“At the mercy of some of the regulations”: the impact of the residency match and return of service requirement on the early-career decisions of international medical graduates in Canada

Human Resources for Health

Emily Gard Marshall¹  Katherine Stringer²  M. Ruth Lavergne²  Kathleen Horrey²  Dana Ryan³  Maria Mathews³  Ian Scott⁴  David Snadden⁵  Lori Jones⁶  Laurie J. Goldsmith⁷  Ellen Randall⁸  Agnes Grudniewicz⁹  Sabrina T. Wong^1,10 

[1] Department of Family Medicine Primary Care Unit, Dalhousie University, 1465 Brenton Street, Suite 402, B3J 3T4, Halifax, NS, Canada;Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, B3J 3T4, Halifax, NS, Canada;Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, 1151 Richmond Street, N6A 5C1, London, ON, United Kingdom;Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Boulevard, V6T 1Z3, Vancouver, BC, Canada;Department of Family Practice, University of British Columbia, Northern Medical Program, UNBC, 3333 University Way, V2N 4Z9, Prince George, BC, Canada;Department of History, University of Ottawa, 55 Laurier Ave E, K1N 6N5, Ottawa, ON, Canada;Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, V5A 1S6, Burnaby, BC, Canada;Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, Clinical Sciences Building (Novena), 11 Mandalay Road, 308232, Singapore, Singapore;School of Population and Public Health, University of British Columbia, 2206 E Mall, V6T 1Z3, Vancouver, BC, Canada;Telfer School of Management, University of Ottawa, Desmarais Building, 55 Laurier Ave East, K1N 6N5, Ottawa, ON, Canada;UBC Centre for Health Services and Policy Research and School of Nursing, University of British Columbia, 201-2206 East Mall, V6T 1Z3, Vancouver, BC, Canada;

关键词: Post-graduate medical education;    Residency;    International medical graduate;    Early-career family physician;    Return-of-service;    Family medicine;    Qualitative research;   

DOI  :  10.1186/s12960-022-00709-0

来源: Springer

【 摘 要 】

BackgroundReturn-of-service (ROS) agreements require international medical graduates (IMGs) who accept medical residency positions in Canada to practice in specified geographic areas following completion of training. However, few studies have examined how ROS agreements influence career decisions. We examined IMG resident and early-career family physicians’ perceptions of the residency matching process, ROS requirements, and how these factors shaped their early career decisions.MethodsAs part of a larger project, we conducted semi-structured qualitative interviews with early-career family physicians and family medicine residents in British Columbia, Ontario and Nova Scotia. We asked participants about their actual or intended practice characteristics (e.g., payment model, practice location) and factors shaping actual or intended practice (e.g., personal/professional influences, training experiences, policy environments). Interviews were transcribed verbatim and a thematic analysis approach was employed to identify recurring patterns and themes.ResultsFor this study, we examined interview data from nine residents and 15 early-career physicians with ROS agreements. We identified three themes: IMGs strategically chose family medicine to increase the likelihood of obtaining a residency position; ROS agreements limited career choices; and ROS agreements delayed preferred practice choice (e.g., scope of practice and location) of an IMGs’ early-career practice.ConclusionsThe obligatory nature of ROS agreements influences IMG early-career choices, as they necessitate strategically tailoring practice intentions towards available residency positions. Existing analyses of IMGs’ early-career practice choices neglect to distinguish between ROS and practice choices made independently of ROS requirements. Further research is needed to understand how ROS influences longer term practice patterns of IMGs in Canada.

【 授权许可】

CC BY