Ten years of graduates: A cross-sectional study of the practice location of doctors trained at a socially accountable medical school.

Abstract

The study predicted practice location of doctors trained at a socially accountable medical school with education programs in over 90 communities. A cross-sectional study examined practice location 10 years after the first class graduated from the Northern Ontario School of Medicine (NOSM), Canada. Exact tests and logistic regression models were used to assess practice location in northern Ontario; northern Canada; or other region; and rural (population <10,000) or urban community. There were 435 doctors with 334 (77%) practising as family doctors (FPs), 62 (14%) as generalist specialists and 39 (9%) as other medical or surgical specialists. Approximately 92% (128/139) of FPs who completed both UG and PG at NOSM practised in northern Ontario in 2019, compared with 63% (43/68) who completed only their PG at NOSM, and 24% (30/127) who completed only their UG at NOSM. Overall, 37% (23/62) of generalist specialists and 23% (9/39) of other specialists practised in northern Ontario. Approximately 28% (93/334) of FPs practised in rural Canada compared with 4% (4/101) of all other specialists. FP northern Ontario practice was predicted by completing UG and PG at NOSM (adjusted odds ratio = 46, 95% confidence interval = 20-103) or completing only PG at NOSM (15, 6.0-38) relative to completing only UG at NOSM, and having a northern Ontario hometown (5.3, 2.3-12). Rural Canada practice was predicted by rural hometown (2.3, 1.3-3.8), completing only a NOSM PG (2.0, 1.0-3.9), and age (1.4, 1.1-1.8). This study uniquely demonstrated the interaction of two mechanisms by which medical schools can increase the proportion of doctors' practices located in economically deprived regions: first, admit medical students who grow up in the region; and second, provide immersive UG and PG medical education in the region. Both mechanisms have enabled the majority of NOSM-trained doctors to practise in the underserved region of northern Ontario.