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Research

Regional differences in where and how family medicine residents intend to practise: a cross-sectional survey analysis

M. Ruth Lavergne, Ian Scott, Goldis Mitra, David Snadden, Doug Blackie, Laurie J. Goldsmith, David Rudoler, Lindsay Hedden, Agnes Grudniewicz, Megan A. Ahuja and Emily Gard Marshall
February 28, 2019 7 (1) E124-E130; DOI: https://doi.org/10.9778/cmajo.20180152
M. Ruth Lavergne
Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
PhD
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Ian Scott
Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
MSc MD
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Goldis Mitra
Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
MD
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David Snadden
Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
MBChB MD
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Doug Blackie
Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
MPA
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Laurie J. Goldsmith
Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
PhD
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David Rudoler
Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
PhD
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Lindsay Hedden
Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
PhD
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Agnes Grudniewicz
Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
PhD
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Megan A. Ahuja
Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
MPH
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Emily Gard Marshall
Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
PhD
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Article Figures & Tables

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    Table 1:

    Characteristics of family medicine residents exiting training programs in 2016 and 2017 who responded to the Family Medicine Longitudinal Survey, by region

    CharacteristicNo. (%) of respondentsp value*
    Total
    n = 1680
    Ontario
    n = 561
    Western Canada
    n = 663
    Atlantic Canada
    n = 68
    Quebec
    n = 388
    Sex/gender< 0.001
    Male619 (37.6)177 (31.9)291 (45.3)23 (35.4)128 (33.7)
    Female1027 (62.4)378 (68.1)355 (54.7)42 (64.6)252 (66.3)
    Location of MD training< 0.001
    Canada1386 (85.6)477 (95.2)523 (78.9)59 (86.8)327 (84.5)
    International233 (14.4)24 (4.8)140 (21.1)9 (13.2)60 (15.5)
    Age, yr< 0.001
    < 30931 (58.6)410 (73.3)318 (48.3)28 (42.4)175 (57.0)
    30–34433 (27.2)80 (14.3)222 (33.7)24 (36.4)107 (34.9)
    ≥ 35226 (14.2)69 (12.3)118 (17.9)14 (21.2)25 (8.1)
    Time since completion of MD training, yr< 0.001
    21325 (79.1)470 (83.8)489 (74.0)56 (82.4)310 (80.3)
    3145 (8.7)28 (5.0)67 (10.1)8 (11.8)42 (10.9)
    ≥ 4206 (12.3)63 (11.2)105 (15.9)4 (5.9)34 (8.8)
    Childhood environment< 0.001
    Inner city, urban or suburban1051 (63.0)317 (56.5)428 (64.9)30 (47.6)276 (71.7)
    Small town280 (16.8)107 (19.1)93 (14.1)15 (23.8)65 (16.9)
    Rural, remote or isolated234 (14.0)92 (16.4)96 (14.6)15 (23.8)31 (8.1)
    Mixed103 (6.2)45 (8.0)42 (6.4)3 (4.8)13 (3.4)
    • Note: The following numbers of residents offered no response or preferred not to answer certain questions: 34 for sex/gender, 61 for place of MD training, 90 for age, 4 for time since completion of MD training and 12 for childhood environment.

    • ↵* Calculated with χ2 test.

    • View popup
    Table 2:

    Practice intentions of family medicine residents exiting residencies in 2016 and 2017 who responded to the Family Medicine Longitudinal Survey, by region

