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Additional skills training for rural physicians. Alberta's rural physician action plan.

https://arctichealth.org/en/permalink/ahliterature169033
Source
Can Fam Physician. 2006 May;52:601-4
Publication Type
Article
Date
May-2006
Author
Ron Gorsche
John Hnatuik
Author Affiliation
Department of Family Medicine, Faculty of Medicine, University of Calgary. john.hnatuik@rpap.ab.ca
Source
Can Fam Physician. 2006 May;52:601-4
Date
May-2006
Language
English
Publication Type
Article
Keywords
Alberta
Education, Medical, Continuing - organization & administration
Family Practice - education - manpower
Humans
Medically underserved area
Personnel Selection
Preceptorship - organization & administration
Rural Health Services - manpower
Abstract
Rural physicians in Alberta identified access to special skills training and upgrading skills as an important practice requirement.
The Rural Physician Action Plan in Alberta developed an Enrichment Program to assist physicians practising in rural Alberta communities to upgrade their existing skills or gain new skills. The Enrichment Program aimed to provide a single point of entry to skills training that was individualized and based on the needs of rural physicians.
Two experienced rural physicians were engaged as "skills brokers" to help rural physicians requesting additional skills training or upgrading to find the training they required. Physicians interested in applying for the Enrichment Program consulted one of the brokers. Each applicant was assigned a preceptor. Preceptors confirmed learning objectives with trainees, provided the required training in keeping with agreed-upon learning objectives, and ensured trainees were evaluated at the end of the training.
The program has helped rural physicians upgrade their skills and gain new skills. More Alberta rural physicians are now able to pursue additional training and return to practise new skills in their rural and remote communities than in the past.
Notes
Cites: J Rural Health. 1994 Summer;10(3):183-9210138034
Cites: CMAJ. 1998 Feb 10;158(3):351-59484262
PubMed ID
16739833 View in PubMed
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Alaska's own family practice residency program.

https://arctichealth.org/en/permalink/ahliterature221399
Source
Alaska Med. 1993 Apr-Jun;35(2):175-7
Publication Type
Article
Author
B J Doty
Author Affiliation
Biomedical Program, University of Alaska, Anchorage 99508.
Source
Alaska Med. 1993 Apr-Jun;35(2):175-7
Language
English
Publication Type
Article
Keywords
Alaska
Family Practice - education - manpower
Health Services Needs and Demand - trends
Humans
Internship and Residency
Managed Care Programs - manpower
PubMed ID
8238774 View in PubMed
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Canadian rural family medicine training programs: growth and variation in recruitment.

https://arctichealth.org/en/permalink/ahliterature167783
Source
Can Fam Physician. 2005 Jun;51:852-3
Publication Type
Article
Date
Jun-2005
Author
Lisa K Krupa
Benjamin T B Chan
Author Affiliation
Lakehead University, Thunder Bay, Ont.
Source
Can Fam Physician. 2005 Jun;51:852-3
Date
Jun-2005
Language
English
Publication Type
Article
Keywords
Canada
Data Collection
Family Practice - education - manpower
Humans
Internship and Residency - manpower - trends
Interprofessional Relations
Personnel Selection
Physicians - supply & distribution
Rural Health Services - manpower
Abstract
To document the proliferation of rural family medicine residency programs and to note differences in design as they affect rural recruitment.
Descriptive study using semistructured telephone interviews.
All family medicine residency programs in Canada in 2002.
Directors of Canadian family medicine residency programs.
Number of rural training programs and positions; months of rural exposure, degree of remoteness, and specialist support of rural communities within rural training programs.
The number of rural training programs rose from one in 1973 to 12 in 2002. Most medical schools now offer dedicated rural training streams. From 1989 to 2002, the number of rural residency positions quadrupled from 36 to 144; large jumps in capacity occurred from 1989 to 1991 and then from 1999 to 2001. Rural positions now represent 20% of all family medicine residency positions. Among rural programs, minimum rural exposure ranged from 4 to 12 months, and the median distance between rural training communities and referral sites ranged from 50 to 440 km (median 187 km). Rotations in communities with no hospital were mandatory in five of 12 rural programs, optional in five, and unavailable in two. The proportion of training communities used by rural programs that had family physicians only (ie, no immediate specialty backup) ranged from 0 to 78% (mean 44%). Most training communities (78%) used by rural programs had fewer than 10 000 residents. Four of 12 rural programs offered various specialty medicine rotations in small communities.
Rural residency programs have proliferated in Canada. The percentage of residency positions that are rural now equals the proportion of the general population in Canada living in rural areas. National guidelines for rural programs recommend at least 6 months of rural rotations and at least some training in communities without hospitals. Major variations among programs exist, and most program designs differ from designs recommended in national guidelines in at least one aspect.
Notes
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PubMed ID
16926955 View in PubMed
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The Class of 1989 and physician supply in Canada.

