临时执照国际医学毕业生的留存情况：对纽芬兰和拉布拉多地区全科医生和家庭医生的一项历史性队列研究。

BACKGROUND

To alleviate the shortage of primary care physicians in rural communities, the Canadian province of Newfoundland and Labrador (NL) introduced provisional licensure for international medical graduates (IMGs), allowing them to practise in under-served communities while completing licensing requirements. Although provisional licensing has been seen as a needed recruitment strategy, little is known about its impact on physician retention. To assess the relationship between provincial retention time and type of initial practice licence, we compared the retention of: (1) IMGs who began practice with a provisional licence; (2) fully licensed Memorial University medical graduates (MMGs); and (3) fully licensed medical graduates from other Canadian medical schools (CMGs).

METHODS

Using administrative data from the NL College of Physicians and Surgeons, the 2004 Scott's Medical Database, and the Memorial University postgraduate database, we identified family physicians/general practitioners (FPs/GPs) who began their practice in NL in the period 1997-2000 and determined where they were in 2004. We used Cox regression to examine differences in retention among these 3 groups of physicians.

RESULTS

There were 42 MMGs, 38 CMGs and 77 IMGs in our sample. The median time for IMGs to qualify for full licensure was 15 months. Twenty-one physicians (13.4%) stayed in NL after beginning their practice (35.7% MMGs, 5.3% CMGs, 5.2% IMGs; p < 0.000). The median retention time was 25 months (MMGs, 39 months; CMGs, 22 months; IMGs, 22 months; p < 0.000). After controlling for Certificant of the College of Family Physicians status, CMGs (hazard ratio [HR] = 2.15; 95% confidence interval [CI] 1.29-3.60) and IMGs (HR = 2.03; 95% CI 1.26-3.27) were more likely to leave NL than MMGs.

CONCLUSIONS

Provisional licensing accounts for the largest proportion of new primary care physicians in NL but does not lead to long-term retention of IMGs. However, IMG retention is no worse than the retention of CMGs.

背景

为缓解农村社区基层医疗医生短缺的状况，加拿大纽芬兰与拉布拉多省（NL）为国际医学毕业生（IMG）引入了临时执照，允许他们在完成执照要求的同时，在服务欠缺的社区执业。尽管临时执照被视为一种必要的招聘策略，但对于其对医生留任的影响却知之甚少。为评估省级留任时间与初始执业执照类型之间的关系，我们比较了以下三类人员的留任情况：（1）持临时执照开始执业的IMG；（2）获得完全执照的纪念大学医学毕业生（MMG）；（3）加拿大其他医学院获得完全执照的医学毕业生（CMG）。

方法

利用NL医师和外科医生学院的管理数据、2004年斯科特医学数据库以及纪念大学研究生数据库，我们确定了1997 - 2000年期间在NL开始执业的家庭医生/全科医生（FP/GP），并确定了他们在2004年的去向。我们使用Cox回归分析这三组医生在留任方面的差异。

结果

我们的样本中有42名MMG、38名CMG和77名IMG。IMG获得完全执照的中位时间为15个月。21名医生（13.4%）在开始执业后留在了NL（MMG为35.7%，CMG为5.3%，IMG为5.2%；p < 0.000）。中位留任时间为25个月（MMG为39个月，CMG为22个月，IMG为22个月；p < 0.000）。在控制了家庭医生学院认证状态后，CMG（风险比[HR] = 2.15；95%置信区间[CI] 1.29 - 3.60）和IMG（HR = 2.03；95% CI 1.26 - 3.27）比MMG更有可能离开NL。