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Associations between education policies and the geographic disposition of family physicians: a retrospective observational study of McMaster University education data

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Abstract

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.

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Acknowledgements

The authors thank Lynda Chryslar from the Ontario Physician Human Resources Data Centre and Geoff Barnum from the Canadian Post-MD Education Registry.

Funding

This work was funded by McMaster University’s 2020 Faculty of Health Sciences’ Education Scholarship Fund and the 2020 Hamilton Academic Family Medicine Associates Research Grant.

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Authors and Affiliations

  1. Department of Family Medicine, Faculty of Health Sciences, McMaster University, 100 Main St. W, Hamilton, ON, L8P 1H6, Canada

    Lawrence Grierson, Asiana Elma, Meera Mahmud, Dorothy Bakker & Gina Agarwal

  2. McMaster Education Research, Innovation and Theory, Faculty of Health Sciences, McMaster University, Hamilton, Canada

    Lawrence Grierson

  3. McMaster Community and Rural Education Program, McMaster University, Hamilton, Canada

    Lawrence Grierson & Dorothy Bakker

  4. Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Canada

    Mathew Mercuri & Neil Johnston

  5. Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Monica Aggarwal

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Contributions

LG designed and supervised all aspects of this study. MMe conducted the data analysis. AE and MMa led the research data management and supported statistical analyses. LG led the writing of the manuscript. All authors (LG, MMe, AE, MMa, DB, NJ, MA, GA) participated in data analysis and interpretation and contributed to the critical revision of the paper, approved the final manuscript for publication, and have agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Grierson, L., Mercuri, M., Elma, A. et al. Associations between education policies and the geographic disposition of family physicians: a retrospective observational study of McMaster University education data. Adv in Health Sci Educ (2023). https://doi.org/10.1007/s10459-023-10273-4

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