https://arctichealth.org/en/permalink/ahliterature206018
Source
CMAJ. 1998 Mar 24;158(6):723-8
Publication Type
Article
Date
Mar-24-1998
Author
E. Ryten
A D Thurber
L. Buske
Author Affiliation
Office of Research and Information Services, Association of Canadian Medical Colleges, Ottawa, Ont.
Source
CMAJ. 1998 Mar 24;158(6):723-8
Date
Mar-24-1998
Language
English
Publication Type
Article
Keywords
Canada
Career Choice
Cohort Studies
Education, Medical
Education, Medical, Graduate - manpower
Emigration and Immigration - statistics & numerical data
Family Practice - education - manpower
Female
Forecasting
Health Services Needs and Demand - statistics & numerical data
Humans
Longitudinal Studies
Male
Physicians - supply & distribution
Population Dynamics
Population Growth
Specialization
Abstract
"The Class of 1989" is a study of 1722 people who were awarded an MD degree by a Canadian university in 1989. This paper reports on migration, specialty choices and patterns of post-MD training in order to assess the contribution of the graduating cohort to the physician workforce of Canada.
A longitudinal study was conducted over 7 years after graduation to trace the current location, the post-MD training history and the professional activity of the graduating cohort. Several medical professional and educational associations in Canada and the United States provided year-by-year information on field and location of post-MD training, certification achieved, whether in practice and location of practice through to spring 1996. Information from all sources was linked to a list of 1989 medical school graduates.
From entry to medical school through to 7 years after graduation the cohort was diminished by about 16%. The main reason for loss was migration to other countries: 193 graduates (11.2%) were outside Canada in 1995-96. Internal migration was extensive also; for example, by 1995-96 relatively few of the graduates were located in Newfoundland or Saskatchewan. Of the 1516 graduates active in Canada in 1995-96, 878 (57.9%) were in general practice/family medicine, and only 638 (42.1%) were practising or training in a specialty.
The "yield" of the Class of 1989 for Canada's physician workforce is insufficient to meet annual physician inflows from Canadian sources to serve population growth and to replace retiring or emigrating physicians. As output from Canada's medical schools drops even further, the gap between requirements and supply will grow even wider.
Notes
Comment In: CMAJ. 1998 Sep 22;159(6):6509780963
Comment In: CMAJ. 1998 Mar 24;158(6):757-99538854
PubMed ID
9538850 View in PubMed
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The Class of 1989 and post-MD training.

https://arctichealth.org/en/permalink/ahliterature206017
Source
CMAJ. 1998 Mar 24;158(6):731-7
Publication Type
Article
Date
Mar-24-1998
Author
E. Ryten
A D Thurber
L. Buske
Author Affiliation
Office of Research and Information Services, Association of Canadian Medical Colleges, Ottawa, Ont.
Source
CMAJ. 1998 Mar 24;158(6):731-7
Date
Mar-24-1998
Language
English
Publication Type
Article
Keywords
Canada - epidemiology
Career Choice
Cohort Studies
Education, Medical
Education, Medical, Graduate - statistics & numerical data
Emigration and Immigration - statistics & numerical data
Family Practice - education - manpower
Female
Health Manpower
Health Services Needs and Demand - statistics & numerical data
Humans
Licensure, Medical - statistics & numerical data
Longitudinal Studies
Male
Specialization
Abstract
"The Class of 1989" is a longitudinal study of 1722 people who were awarded an MD degree by a Canadian university in 1989. This paper reports on the details of their post-MD training up to spring 1996.
Several medical professional and educational associations in Canada and the United States provided year-by-year information on field and location of post-MD training, certification achieved, whether in practice and location of practice through to spring 1996. Information from all sources was linked to a list of 1989 medical school graduates.
Of the 1722 graduates 57 (3.3%) never entered post-MD training in Canada; 147 (8.5%) did 1 or more years of training in the United States. A total of 222 graduates (12.9%) took a break of at least 1 year from training, and 301 (17.5%) changed their choice of field or specialty after starting training. Substantial numbers took 1 or more years longer to complete training than would be expected based on the prescribed length of the training program chosen. The field or specialty choices of the cohort produced a generalist:specialist ratio of 58:42. The final numbers in several fields depended heavily on trainees changing their initial career choice.
The data point out widely differing and often very long lead times from start to completion of training. Since 1993, changes to licensure requirements have reduced opportunities for recent graduating cohorts to delay final career choices, take a break in training, prolong training or change initial career choices. Rigidities in the post-1993 training environment point to the emergence of a number of serious problems, such as dissatisfaction and high anxiety levels among residents, licensing authorities being faced with people who have not completed a training program to certification, and insufficient provision of positions for post-MD training because of underestimates of the time needed to complete training programs. The insights gained from this study lead to the recognition that planning the specialty distribution of the physician workforce is highly complex and difficult.
Notes
Comment In: CMAJ. 1998 Sep 22;159(6):6509780963
Comment In: CMAJ. 1998 Aug 25;159(4):3159732705
Comment In: CMAJ. 1998 Mar 24;158(6):757-99538854
PubMed ID
9538851 View in PubMed
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The contribution of Memorial University's medical school to rural physician supply.

