Departments of Community Health Sciences (Ogundeji, Clement, Wellstead, Farkas, Manns) and Medicine (Clement, Manns), University of Calgary, Calgary, Alta.
CMAJ Open. 2021 Jul 20;9(3):E788-E794. doi: 10.9778/cmajo.20200202. Print 2021 Jul-Sep.
Despite well-documented challenges in recruiting physicians to rural practice, few Canadian studies have described the role physician payment models may play in attracting and retaining physicians to rural practice. This study examined the perspectives of rural primary care physicians on the factors that attract and retain physicians in rural locations, including the role that alternative payment models (APMs) might play.
This was a qualitative study involving in-depth, open-ended interviews with rural primary care physicians practising under fee-for-service (FFS) models and APMs in Alberta, Canada. Participants were recruited from the Rural Health Professions Action Plan member list (consisting of physicians practising in rural or remote locations in Alberta) and the College of Physicians and Surgeons of Alberta online database. Interviews were conducted April to June 2020, and data were analyzed using a thematic framework approach.
Fourteen physicians were interviewed. There were 5 themes identified: factors that attract physicians to rural practice, barriers and challenges associated with rural practice, the potential role of APMs in recruitment and retention, factors that physicians consider in deciding to change payment models, and physician perceptions of APMs compared with FFS models. Participants expressed that APMs may have some role to play in retaining rural physicians but identified professional challenges, and family-related and personal factors as key determinants. Most FFS physicians indicated that they were interested in exploring APMs provided specific concerns were addressed (e.g., clear and adequately compensated APM contracts, and physician involvement in the development of APMs).
Primary care physicians practising in rural regions in Alberta view payment models as one consideration among many in their decision to pursue rural practice. Alternative payment model contracts designed with the input of physicians may have a role to play in attracting and retaining physicians to rural practice.
尽管有大量文献记录表明招募医生到农村地区行医存在挑战，但加拿大很少有研究描述医生薪酬模式在吸引和留住医生到农村地区行医方面可能发挥的作用。本研究考察了农村初级保健医生对吸引和留住农村地区医生的因素的看法，包括替代支付模式（APM）可能发挥的作用。
这是一项定性研究，涉及对在加拿大艾伯塔省以按服务收费（FFS）模式和 APM 模式执业的农村初级保健医生进行深入的开放式访谈。参与者是从农村卫生专业人员行动计划成员名单（由在艾伯塔省农村或偏远地区执业的医生组成）和艾伯塔省医师和外科医生学院的在线数据库中招募的。访谈于 2020 年 4 月至 6 月进行，使用主题框架方法进行数据分析。
共采访了 14 名医生。确定了 5 个主题：吸引医生到农村执业的因素、与农村执业相关的障碍和挑战、APM 在招聘和留用方面的潜在作用、医生在决定改变支付模式时考虑的因素，以及医生对 APM 与 FFS 模式的看法。参与者表示，APM 可能在留住农村医生方面发挥一定作用，但也指出了专业挑战以及与家庭相关和个人因素是关键决定因素。大多数 FFS 医生表示，他们有兴趣探索 APM，前提是解决具体问题（例如，明确和充分补偿的 APM 合同，以及医生参与 APM 的制定）。
在艾伯塔省农村地区执业的初级保健医生认为支付模式是他们决定从事农村执业的众多考虑因素之一。在医生的参与下设计的 APM 合同可能在吸引和留住农村医生方面发挥作用。
