ST. JOHN’S, NL/ Troy Media/ - New research indicates that some programs aimed at retaining doctors in rural areas might not be as successful as we’d hoped.
Almost all provinces and territories in Canada offer “return-for-service” agreements to attract and retain physicians in rural and underserved communities. These agreements provide medical students and post-graduate residents with financial support for a commitment to practice in an underserved community, usually for one year for each year they receive support. Physicians have the option to pay back their funding if they can’t complete their service commitments.
In a study published recently in Healthcare Policy, my colleagues and I found that most medical trainees who take return-for service agreements in the province of Newfoundland and Labrador complete their service commitments in full. Moreover, return-for-service physicians stayed in these underserved communities for the long term (up to 10 years after their required service). We also found that return-for-service physicians were less likely to leave these communities than their counterparts who did not hold similar agreements.
Sounds pretty good, right?
Except that we also discovered that most physicians who chose to take return-for-service agreements wanted to work in these underserved communities in the first place.
Rather than finding new physicians who were uninterested in working in rural Canada, in Newfoundland and Labrador, these agreements appear to be encouraging already interested physicians to stay the course.
Our study also uncovered another important finding: of the 20 per cent of physicians who defaulted on some or all of their return-for-service contract obligations, more than half were international medical graduates (IMGs) – physicians who graduated from a medical school outside of Canada.
Why might this be? IMGs are obligated to take a return-for-service agreement in order to obtain a residency position in Canada, which is a necessary step for full licensure. In other words, their return-for-service commitments aren’t really as ‘optional,’ as with Canadian graduates. Results from our study suggest that few of these physicians go on to complete their service commitment or pay back their funding.
In 2013, the federal government will introduce its own “return-for-service program” to encourage physicians and nurses to work in underserved communities. Physicians can qualify for the program’s financial incentive ($8,000 student loan remission each year for up to five years) if they work in “eligible” communities, defined in the federal program generally as a rural community with a population of 50,000 or less that is not near a large urban center.
The federal government’s program does not require physicians to coordinate their “return” community with provincial planners, so eligible communities may not necessarily be considered underserved from the local perspective.
Problems with physician shortages in rural regions in Canada have existed for a long time. Isn’t it about time we had a better idea about what actually works?
– Maria Mathews is an advisor with EvidenceNetwork.ca and a professor of Health Policy/Health Care Delivery at Memorial University of Newfoundland.