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Introduction: In a previous study, we found a decline in the proportion of Memorial University of Newfoundland (MUN) medical alumni practising in rural areas, particularly in Newfoundland and Labrador. The current study focused on the work location of recent graduates and examined the predictors of working in rural Canada and in rural Newfoundland and Labrador within the first 15 years following graduation. Methods: We linked data from graduating class lists and the alumni and postgraduate databases with Scott's Medical Database to create a record of all graduates from 1973 to 2008, including their work location. We identified differences and significant predictors for each outcome and then described and compared the characteristics of 4 cohorts of graduating classes. Results: In their early career, 127/1113 (11.4%) MUN medical graduates were working in rural Canada, and 57 (5.1%) were working in rural Newfoundland and Labrador. Having a rural background and being a family physician were predictors of working in rural Canada, and having a rural background, doing at least part of the residency at MUN, being from Newfoundland and Labrador and being a family physician were predictors of working in rural Newfoundland and Labrador. Seventy-four (13.6%) and 33 (6.1%) of 1989-1998 graduates worked in rural Canada and rural Newfoundland and Labrador, respectively, compared to 53 (9.3%) and 24 (4.2%), respectively, of 1999-2008 graduates. Conclusion: The proportion of MUN medical graduates who worked in rural communities early in their career decreased among recent cohorts. The results show the impact of changes in the characteristics of MUN medical graduates, who increasingly opt for specialist practice and residency training outside the province, and the important role of local postgraduate training. Introduction: Une etude anterieure a revele une baisse du nombre de diplomes en medecine de l'Universite Memorial de Terre-Neuve (MUN) exercant en region rurale, plus particulierement a Terre-Neuve-et-Labrador. L'etude actuelle portait sur le lieu de travail de diplomes recents et sur les predicteurs du travail en milieu rural au Canada et dans la province de Terre-Neuve-et-Labrador dans les 15 premieres annees suivant l'obtention du diplome. Methodes: Nous avons etabli un lien entre les listes de diplomes, les bases de donnees des anciens et des postdoctorants et la Base de donnees medicales Scott's afin de creer un dossier de tous les diplomes de 1973 a 2008, y compris de leur lieu de travail. Nous avons etabli des differences et des predicteurs importants pour chaque resultat et avons ensuite decrit et compare les caracteristiques de 4 cohortes de classes de diplomes. Resultats: Au debut de leur carriere, 127 sur 1113 (11,4 %) diplomes en medecine de MUN travaillaient en region rurale au Canada et 57 (5,1 %) en region rurale a Terre-Neuve-et-Labrador. Le fait de venir d'un milieu rural et d'etre un medecin de famille etait des predicteurs de travail en milieu rural au Canada alors que le fait de venir d'un milieu rural, d'avoir fait au moins une partie de sa residence a MUN, d'etre originaire de Terre-Neuve-et-Labrador et d'etre medecin de famille etaient des predicteurs de travail en milieu rural a Terre-Neuve-et-Labrador. Soixante-quatorze (13,6 %) et 33 (6,1 %) diplomes de 1989 a 1998 travaillaient en milieu rural au Canada et en milieu rural a Terre-Neuve-et-Labrador, respectivement, par comparaison a 53 (9,3 %) et a 24 (4,2 %), respectivement, pour les diplomes de 1999 a 2008. Conclusion: La proportion de diplomes en medecine de MUN qui ont travaille dans des localites rurales au debut de leur carriere a diminue au sein des cohortes recentes. Les resultats de notre etude montrent l'incidence du changement des caracteristiques des diplomes en medecine de MUN, lesquels choisissent de plus en plus de se specializer et de faire leur residence a l'exterieur de la province, ainsi que le role important de la formation medicale postdoctorale a l'echelle locale., INTRODUCTION Part of the social accountability mandate of medical schools is to address the local, regional and national physician workforce. (1, 2) Medical schools, through their 'organization, location and mission [...]

Background: Part of the mandate for social accountability of medical schools is to address physician needs at the local, regional and national levels. We determined the work locations in 2014 of medical graduates of Memorial University of Newfoundland (MUN) and identified the characteristics and predictors of working in urban and rural areas of Canada and the province of Newfoundland and Labrador (NL)., Methods: We linked data from class lists, and alumni and postgraduate databases with data from the Scott's Medical Database to determine work locations in 2014 of MUN medical graduates from 1973 to 2008. Multiple logistic regression analysis was used to identify predictors of working in urban and rural areas of Canada and NL., Results: Of the 1864 graduates in our study, 1642 (88.1%) were working in Canada, 638 (34.2%) in NL, 217 (11.6%) in rural Canada and 92 (4.9%) in rural NL in 2014. Predictors of physicians working in Canada included having a rural background, being from NL and graduating in the 1980s, 1990s or 2000s. Predictors of physicians working in NL included having a rural background, being from NL, graduating in the 2000s and having done some or all of their residency training at MUN. Having a rural background and being a family physician were predictors of working in rural Canada. Having a rural background, being from NL, having done some or all residency training at MUN and being a family physician were predictors of working in rural NL., Interpretation: Most MUN graduates were working in Canada in 2014, with about one-third remaining in NL and much smaller percentages working in rural communities, especially in rural NL. These findings have implications for the physician supply in NL.

Introduction: 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., Methods: 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., Results: 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)., Conclusion: 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., (Copyright © 2013 Longwoods Publishing.)