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Original Research

Does rural generalist focused medical school and family medicine training make a difference? Memorial University of Newfoundland outcomes.

AUTHORS

name here
James Rourke1
MD, Former Dean of Medicine, 2004-2016 - Director, Centre for Rural Health Studies - Professor of Family Medicine *

Shabnam Asghari2 PhD, Research Director, Centre for Rural Health Studies - Associate Professor, Faculty of Medicine, Memorial University

Oliver Hurley3 MEnvSc, Research Coordinator, Centre for Rural Health Studies, Discipline of Family Medicine

Mohamed Ravalia4 CM, Assistant Dean, Rural Medical Education Network - Associate Professor of Family Medicine

Michael Jong5 MBBS, Professor of Family Medicine, Labrador Health Centre

Wendy Graham6 MD, Associate Professor, Discipline of Family Medicine

Wanda Parsons7 MD, Assistant Dean, Admissions - Associate Professor of Family Medicine

Norah Duggan8 MD, Family Medicine Undergraduate Director - Associate Professor of Family Medicine

Danielle O'Keefe9 MD, Postgraduate Family Medicine Program Director - Assistant Professor of Family Medicine

Scott Moffatt10 MD, Assistant Dean, Student Affairs - Associate Professor of Family Medicine

Katherine Stringer11 MBChB, Chair and Associate Professor of Family Medicine

Carolyn Sturge Sparkes12 PhD, Clinical Assistant Professor - Coordinator, Aboriginal Health Initiative

Janelle Hippe13 MA, Research Assistant, Learners & Locations project

Kristin Harris Walsh14 PhD, Research Assistant, Learners & Locations project

AFFILIATIONS

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14 Faculty of Medicine, Memorial University of Newfoundland St. John's, Canada

ACCEPTED: 1 September 2017


early abstract:

Introduction: Rural recruitment and retention of physicians is a global issue. Memorial was established as a rural-focused medical school with a social accountability mandate that aimed to meet the healthcare needs of a sparse population distributed over a large landmass as well as the needs of other rural and remote areas of Canada. This study aimed to assess whether Memorial was effective at producing physicians for Newfoundland and Labrador (NL) and rural physicians for Canada compared to other Canadian medical schools.
Methods: This retrospective cohort study included medical school graduates who completed their postgraduate (PG) training between 2004 and 2013 in Canada. Practice locations of study subjects were georeferenced and assigned to three geographic classes: Large Urban, Small City/Town, and Rural. Analyses were performed at two levels: 1) Provincial level analysis compared Memorial PG graduates practicing where they received their medical degree (MD)/PG training or both to other medical schools
who are the only medical school in their province (N=4). 2) National level analysis compared Memorial PG graduates practicing in rural Canada to all other Canadian medical schools (N=16). Descriptive and bivariate analyses were performed.
Results: Overall, 18,766 physicians practicing in Canada completed Canadian PG training (2004-2013), and of those 8,091 (43%) completed Family Medicine (FM) training. Of all physicians completing Canadian PG training, 1,254 (7%) physicians were practicing rurally and of those, 1,076 were family physicians. There were 379 Memorial PG graduates and of those, 208 (55%) completed FM training and 72 (19%) were practicing rurally, and of those 56 were family physicians. At the national level, the percentage of all Memorial PG graduates (19.0%) and FM PG graduates (26.9%) practicing rurally was
significantly better than the national average for PG (6.4%, p<0.000) and FM (12.9%, p<0.000). Among 391 physicians practicing in NL, 257 (65.7%) were Memorial PG grads and 247 (63.2%) were Memorial MD grads. Of the 163 FM grads, 148 (90.8%) were Memorial FM grads and 118 (72.4%) were Memorial MD grads. Of the 68 in rural practice, 51 (75.0%) were Memorial PG grads and 31 (45.6%) were Memorial MD grads. Of the 41 FM grads in rural practice 39 (95.1%) were Memorial FM grads and 22 (53.7%) were Memorial MD grads. Two-sample proportion tests demonstrate Memorial provided a larger proportion of its provincial
physician resource supply than the other 4 single provincial medical schools, by medical school MD for FM (72.4% vs 44.3%, p<0.000) and for overall (63.2% vs 43.5% p<0.000), and by medical school PG for FM (90.8 % vs 72.0%, p<0.000).
Conclusion: This study found Memorial graduates were
more likely to establish practice in rural areas compared to the national average for most program types as well as more likely to establish practice in NL compared to other single medical school's graduates in their provinces. This study highlights
the impact a comprehensive rural focused social accountability approach can have at supplying the needs of a population both at the regional and rural national levels.