The maldistribution of family physicians challenges equitable primary care access in Canada. The Theory of Social Attachment suggests that preferential selection and distributed training interventions have potential in influencing physician disposition. However, evaluations of these approaches have focused predominantly on rural underservedness, with little research considering physician disposition in other underserved communities. Accordingly, this study investigated the association between the locations from which medical graduates apply to medical school, their undergraduate preclerkship, clerkship, residency experiences, and practice as indexed across an array of markers of underservedness. We built association models concerning the practice location of 347 family physicians who graduated from McMaster University's MD Program between 2010 and 2015. Postal code data of medical graduates' residence during secondary school, pre-clerkship, clerkship, residency and eventual practice locations were coded according to five Statistics Canada indices related to primary care underservedness: relative rurality, employment rate, proportion of visible minorities, proportion of Indigenous peoples, and neighbourhood socioeconomic status. Univariate and multivariable logistic regression models were then developed for each dependent variable (i.e., practice location expressed in terms of each index). Residency training locations were significantly associated with practice locations across all indices. The place of secondary school education also yielded significant relationships to practice location when indexed by employment rate and relative rurality. Education interventions that leverage residency training locations may be particularly influential in promoting family physician practice location. The findings are interpreted with respect to how investment in education policies can promote physician practice in underserved communities.

中文翻译：

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教育政策与家庭医生地理分布之间的关联：麦克马斯特大学教育数据的回顾性观察研究。

家庭医生的分布不均对加拿大公平的初级保健提出了挑战。社会依恋理论表明，优先选择和分布式培训干预措施有可能影响医生的性格。然而，对这些方法的评估主要集中在农村服务不足的情况，很少有研究考虑其他服务不足社区的医生配置。因此，这项研究调查了医学毕业生申请医学院的地点、他们的本科预科实习、实习、住院医师经验和实践之间的关联，并以一系列服务不足的标志为索引。我们针对 2010 年至 2015 年间从麦克马斯特大学医学博士项目毕业的 347 名家庭医生的执业地点建立了关联模型。根据医学毕业生中学期间、实习前、实习、住院期间和最终执业地点的邮政编码数据进行编码与初级保健服务不足相关的加拿大统计局五项指数：相对农村性、就业率、少数族裔比例、原住民比例以及社区社会经济地位。然后针对每个因变量（即，以每个指数表示的实践位置）开发单变量和多变量逻辑回归模型。住院医师培训地点与所有指数的实践地点显着相关。当以就业率和相对农村程度为索引时，中学教育的地点也与实践地点产生了显着的关系。利用住院医师培训地点的教育干预措施可能对促进家庭医生执业地点特别有影响力。研究结果被解释为教育政策投资如何促进服务欠缺社区的医生执业。