https://arctichealth.org/en/permalink/ahliterature159266
Source
Can J Rural Med. 2008;13(1):15-21
Publication Type
Article
Date
2008
Author
Maria Mathews
James T B Rourke
Amanda Park
Author Affiliation
Division of Community Health & Humanities, Faculty of Medicine, Memorial University of Newfoundland, St. John's, NL.
Source
Can J Rural Med. 2008;13(1):15-21
Date
2008
Language
English
Publication Type
Article
Keywords
Adult
Canada
Databases, Factual
Family Practice - education - manpower
Female
Humans
Logistic Models
Male
Medically underserved area
Newfoundland and Labrador
Physician Incentive Plans
Physicians - psychology - supply & distribution
Professional Practice Location - statistics & numerical data
Rural Health Services - manpower
Schools, Medical
Abstract
This study identifies the characteristics and predictors of Memorial University of Newfoundland (MUN) medical graduates working in rural Canada and rural Newfoundland and Labrador (NL).
We linked data from class lists, the alumni and postgraduate databases with the Southam Medical database to determine 2004 practice locations for MUN graduates from 1973 to 1998 (26 yr, inclusive). Multiple logistic regression was used to identify predictors for each outcome.
In 2004, 167 (12.6%) MUN graduates worked in rural Canada and 81 (6.1%) MUN graduates worked in rural NL. Those who were more likely to practise in rural Canada (when compared with graduates from urban backgrounds, those who had not done any residency training at MUN or specialists, respectively) were graduates from a rural background (odds ratio [OR] 1.95, 95% confidence interval [CI] 1.38-2.76), those who had done residency training at MUN (OR 1.56, 95% CI 1.06-2.29) and family physicians (FPs)-general practitioners (GPs) (OR 6.64, 95% CI 4.31-10.23). Those who were more likely to practise in rural NL (when compared with graduates from urban backgrounds, those who had not done any residency training at MUN, specialists or non-Newfoundlanders, respectively) were graduates from a rural background (OR 2.54, 95% CI 1.57-4.11), those who had done residency training at MUN (OR 4.12, 95% CI 1.94-8.76), FP-GPs (OR 6.39, 95% CI 3.39-12.05) and Newfoundlanders (OR 7.01, 95% CI 2.16-22.71).
The MUN medical school has made a substantial contribution to rural physician supply in both NL and Canada. Increasing the number of local rural students as well as providing incentives to graduates to complete postgraduate training in family medicine in the province may increase the number of locally trained rural physicians.
PubMed ID
18208648 View in PubMed
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Cultural competency training in a new-start rural/frontier family practice residency: a cultural immersion integrated model.

https://arctichealth.org/en/permalink/ahliterature196283
Source
J Rural Health. 2000;16(3):278-9
Publication Type
Article
Date
2000
Source
CMAJ. 1998 Feb 10;158(3):377-8
Publication Type
Article
Date
Feb-10-1998
Author
B. Sibbald
Source
CMAJ. 1998 Feb 10;158(3):377-8
Date
Feb-10-1998
Language
English
Publication Type
Article
Keywords
Career Choice
Education, Medical
Family Practice - education - manpower
Humans
Medically underserved area
Ontario
Personnel Selection
Rural Health Services - manpower
Abstract
Deer aren't the only targets when hunting season begins in Ontario each fall. Physician shortages throughout the province mean fall job fairs that bring recruiters and soon-to-be practising physicians together are growing in popularity, with some communities offering incentives to would-be-recruits as competition increases. Barbara Sibbald reports on a fair organized by the University of Ottawa.
Notes
Cites: CMAJ. 1997 Jun 1;156(11):1593-69176427
PubMed ID
9484266 View in PubMed
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Determining priorities for family physician education in substance abuse by the use of a survey.

