Fleming Patrick, Mathews Maria
Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
Open Med. 2012;6(1):e1-9. Epub 2012 Jan 24.
Although specialist physicians comprise nearly half of the physician workforce in Newfoundland and Labrador (NL), relatively little is known about their retention patterns. We compared 2 cohorts of physicians who were initially licensed to practise in NL between 1993 and 1997 and between 2000 and 2004, to examine whether retention had changed over time. Additionally, we examined the retention of 4 groups of physicians in each cohort: (1) fully licensed medical graduates of Memorial University, (2) fully licensed medical graduates of other Canadian universities, (3) provisionally licensed international medical graduates (IMGs) and (4) fully licensed IMGs. Provisional licences allow physicians who have not received Canadian certification to practise while obtaining credentials. We hypothesized that fully licensed physicians (largely physicians who are locally trained) would remain in NL longer than provisionally licensed physicians (largely IMGs).
Using data from the provincial medical registrar and Memorial University's office of postgraduate medical education, we used survival analysis (Cox regression) to compare the retention of the 2 cohorts and the 4 groups of physicians within each cohort.
After 48 months, roughly 60% of the physicians in the 2000-04 cohort and 45% of the physicians in the 1993-97 cohort remained in NL. Medical graduates of Memorial University comprised 61/180 (33.9%) of the 2000-04 cohort and 38/211 (18.0%) of the 1993-97 cohort.Physicians in the 2000-04 cohort were 1.6 (95% confidence interval [CI] 1.23-2.08) times less likely to leave NL than physicians in the 1993-97 cohort. In the 2000-04 cohort, medical graduates of Canadian universities, provisionally licensed IMGs and fully licensed IMGs were 3.19 (95% CI 1.47-6.89), 1.85 (95% CI 1.09-3.17) and 4.39 (95% CI 1.91-10.10) times more likely to leave NL than medical graduates of Memorial University. In the 1993-97 cohort, IMGs with provisional licences were 2.16 (95% CI 1.37-3.42) times more likely to leave NL than medical graduates of Memorial University. There was no significant difference in retention between medical graduates of Memorial University and other Canadian universities or IMGs with full licences in the 1993-97 cohort.
The improvement in the retention of specialist physicians in NL since the 1990s may be attributable to the increase in the relative proportion of medical graduates of Memorial University. Although provisional licensing enables IMGs to begin practice in NL, it does not lead to long-term retention.
尽管专科医生占纽芬兰和拉布拉多省（NL）医生总数的近一半，但对他们的留任模式了解相对较少。我们比较了1993年至1997年以及2000年至2004年期间最初在NL获得行医执照的两组医生，以研究留任情况是否随时间发生了变化。此外，我们还研究了每组中的4类医生的留任情况：（1）纪念大学的完全执照医学毕业生；（2）加拿大其他大学的完全执照医学毕业生；（3）临时执照国际医学毕业生（IMG）；（4）完全执照IMG。临时执照允许未获得加拿大认证的医生在获取资质期间行医。我们假设完全执照医生（主要是本地培养的医生）在NL的留任时间会比临时执照医生（主要是IMG）更长。
利用省级医学注册官和纪念大学研究生医学教育办公室的数据，我们采用生存分析（Cox回归）来比较两组医生以及每组中4类医生的留任情况。
48个月后，2000 - 2004年组中约60%的医生和1993 - 1997年组中45%的医生仍留在NL。纪念大学的医学毕业生在2000 - 2004年组中占180人中的61人（33.9%），在1993 - 1997年组中占211人中的38人（18.0%）。2000 - 2004年组的医生离开NL的可能性比1993 - 1997年组的医生低1.6倍（95%置信区间[CI] 1.23 - 2.08）。在2000 - 2004年组中，加拿大大学的医学毕业生、临时执照IMG和完全执照IMG离开NL的可能性分别比纪念大学的医学毕业生高3.19倍（95% CI 1.47 - 6.89）、1.85倍（95% CI 1.09 - 3.17）和4.39倍（95% CI 1.91 - 10.10）。在1993 - 1997年组中，持有临时执照的IMG离开NL的可能性比纪念大学的医学毕业生高2.16倍（95% CI 1.37 - 3.42）。在1993 - 1997年组中，纪念大学的医学毕业生与加拿大其他大学的医学毕业生或完全执照IMG在留任方面没有显著差异。
自20世纪90年代以来，NL专科医生留任情况的改善可能归因于纪念大学医学毕业生相对比例的增加。尽管临时执照使IMG能够在NL开始行医，但这并不能带来长期留任。
