1

The More Things Change, The More They Stay the Same:Key factors influencing choice of practice locations of family physicians at four different career points

Denis Heng1, Raymond W. Pong1, Miriam McDonald2,

Tom Crichton31 Centre for Rural & Northern Health Research,

Laurentian University2 Northeastern Ontario Medical Education Corporation,

Sudbury ON3 Northeastern Ontario Family Medicine Program,

NOMEC

Northern Health Research Conference – June 3, 2006

Factors Influencing Practice Location

n Rural medical exposure

n Remuneration

n Workload

n Professional support

n Spousal employment opportunities

n Children’s education

n Community characteristics

n Personal characteristics

Welcome to Northern Ontario

n Really bign 89% of Ontario

n Pop: 839,549

n 7.4% of Ontario

n Primary industry sectorn Mining and Forestry

n Public sector employmentn Education and Health care

Northeastern Ontario Family Medicine (NOFM) Program

n Affiliated with the Northern Ontario School of Medicine

n Trains graduates from any Canadian medical school in family medicine

n Community-based, 2-yr residency program

n Northern ON regional programs begun in 1991

Methods

n Years of data: 2001-2005

n Two measures of importance:n Indicate the relative importance of different

factors on influencing choice of practice location

n Indicate the top three factors of importance in influencing the choice of practice location

n 5-point response scale

n Approved by Laurentian University REB

Nineteen Factors of Influence

§ Opportunity for a variety of medical experiences § Adequate on-call coverage§ Availability of hospital facilities / services§ Previous contacts with health care professionals in community§ Access for specialists for consultation§ Previous medical practice in community § Availability of CME opportunities§ Income potential§ Bursaries’ / incentive program’s return-of-service requirements§ Opportunity for career advancement

Professional factors (11)

§ Lifestyle of the community§ Quality of the physical environment in the area§ Cultural and recreational opportunities§ Size / population of community§ Medical needs in community

Community Factors (5)

§ Influence of spouse/partner§ Proximity to family/relatives§ Proximity to friends / colleagues

Personal factors (3)

2

Relative Importance – Entry respondents

3.08

4.14

4.23

4.25

4.27

2.0 2.5 3.0 3.5 4.0 4.5 5.0

Income Potential

Quality of the physical environment

Influence of spouse / partner

Opportunity for a variety of medicalexperiences

Life-style of the community

Relative Importance – Exit respondents

3.05

4.15

4.25

4.32

4.35

2.0 2.5 3.0 3.5 4.0 4.5 5.0

Opportunity for career advancement

Opportunity for a variety of medicalexperiences

Adequate on-call coverage

Influence of spouse / partner

Life-style of the community

Relative Importance –2-Yr respondents

2.83

4.00

4.15

4.24

4.35

2.0 2.5 3.0 3.5 4.0 4.5 5.0

Opportunity for career advancement

Opportunity for a variety of medicalexperiences

Quality of the physical environment in thearea

Influence of spouse / partner

Life-style of the community

Relative Importance – 5-Yr respondents

2.46

3.81

4.02

4.12

4.30

2.0 2.5 3.0 3.5 4.0 4.5 5.0

Opportunity for career advancement

Cultural and recreational opportunities

Opportunity for a variety of medicalexperiences

Life-style of the community

Influence of spouse / partner

Relative Importance

5th3rd6th4thQuality of the physical environment in the area

1st2nd2nd3rdInfluence of spouse / partner

3rd4th4th2ndOpportunity for a variety of medical experience

2nd1st1st1stLife-style of the community

5-Yr2-YrExitEntryRelative Influence

Relative Importance

2

2.5

3

3.5

4

4.5

5

Income potential

Medical needs in com

munity

Influence of spouse / partner

Quality of education for child(ren)

Availability of hospital facilities / services

Previous contacts with healthcare professionals

Adequate on-call coverage

Proximity to extended fam

ily / relatives

Proximity to friends / colleagues

Cultural and recreational opportunities

Opportunity for career advancem

ent

Access for specialists for consultation

Opportunity for a variety of m

edical experiences

Quality of the physical environm

ent in the area

Life-style of the comm

unity

Previous medical practice in com

munity

Size / population of comm

unity

Availability of CME opportunities

Bursaries / incentive program's return-of-service

Ave

rag

e R

atin

g S

core

EntryExit

2-Year

5-Year

3

Rank Order of Importance

4th3rd3rd4thLife-style of the community

2nd2nd2nd3rdProximity to extended family / relatives

3rd4th4th2ndOpportunity for a variety of medical experience

1st1st1st1stInfluence of spouse / partner

5-Yr2-YrExitEntryRank Order of Influence

Some factors influencing practice location remain stable across different career points

n Influence of spouse/partnern Opportunity for a variety of medical experiences

n Proximity to extended family/relativesn Lifestyle of the community

n Opportunity for career advancement

n Availability of CME opportunities

Some factors influencing practice location change between different career points

n Cultural and recreational opportunities

n Previous medical practice in the community

n Adequate on-call coveragen Proximity to friends/colleagues

And sometimes it depends on how you ask the question

n Previous contacts with health care professionals in the community

n Medical needs in the community

n Income potential

n Bursaries’/Incentives program’s return-of-service requirements

n Quality of the physical environment in the area

n Quality of education for children

n Availability of hospital facilities/services

n Access for specialists for consultation,

n Size/population of community

Study Limitations

n Unable to establish causation

n Small sample size of unique group of family medicine graduates

n Generalizability of results

Acknowledgements

n Northeastern Ontario Family Medicine Program

n Monique Lapointeand Linda Liboiron-Grenier

n Past and present CRaNHR colleagues who have worked on this project.