Effective physician retention strategies in Norway's northernmost county.
OBJECTIVE
Retaining physicians in remote settings can be challenging owing to the heavy workload and harsh environmental conditions and to the lack of opportunities for professional development. In Norway, poor physician distribution between urban and rural areas has been persistent, particularly in the north, where in 1997 a total of 28% of the primary care physician positions were vacant.


METHODS
Several corrective measures have been tried over the years. One was the establishment of a medical school in the northern city of Tromsø, which proved effective but did not avert new crises. A 1998 survey among primary care physicians signalled the need for new interventions conducive to professional development in rural areas. The existing medical internship and in-service training model for general practice were systematically adopted as tools for retaining physicians.


METHODS
In Finnmark - Norway's northernmost and most sparsely-populated county - medical practice is challenging, especially at the primary care level. In 1997, a 38% shortage of general practitioners (30 positions) threatened primary care safety.


RESULTS
Almost twice as many medical interns as expected now take their first fully licensed job in the north of Norway. The post-training retention of primary care physicians after 5 years currently stands at 65%.


CONCLUSIONS
Postgraduate medical training can be conducted in remote areas in a manner that ensures professional development, counteracts professional isolation, and allows trainees and their families to grow roots in rural communities. Rural practice satisfies modern principles of adult learning (problem-based and attached to real-life situations) and offers excellent training conditions.
Straume
Karin
K
Department of Health and Social Affairs, Governor of Finnmark County, Vardoeveien 46, Vadsoe, N-9800, Norway. karinstraume@hotmail.com
Shaw
Daniel M P
DM
D002321:Career Choice; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D006280:Health Workforce / Q000458:organization & administration*; D006801:Humans; D009664:Norway; D010821:Physicians, Family / Q000458:organization & administration*; D015397:Program Evaluation; D019035:Rural Health Services / Q000458:organization & administration*
Rural Remote Health. 2010 Apr-Jun;10(2):1366
20572749
Soc Sci Med. 1998 Dec;47(12):1937-46
10075237
Fam Pract. 1988 Dec;5(4):244-52
3229597
Tidsskr Nor Laegeforen. 1999 Apr 10;119(9):1296-8
10327852
Med Educ. 1993 May;27(3):250-3
8336575
Tidsskr Nor Laegeforen. 1988 Aug 20;108(23):1809-10
3420591
Rural Remote Health. 2010 Apr-Jun;10(2):1356
20572748
Hum Resour Health. 2003 Nov 25;1(1):12
14641940
Hum Resour Health. 2009 Apr 01;7:28
19338669