Mathews Maria, Heath Sara Lynn, Neufeld Shelley May, Samarasena Asoka
Division of Community Health & Humanities, Faculty of Medicine, Memorial University, St. John's, NL, Canada.
Healthc Policy. 2013 Feb;8(3):42-56.
Despite the widespread use of physician return-for-service (RFS) programs in Canada, few have been evaluated. We examined two types of RFS agreements (Family Medicine Bursary and Special Funded Residency Position) and (a) describe the proportion of RFS physicians who complete their service obligation and identify the predictors of completion and (b) compare the retention of RFS physicians to that of non-RFS physicians.
Using administrative data on physicians with RFS agreements in Newfoundland and Labrador (NL), Memorial University's Postgraduate Medical Education Office and the Physician and Medical Practice Database, we calculated the proportion of RFS physicians (1997-2009) who fulfilled their service obligation and also identified predictors of completion. We then followed to 2010 a cohort of physicians who started practice in NL between 2000 and 2005 to compare the retention of RFS and non-RFS physicians.
Ninety-six (71.6%) of 134 RFS physicians fulfilled the service obligation in full. Physicians who held Special Funding Residency Position RFS agreements were 11.1 times less likely (95% CI: 4.0-33.3) to complete their service commitment than physicians who held Family Medicine Bursary RFS agreements. In the cohort of 60 RFS and 67 non-RFS physicians, 16.9% of RFS versus 41.8% of non-RFS physicians left NL by 2010 (p=0.004). RFS physicians were 3.22 times less likely (95% CI: 1.41-7.14) than non-RFS physicians to leave the province. Four years after starting practice, roughly 90% of RFS versus 60% of non-RFS physicians remained in NL; after 10 years, 70% of RFS versus 60% of non-RFS physicians remained (p=0.006).
The RFS program improves the retention of physicians in NL. Using RFS tied to bursaries rather than residency positions may increase service completion and retention rates.
尽管加拿大广泛使用医生按服务付费（RFS）计划，但很少有计划得到评估。我们研究了两种类型的RFS协议（家庭医学助学金和特殊资助住院医师职位），并（a）描述了履行服务义务的RFS医生的比例，确定了完成服务义务的预测因素，以及（b）比较了RFS医生与非RFS医生的留用情况。
利用纽芬兰和拉布拉多省（NL）有RFS协议的医生的行政数据、纪念大学的研究生医学教育办公室以及医生和医疗实践数据库，我们计算了履行服务义务的RFS医生（1997 - 2009年）的比例，并确定了完成服务义务的预测因素。然后，我们追踪了2000年至2005年间在NL开始执业的一组医生至2010年，以比较RFS医生与非RFS医生的留用情况。
134名RFS医生中有96名（71.6%）完全履行了服务义务。持有特殊资助住院医师职位RFS协议的医生完成服务承诺的可能性比持有家庭医学助学金RFS协议的医生低11.1倍（95%置信区间：4.0 - 33.3）。在60名RFS医生和67名非RFS医生的队列中，到2010年，16.9%的RFS医生离开了NL，而非RFS医生的这一比例为41.8%（p = 0.004）。RFS医生离开该省的可能性比非RFS医生低3.22倍（95%置信区间：1.41 - 7.14）。开始执业四年后，约90%的RFS医生留在了NL，而非RFS医生的这一比例为60%；10年后，70%的RFS医生留在了NL，而非RFS医生的这一比例为60%（p = 0.006）。
RFS计划提高了NL医生的留用率。使用与助学金而非住院医师职位挂钩的RFS可能会提高服务完成率和留用率。
