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REF NO.: 299

SUBJECT: New study shows Memorial's medical school is making a major contribution to supply of province's doctors

DATE: May 23,2006

A new study by Dr. Maria Mathews, assistant professor of Health Policy and Health Care Delivery at Memorial University of Newfoundland (MUN), shows that the university's medical school is making a major contribution to the supply of full-licensed doctors practicing in Newfoundland and Labrador, including rural communities.
"Physicians trained at MUN make up more than half of all doctors in the province with about one-fifth of those working in the province's rural areas," said Dr. Mathews.
A second part of the study looked at where residents trained at Memorial are working. "Nearly 60 per cent of all fully licensed doctors practicing in the province in 2004 did their postgraduate training at MUN, including one-quarter of those serving the province's rural communities," she said.
The study shows that almost 13 per cent of MUN medical graduates were working in rural communities with a population of fewer than 10,000 throughout Canada in 2003. "This represents five per cent of the rural physician workforce nation-wide and about one-fifth of Newfoundland and Labrador's supply of rural doctors."
Dr. Mathews said there are a number of factors that predict where MUN graduates end up practicing medicine. "Medical graduates who have a rural background, are originally from the province, or do some or all of their postgraduate training at MUN are more likely to work in Newfoundland and Labrador. Fifty-five per cent of MUN graduates with a rural background who did some or all of their residency training at Memorial were working in the province in 2004."
The dean of Medicine at Memorial, Dr. James Rourke, noted that over 40 per cent of medical students at MUN come from rural areas, compared to a Canadian average of 11 per cent. He said that of the 822 fully licensed doctors in Newfoundland and Labrador, 237 are graduates of Memorial's medical school and another 208 MUN medical graduates are in specialist practice.
Based on the findings in her study, Dr. Mathews has the following recommendations for the province and Memorial University.
  • MUN should identify and build upon those aspects of the medical school's residency program that influence physicians to practice in Newfoundland and Labrador, including its rural communities.
  • The province should provide incentives for MUN's medical school graduates to do their residency training at Memorial University.
  • MUN should increase, or at the very least maintain, the number of medical school seats reserved for Newfoundland and Labrador students. The province should encourage and support students from rural areas to study medicine.
  • MUN should develop strategies aimed at encouraging more international medical graduates who go through the university's residency programs to set up practice in Newfoundland and Labrador.

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For further information contact Dr. Maria Mathews at 709 777-7845 or mmathews@mun.ca; or Sharon Gray, communications co-ordinator (health sciences), at 709 777-8397 or sgray@mun.ca.

Background and further findings
 
The study by Dr. Maria Mathews is based on an analysis of 26 years of data from Faculty of Medicine class lists, alumni database, postgraduate databases, and the 2004 Southam Medical database. The Southam Medical database is an annually updated listing of 56,000 physicians in Canada who are members of the Canadian Medical Association and permit release of their information. The study starts with the class of 1973 when the first medical students graduated from Memorial and ends with the class of 1998, since medical students graduating after this date may still be doing their postgraduate training.
           
The researcher said her findings should be interpreted with caution. "Because the Southam Database is incomplete we could not determine the practice location of nearly one-third of MUN residents. Still, we believe our findings suggest or support some general recommendations."
           
Dr. Mathews recommends that the province maintain, and likely expand, enrolment in MUN's medical training programs. At present, 40 seats in each entering class are reserved for students from Newfoundland and Labrador, 10 for students from New Brunswick, two from Prince Edward Island, and the remaining six to 10 seats are open to other applicants from Canada and the U.S.
           
In order to encourage MUN medical graduates to do their residency training at Memorial, Dr. Mathews recommends that the province offer incentives; she also urges the university to develop strategies aimed at encouraging more international medical graduates who go through Memorial's residency program to set up practice in the province.
           
Dr. Mathews' research determined that in 2004, 87 per cent of MUN graduates were practicing in Canada. This figure is around the average for Canadian medical schools. "Nearly one-third of those doctors were working in the province, accounting for more than half - 52.6 per cent to be precise - of all fully licensed physicians in the province."
           
The first class of medical students started at Memorial in 1969 and part of the reason for having a medical school at MUN was to make Newfoundland and Labrador, particularly its rural communities, less dependent on other medical schools for doctors. Since the first graduating class in 1973, almost 2,000 doctors have earned their degrees at Memorial. Dr. Mathews' study is the first comprehensive look at where these physicians are practicing and what factors influenced their decision.
           
Consistent with previous research, Dr. Mathews found that family physicians and graduates from a rural background are more likely to work in rural communities. Completing some or all of their residency training at MUN is also a strong predictor of rural practice. "More than one-quarter of family doctors from rural backgrounds who did some or all of their family medicine residency at Memorial were practicing in rural parts of the province in 2004."
           
Another important factor that influences where doctors practice is calling Newfoundland and Labrador home. The study shows that all but three of MUN graduates practicing in rural areas in 2004 were originally from the province.
           
Dr. Mathews said the university should identify and build on aspects of the medical school's residency programs that influence physicians to practice in the province. "The province should provide incentives for MUN medical school graduates to do their residency training at Memorial and the university should increase, or at the very least maintain, the number of medical school seats reserved for Newfoundland and Labrador students. As well, the province should encourage and support students from rural areas to study medicine."
           
She noted that although Memorial's residency program is doing a good job of attracting international medical graduates (IMGs), few of these doctors set up practice in the province. Postgraduate training for doctors began at Memorial in the late 1960s, and since then the program has turned out more than 3,000 medical residents. "In order to determine whether doctors who do their residency training at MUN go on to establish practices in the province, we linked the same sort of information as we did in the other study, including all MUN residents who started their post-grad training by 1998. These doctors, we reasoned, would have completed their residency by 2004. Two-thirds of MUN residency graduates were practicing in Canada in 2004 with 19 per cent working in the province. This represents 60 per cent of all fully licensed physicians in the province."
           
Although IMGs make up a larger proportion of MUN residents than graduates of Memorial's medical school - 37 per cent versus 34 per cent - few were working in the province in 2004. "Only eight percent versus 42 per cent of MUN-trained residents established practice here," explained Dr. Mathews.
           
The study shows that residents in family medicine and general internship programs are more likely than specialists to stay in the province. "Family medicine residents in particular are more likely to establish practices in rural communities," she explained.
           
Residency positions at Memorial's Faculty of Medicine filled for the coming year include 20 in family medicine and 42 in the following specialist training programs: anesthesia, internal medicine, neurology, obstetrics and gynecology, orthopedics, anatomical pathology, pediatrics, psychiatry, radiology and surgery.

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