    IntentionNo. (%) of respondentsp value*
    TotalOntarioWestern CanadaAtlantic CanadaQuebec
    Comprehensive care and confidence in current ability
    Residents reporting that it was somewhat or highly likely that they would commit to providing comprehensive care to the same group of patients in their first 3 years of practice (Q17, n = 1652)1095 (66.3)474 (85.1)401 (61.2)27 (40.3)193 (51.7)< 0.001
    Residents reporting that they agreed or strongly agreed with this statement: “I am confident in my current ability to provide comprehensive care to the same group of patients over time.” (Q19, n = 1658)1529 (92.2)509 (91.2)609 (93.4)55 (82.1)356 (93.4)0.006
    Residents reporting it was somewhat or highly likely they would practise in the following organizational models
    Comprehensive care delivered in 1 clinical setting (e.g., office based) (Q16a, n = 1659)1019 (61.4)320 (57.5)416 (63.7)32 (47.8)251 (65.7)0.004
    Comprehensive care provided across multiple clinical settings (in-hospital, long-term care, office) (Q16b, 1661)1261 (75.9)437 (78.0)504 (77.2)56 (83.6)264 (69.3)0.004
    Comprehensive care that includes a special interest (sports medicine, emergency medicine, palliative care, etc.) (Q16c, n = 1661)1122 (67.6)372 (66.6)451 (69.1)49 (73.1)250 (65.5)0.4
    Practice focused only on specific clinical areas (e.g., sports medicine, maternity care, emergency medicine, palliative care, hospital medicine) (Q16d, n = 1658)522 (31.5)225 (40.3)179 (27.5)18 (26.9)100 (26.3)< 0.001
    Solo practice (Q15a, n = 1645)126 (7.7)25 (4.6)59 (9.1)8 (12.1)34 (9.0)0.007
    Group physician practice (Q15b, n = 1658)1556 (93.8)536 (96.2)615 (94.0)60 (90.9)345 (90.6)0.003
    Interprofessional team-based practice (Q15c, n = 1656)1459 (88.1)520 (93.7)561 (85.9)59 (89.4)319 (83.5)< 0.001
    Practice that includes teaching health profession learners (Q15d, n = 1652)1293 (78.3)370 (66.9)566 (86.8)53 (79.1)304 (80.0)< 0.001
    Residents reporting it was somewhat or highly likely they would provide care in the following clinical domains in their first 3 years of practice
    Care across the life cycle (Q21a, n = 1658)1506 (90.8)515 (92.1)594 (91.0)56 (83.6)341 (90.0)0.1
    Intrapartum care (Q21b, n = 1654)623 (37.7)174 (31.2)276 (42.5)28 (41.8)145 (38.3)0.001
    Mental health care (Q21c, n = 1654)1467 (88.7)484 (86.7)587 (90.3)60 (89.6)336 (88.7)0.3
    Chronic disease management (Q21d, n = 1650)1541 (93.4)513 (92.1)618 (94.8)59 (90.8)351 (93.4)0.2
    Palliative care, end-of-life care (Q21e, n = 1653)1060 (64.1)276 (49.6)483 (74.1)48 (72.7)253 (66.8)< 0.001
    Office-based clinical procedures (Q21f, n = 1649)1382 (83.8)435 (78.4)585 (90.0)52 (78.8)310 (82.0)< 0.001
    In-hospital clinical procedures (e.g., chest tube insertion, adult lumbar puncture, nasogastric tube insertion) (Q21g, n = 1655)646 (39.0)193 (34.6)296 (45.5)24 (35.8)133 (35.1)< 0.001
    Residents reporting it was somewhat or highly likely they would provide care in the following practice settings or to the following populations in their first 3 years of practice
    In emergency departments (Q21h, n = 1656)693 (41.8)194 (34.8)324 (49.7)32 (47.8)143 (37.7)< 0.001
    In hospital (Q21i, n = 1653)983 (59.5)315 (56.7)430 (66.0)49 (74.2)189 (49.9)< 0.001
    In the home (Q21j, n = 1654)695 (42.0)176 (31.6)298 (45.8)35 (52.2)186 (49.1)< 0.001
    In long-term care facilities (Q21k, n = 1655)678 (41.0)169 (30.3)344 (52.8)27 (40.3)138 (36.4)< 0.001
    Marginalized, disadvantaged and vulnerable populations (Q21l, n = 1652)873 (52.8)177 (31.9)449 (69.0)43 (64.2)204 (53.8)< 0.001
    Rural populations (Q21m, n = 1577)852 (54.0)252 (45.2)383 (58.7)46 (68.7)171 (57.2)< 0.001
    Elderly populations (Q21n, n = 1576)1425 (90.4)480 (86.0)607 (93.0)62 (92.5)276 (92.6)< 0.001
    First Nations, Inuit and Métis (Q21o, n = 1656)694 (41.9)121 (21.7)422 (64.6)22 (32.8)129 (34.0)< 0.001
    • ↵* Calculated with χ2 test.

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Regional differences in where and how family medicine residents intend to practise: a cross-sectional survey analysis
M. Ruth Lavergne, Ian Scott, Goldis Mitra, David Snadden, Doug Blackie, Laurie J. Goldsmith, David Rudoler, Lindsay Hedden, Agnes Grudniewicz, Megan A. Ahuja, Emily Gard Marshall
Jan 2019, 7 (1) E124-E130; DOI: 10.9778/cmajo.20180152

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Regional differences in where and how family medicine residents intend to practise: a cross-sectional survey analysis
M. Ruth Lavergne, Ian Scott, Goldis Mitra, David Snadden, Doug Blackie, Laurie J. Goldsmith, David Rudoler, Lindsay Hedden, Agnes Grudniewicz, Megan A. Ahuja, Emily Gard Marshall
Jan 2019, 7 (1) E124-E130; DOI: 10.9778/cmajo.20180152
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