https://arctichealth.org/en/permalink/ahliterature216271
Source
J Addict Dis. 1995;14(2):23-31
Publication Type
Article
Date
1995
Author
N. el-Guebaly
J M Lockyer
J. Drought
J. Parboosingh
B B Juschka
W A Weston
W. Campbell
S. Chang
Author Affiliation
Department of Psychiatry, University of Calgary, Alberta, Canada.
Source
J Addict Dis. 1995;14(2):23-31
Date
1995
Language
English
Publication Type
Article
Keywords
Canada
Education, Medical, Continuing
Family Practice - education - manpower
Female
Health Surveys
Humans
Male
Patients
Physician-Patient Relations
Questionnaires
Referral and Consultation
Substance-Related Disorders - diagnosis
Abstract
As the initial stage in developing a curriculum to assist family physicians to diagnose and manage alcohol abuse in their practices, questionnaires were mailed to a selected group of family physicians. A total of 117 physicians (34%) completed the questionnaire. The majority of physicians (70.1%) reported that fewer than 10% of their caseload experienced alcohol-related problems. Most physicians (59.3%) did not use any of the standard diagnostic instruments but reported that screening and detection was the most challenging alcohol-related problem along with patient management. The questionnaire identified a number of areas that could be used in the development of educational strategies to increase the expertise of primary care physicians in the diagnosis and management of alcohol-related problems.
PubMed ID
8541357 View in PubMed
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Does an activity based remuneration system attract young doctors to general practice?

https://arctichealth.org/en/permalink/ahliterature125990
Source
BMC Health Serv Res. 2012;12:68
Publication Type
Article
Date
2012
Author
Birgit Abelsen
Jan Abel Olsen
Author Affiliation
National Centre of Rural Medicine, University of Tromsø, Tromsø, Norway. birgita@norut.no
Source
BMC Health Serv Res. 2012;12:68
Date
2012
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Career Choice
Clinical Competence
Family Practice - education - manpower - organization & administration
Fees and Charges
Female
Humans
Income
Internship and Residency
Job Satisfaction
Logistic Models
Male
Middle Aged
Norway
Personnel Loyalty
Questionnaires
Remuneration
Sex Distribution
Students, Medical - psychology - statistics & numerical data
Work Schedule Tolerance - psychology
Young Adult
Abstract
The use of increasingly complex payment schemes in primary care may represent a barrier to recruiting general practitioners (GP). The existing Norwegian remuneration system is fully activity based - 2/3 fee-for-service and 1/3 capitation. Given that the system has been designed and revised in close collaborations with the medical association, it is likely to correspond - at least to some degree - with the preferences of current GPs (men in majority). The objective of this paper was to study which preferences that young doctors (women in majority), who are the potential entrants to general practice have for activity based vs. salary based payment systems.
In November-December 2010 all last year medical students and all interns in Norway (n = 1.562) were invited to participate in an online survey. The respondents were asked their opinion on systems of remuneration for GPs; inclination to work as a GP; risk attitude; income preferences; work pace tolerance. The data was analysed using one-way ANOVA and multinomial logistic regression analysis.
A total of 831 (53%) responded. Nearly half the sample (47%) did not consider the remuneration system to be important for their inclination to work as GP; 36% considered the current system to make general practice more attractive, while 17% considered it to make general practice less attractive. Those who are attracted by the existing system were men and those who think high income is important, while those who are deterred by the system are risk averse and less happy with a high work pace. On the question of preferred remuneration system, half the sample preferred a mix of salary and activity based remuneration (the median respondent would prefer a 50/50 mix). Only 20% preferred a fully activity based system like the existing one. A salary system was preferred by women, and those less concerned with high income, while a fully activity based system was preferred by men, and those happy with a high work pace.
Given a concern about low recruitment to general practice in Norway, and the fact that an increasing share of medical students is women, we were interested in the extent to which the current Norwegian remuneration system correspond with the preferences of potential GPs. This study suggests that an existing remuneration mechanism has a selection effect on who would like to become a GP. Those most attracted are income motivated men. Those deterred are risk averse, and less happy with a high work pace. More research is needed on the extent to which experienced GPs differ along the questions we asked potential GPs, as well as studying the relative importance of other attributes than payment schemes.
Notes
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PubMed ID
22433750 View in PubMed
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34 records – page 1 of 4.