Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada.
McMaster Education Research, Innovation and Theory, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
Adv Health Sci Educ Theory Pract. 2024 May;29(2):641-657. doi: 10.1007/s10459-023-10273-4. Epub 2023 Aug 15.
The maldistribution of family physicians challenges equitable primary care access in Canada. The Theory of Social Attachment suggests that preferential selection and distributed training interventions have potential in influencing physician disposition. However, evaluations of these approaches have focused predominantly on rural underservedness, with little research considering physician disposition in other underserved communities. Accordingly, this study investigated the association between the locations from which medical graduates apply to medical school, their undergraduate preclerkship, clerkship, residency experiences, and practice as indexed across an array of markers of underservedness. We built association models concerning the practice location of 347 family physicians who graduated from McMaster University's MD Program between 2010 and 2015. Postal code data of medical graduates' residence during secondary school, pre-clerkship, clerkship, residency and eventual practice locations were coded according to five Statistics Canada indices related to primary care underservedness: relative rurality, employment rate, proportion of visible minorities, proportion of Indigenous peoples, and neighbourhood socioeconomic status. Univariate and multivariable logistic regression models were then developed for each dependent variable (i.e., practice location expressed in terms of each index). Residency training locations were significantly associated with practice locations across all indices. The place of secondary school education also yielded significant relationships to practice location when indexed by employment rate and relative rurality. Education interventions that leverage residency training locations may be particularly influential in promoting family physician practice location. The findings are interpreted with respect to how investment in education policies can promote physician practice in underserved communities.
家庭医生的分布不均挑战了加拿大公平获得初级保健的机会。社会依附理论表明，优先选择和分布式培训干预措施有可能影响医生的倾向。然而，这些方法的评估主要集中在农村服务不足的情况，很少有研究考虑到其他服务不足社区的医生倾向。因此，本研究调查了医学毕业生申请医学院的地点、他们的本科预科、实习、住院医师经历以及在一系列服务不足指标上的执业之间的关联。我们构建了与 2010 年至 2015 年期间从麦克马斯特大学 MD 项目毕业的 347 名家庭医生的执业地点相关的关联模型。根据与初级保健服务不足相关的五个加拿大统计局指数，对医学毕业生在中学、预科、实习、住院医师和最终执业地点的住所的邮政编码数据进行了编码：相对农村化、就业率、少数族裔比例、原住民比例和社区社会经济地位。然后为每个因变量（即，以每个指数表示的执业地点）开发了单变量和多变量逻辑回归模型。住院医师培训地点与所有指数的执业地点显著相关。中学教育的地点也与就业率和相对农村化指数的执业地点有显著关系。利用住院医师培训地点的教育干预措施可能在促进家庭医生执业地点方面具有特别的影响力。这些发现是在考虑教育政策的投资如何能够促进在服务不足社区的医生执业的背景下进行解释的。
