Original Research

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

AUTHORS

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

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

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

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Mohamed Ravalia4
MBChB, Assistant Dean, Rural Medical Education Network – Associate Professor of Family Medicine

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

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Wendy Graham6
MD, Associate Professor, Discipline of Family Medicine

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

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

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

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

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Katherine Stringer11
MBChB, Chair and Associate Professor of Family Medicine

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

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Janelle Hippe13
MA, Research Assistant, Learners & Locations project

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

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Donald McKay15
PhD, Associate Dean Undergraduate Medical Education, Professor of Physiology

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Asoka Samarasena16
MBBS, Assistant Dean Post Graduate Medical Education, Associate Professor of Anesthesia

AFFILIATIONS

1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16 Faculty of Medicine, Memorial University of Newfoundland, Health Sciences Centre, Prince Philip Drive, St. John's, NL A1B 3V6, 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.