call this home and what kind of keeps me here and draws me here really is that um proximity to the outdoors. So kind of being able to get outside really easily is really great. And it's been fun actually talking to the kids who are both at school. They're both actually at McMaster. But what they miss is they've described the fresh air. So missing sort of uh just being outside and and the fresh air, though right now I think they are bragging a little bit because it's like 18 and 20 degrees, whereas we're expecting another snowstorm here uh in northern Ontario at the beginning of April when we're recording this, knowing this may not come out till later, but just to provide some context. But like I'm okay with the snow because it means you can ski some more. So that's okay.

SPEAKER_01 56:57

Absolutely. Um, and finally, a topic that we discuss often at NAWSMU is rural generalism. Um, so we kind of spoke about your transition from training in a more urban setting to now working in a rural area. And I'm curious to hear, are there aspects to your practice that have required you to have more of an expanded scope compared to some of your colleagues who may work in a more urban setting?

SPEAKER_02 57:26

So I would say definitely. Um, and I think one of the things uh that we've talked about a little bit is about being able to provide emergency medicine coverage uh in the emergency department, certainly as part of being a rural generalist in a smaller community. The opportunity to look after inpatients and essentially be a hospitalist is another part. And then another part that for me has been really fun was actually uh sort of developing ultrasound skills. So um, so I think that's been another really helpful sort of skill set to acquire that I think is really applicable to rural generalism. Um I don't do obstetrics anymore. I stopped a few years ago, and that was at the time when my kids were getting busier in activities. And so, so the the idea of sort of the call was uh just a bit too much. And then going back to some of the questions around work-life balance, it just I was carrying around sort of that need of being on call. Uh, it just felt really heavy at that time. So had to step away from doing OB. But OB, again, just as far as a skill for rural generalism, I think is a is a wonderful thing to be able to offer. I think for people to be able to deliver in their home communities, close to home, not having to drive and be away for long periods of time is another kind of gift, I think, that to um rural generalists who have an interest in obstetrics and are willing to develop that skill set could offer.

SPEAKER_00 58:58

That's a great answer. And it kind of works into our next question, which is now thinking into the future, where do you see your practice in the future? And what are some changes that you might like to see in your specialty moving forward?

SPEAKER_02 59:16

Um, so for me, in terms of my practice in the future, I imagine that I will continue to do sort of low-come rural generalist work for the next few years. So I am sort of uh 26 years into my career. So hoping to sort of be entering the later years of my career. So I think the the question that also that comes back was that the one you had about, you know, doing night shifts and things, I think uh those shifts do get harder as you get older. So, you know, a few more years of probably providing some of this uh rural generalist low-come work uh is what I imagine. I do hope to remain active in research and build capacity for our clinical faculty at Nelson University. So I see that part as a part of my kind of broader, uh broader career. Um, and then this is a super just uh uh exciting opportunity that's coming up is that I was recently elected to the College of Physicians and Surgeons of Ontario Board of Directors. So again, I think there's just so many great skills that I've learned as a rural journalist and through my opportunities in leadership at Nossam University that will be able to support my role as a director on that board. So I'm excited about that. And then another just fun thing is I recently uh completed the first part of my coaching certification in terms of leadership kind of life coaching. So so I'm at this really fun stage of thinking about how all these kind of various skills that I've had the great privilege to build over the years will kind of flow. And I think there'll be kind of uh ebbs and flows to to how much time each of those take. Um, but it's really, again, I just like a gift to be at this stage and and know that things can look uh a lot of different ways, and that I don't necessarily know what that is going to be, um, but I'm really open to seeing where the next few years take me.

SPEAKER_00 1:01:21

That's fantastic. And congratulations in that new role. And we wish you the uh the most luck in that new role. And for our final question, if you could go back and give yourself one piece of advice to getting you through medical school, what would it be?

SPEAKER_02 1:01:36

Oh, that's that is a great question. I think be open to opportunities that come up. Um again, and maybe most medical students are that way, but I just I think you know, stay clinically curious and stay open to opportunities that might present. And if you're able to kind of pivot to because of the sort of the the doors uh that might open up and what you will you might be able to learn from that, then I think that again, there can be so many beautiful things that come out of that.

SPEAKER_00 1:02:14

That's fantastic. And I think that's some advice that you know a lot of physicians have uh provided. And I think echoing that advice is is really important to continue to be open and follow, you know, the opportunities as they come is is a good way to set yourself up for success in medical school. So I really appreciate that. And that uh wraps up our episode. So we wanted to thank you again, Dr. Zelek, for being a guest on our podcast. And we appreciate all of your time and sharing your stories and insights and your life being a doctor in Northern Ontario. So thank you so much.

SPEAKER_02 1:02:50

And thanks for the opportunity to chat and connect. And uh huge congratulations on the great work that you're doing in producing this podcast. I know it's uh probably a lot of work, um, but I am confident that uh that it will have good impact to other folks who are interested in medicine.

SPEAKER_00 1:03:11

Thank you so much.

SPEAKER_02 1:03:13

Thank you.