Scheduling and staff retention in an FMG.

The labour shortage does not explain everything

An FMG has little grip on the big causes people cite when someone leaves. Pay scales are negotiated in Quebec City, the position structure belongs to the establishment, and the number of candidates on the market does not depend on any decision made inside the clinic. The schedule is one of the few things decided entirely within the walls of the FMG.

On top of that sits a peculiarity generic tools ignore. An FMG manager schedules physicians who are not her employees, alongside staff whose status varies from one clinic to the next. The next section sets out the two possible arrangements, because they do not leave the same room to manoeuvre on the schedule.

We have no FMG-specific turnover rate for Quebec to cite, and we are not going to invent one. What follows describes situations you can read in a schedule, without claiming to measure how widespread they are across the network.

The five signals of a schedule that pushes people out

1. The publication lead time getting shorter

The schedule used to come out a month ahead, then three weeks, then ten days. Nobody decided that; it is the result of periods built later and later because someone had to wait on an answer, a replacement, a confirmation. The slide is invisible inside the clinic and perfectly visible in the lives of the people receiving the grid.

Someone with five days' notice cannot book a daycare spot, register for a course, or make an appointment for her own child. The publication lead time is one of the few things an FMG can improve with no budget and nobody's authorization. Moving publication back by one week per period is the kind of change people feel immediately.

2. Changes made mid-period

The schedule published on Friday is no longer the right one by Tuesday. A withdrawal accepted by text, a replacement settled between two colleagues, an addition at the front desk's request, and the grid taped up beside the photocopier describes a week that no longer exists. In our eight moments that wreck an FMG schedule, six of the eight happen after publication.

What this does to a team matters more than the error itself. Someone who has already come in for nothing stops trusting the document, starts checking every week by message, and ends up keeping her own copy. The coordination work shifts onto the people who live with the schedule, on top of their shift.

3. Weekends landing on the same people

An FMG holding the accès-réseau designation has to offer services on weekdays, at the weekend and on statutory holidays. The number of hours required varies with its designation level, which follows from its consultation volume, but the obligation to cover all seven days does not vary. Somebody therefore works the evenings and the weekends, and the trouble starts when it is always the same people. In practice, those are the ones with the least seniority, or the ones who say yes.

The second group is the expensive one, because it is made up of people the FMG does not want to lose. An accommodating person absorbs the gaps for two years without saying anything, then resigns on a Tuesday morning, and the team cannot work out what just happened.

4. Time-off requests left unanswered

The request goes in during April for a week in August. It is reasonable, it is filed on time, and it sits unanswered until July because the manager is waiting to find out who else will be away. For those three months, the person who asked can book nothing and reads the silence as a refusal.

A no delivered in 48 hours with a reason costs less than a yes delivered in three months. The request log has to live in the same place as the schedule, or it scatters across an inbox, a notebook at the front desk and two hallway conversations. An email inbox does not get reread when the period is being built, and it does not flag that one request contradicts another.

5. Unfairness nobody can put a number on

Two people have the same number of evenings and one of them still finds the split unfair. She is often right: her evenings fall on Fridays, her colleague's on Tuesdays, and the comparison made out loud in the hallway stops at the headcount. With no numbers on the table, the discussion lands on people and starts again the following month.

Counting is not enough; hard blocks need a weight of their own. A team that agrees once on what an evening, a weekend and a statutory holiday are worth can then look up its own running total without asking permission. Someone who feels wronged and cannot demonstrate it either goes quiet or goes elsewhere, and both outcomes are bad for the FMG.

Who signs the cheque changes the conversation

The Programme de financement et de soutien professionnel pour les GMF provides for two arrangements, and plenty of managers do not know which one applies to them. In the first, the establishment assigns one of its own resources to the FMG, and the terms of that assignment are worked out with the physician responsible for the FMG. In the second, an FMG whose site is not operated by a network establishment asks for the support to be paid to it in cash, in part or in full, so it can hire directly.

The second case brings considerably more latitude and considerably more responsibility. The person hired must work in the FMG's own premises, under the functional and administrative authority and the clinical supervision of the FMG's physicians. The program also requires the FMG to put its own replacement arrangements in place to cover that resource's absences, which lands straight back in the schedule.

In the first case, part of the rulebook is out of your hands, because the assignment is made subject to the collective agreements in force. The posting notice period, the replacement rules and the order in which time off is granted are written elsewhere, and the manager works around them.

Both arrangements lead to the same place for our purposes. In one the clinic carries retention entirely, in the other it carries half of it, and in both the schedule is the lever that responds fastest. Find out which one applies to you before promising anything to the team.

Where to start this quarter

1. Date and version the schedule. The date and time of the last change, visible to everyone. A team that knows when the document changed stops working from a screenshot taken last week.
2. Announce a response time for time-off requests and hold to it. Two weeks, five business days, whatever you choose, as long as the deadline is known and a refusal comes with a reason.
3. Move publication back by one week, one period at a time. Look at what stopped you from publishing earlier last time. In most FMGs, a single missing piece of information is holding up the whole grid.
4. Produce the fairness numbers before the next discussion. The weighted running total of evenings, weekends and statutory holidays per person, handed to everyone at the same time.
5. Ask the team what they would change first. The answer is rarely the one you expect, and it often costs less than you feared.

Where Synchro fits

Synchro builds schedules for medical teams in Quebec using the objects of the job: walk-in blocks, weighted on-call shifts, shared offices, constraints each person writes in plain language, and transfers between colleagues with a record of who accepted and when. Against the five signals above, the tool works on visibility: a change becomes visible to the whole team the moment it is made, requests live with the schedule instead of beside it, and the weighted total of hard blocks can be looked up without going through the manager. In our pilot FMG in Saint-Hyacinthe, a team of about thirty managed in Excel took roughly 30 management hours a month, corrections after publication included, and about one hour with a dedicated tool. Those are our own measurements, not a network average.

What Synchro does not do deserves saying just as plainly. No patient data flows through it, and it does not replace your EMR, whether that is Ofys, Omnimed, Medesync or Kinlogix, all of which consume the schedule rather than produce it. No tool replaces a hard decision either, and if your FMG is short-staffed on Thursday evenings, no software is going to go find anyone.

Further reading

• 8 moments that wreck your FMG schedule
• Why Excel is not enough for FMG scheduling
• The shared clinic team calendar
• FMG scheduling software: the complete guide