July 25, 2016 - Practising as a family physician in a rural area can be challenging. For example, rural areas have fewer physicians, but more patients with complex needs and greater distances from advanced health care services. All of this means that doctors often need to wear many hats and have complex workloads while dealing with a lack of resources and professional isolation. In Ontario, there have been many initiatives by governments and communities to attract physicians to rural northern regions including offering financial incentives, marketing the rural and northern “lifestyle” to physicians and enhancing supports for medical practice to reduce stress. However, these attempts have been largely unsuccessful, resulting in high turnover rates of doctors who return to the urban south once the financial incentives have run out or when the northern lifestyle has lost its appeal.
But there is hope for the rural north. Studies have found that individuals with extensive rural experience (including where they grew up and where they are educated) are more likely to come to work and stay in rural areas. The more familiar they are, and become, with rural communities, the more likely they are to be comfortable practising in them. It was this philosophy that underpinned the creation of the Northern Ontario School of Medicine (NOSM). One of NOSM’s main goals is to increase the number of physicians in rural and Northern Ontario by recruiting students from, and training them in, rural and northern regions. Now that the first few cohorts of NOSM graduates are entering practice, our research team from the Centre for Rural and Northern Health Research took a look to see where NOSM grads are actually practising.
Using the data from the College of Physicians and Surgeons of Ontario physician register, we compared the Ontario practice locations of family physicians (FPs) who were medical students and/or residents at NOSM to other Ontario FPs who were medical students and residents from other institutions across Canada who also graduated at the same time frame as the NOSM FPs. We looked at the first 2 cohorts (graduated in 2009 or 2010) of NOSM graduates for a total of 50 physicians who completed their first 4 years of training at NOSM. Most of those 50 physicians also completed their residency with NOSM, with 36 training in the north for an additional 2 years of residency. An additional 17 physicians who completed their first 4 years elsewhere came to NOSM for their residency training during that time. In total, we looked at the 67 FPs who had any NOSM education (as medical students or residents) compared with the 468 Ontario FPs who were trained elsewhere in Canada during that same time frame.
Over two thirds (67.2%) of FPs with any NOSM education were located in Northern Ontario compared with only 4.3% of those who were trained elsewhere in Canada. In addition, 25.4% of those with any NOSM education were in rural areas, either in Northern or Southern Ontario, compared with 10.3% of those who were trained elsewhere. FPs who did not have any medical training at NOSM were overwhelmingly located in the urban south (87.8%). Furthermore, of the 36 FPs that we looked at who did all their training in the north, only 4 are not currently practising in a northern community.
This preliminary study of the first few cohorts of NOSM graduates supports the idea that exposure to rural and northern areas during education may help keep physicians in these areas once they start independent practice. These findings were supported by a separate study that examined 3 cohorts of NOSM graduates, including graduates practising outside of Ontario, but with a focus on learners with at least some NOSM medical education (i.e., NOSM UG, NOSM PG or both). Both studies found that the majority of family physicians who were NOSM learners were practising in rural and/or Northern Ontario. This positive result might be partly attributed to NOSM’s undergraduate admission criteria that preferentially looks for students with rural and northern backgrounds, or it could be due to the exposure to rural and northern settings throughout NOSM training. In either case we know that, at least the first few cohorts, NOSM-educated FPs are more likely to be in rural and northern areas. As more and more NOSM graduates enter independent practice, it will be important to watch if this trend continues, and perhaps most importantly, to see if they stay in rural and Northern Ontario for the long haul.
By: Elizabeth Wenghofer, PhD-School of Rural and Northern Health, Laurentian University (NPI Fellow in Rural and Northern Health), John Hogenbirk, MSc-Centre for Rural and Northern Health Research, Laurentian University, and Patrick Timony, PhD (Candidate)-Centre for Rural and Northern Health Research, Laurentian University
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