title: Retention of provisionally licensed international medical graduates: a historical cohort study of general and family physicians in Newfoundland and Labrador.
abstract: BACKGROUND
  To alleviate the shortage of primary care physicians in rural communities, the Canadian province of Newfoundland and Labrador (NL) introduced provisional licensure for international medical graduates (IMGs), allowing them to practise in under-served communities while completing licensing requirements. Although provisional licensing has been seen as a needed recruitment strategy, little is known about its impact on physician retention. To assess the relationship between provincial retention time and type of initial practice licence, we compared the retention of: (1) IMGs who began practice with a provisional licence; (2) fully licensed Memorial University medical graduates (MMGs); and (3) fully licensed medical graduates from other Canadian medical schools (CMGs).
  
  
  METHODS
  Using administrative data from the NL College of Physicians and Surgeons, the 2004 Scott's Medical Database, and the Memorial University postgraduate database, we identified family physicians/general practitioners (FPs/GPs) who began their practice in NL in the period 1997-2000 and determined where they were in 2004. We used Cox regression to examine differences in retention among these 3 groups of physicians.
  
  
  RESULTS
  There were 42 MMGs, 38 CMGs and 77 IMGs in our sample. The median time for IMGs to qualify for full licensure was 15 months. Twenty-one physicians (13.4%) stayed in NL after beginning their practice (35.7% MMGs, 5.3% CMGs, 5.2% IMGs; p < 0.000). The median retention time was 25 months (MMGs, 39 months; CMGs, 22 months; IMGs, 22 months; p < 0.000). After controlling for Certificant of the College of Family Physicians status, CMGs (hazard ratio [HR] = 2.15; 95% confidence interval [CI] 1.29-3.60) and IMGs (HR = 2.03; 95% CI 1.26-3.27) were more likely to leave NL than MMGs.
  
  
  CONCLUSIONS
  Provisional licensing accounts for the largest proportion of new primary care physicians in NL but does not lead to long-term retention of IMGs. However, IMG retention is no worse than the retention of CMGs.
authors: Maria
authors: M
authors: Mathews
authors: Alison C
authors: AC
authors: Edwards
authors: James Tb
authors: JT
authors: Rourke
references: CMAJ. 2005 Nov 22;173(11):1315-6
references: 16301695
references: CMAJ. 2006 Aug 15;175(4):357-60
references: 16908895
references: CMAJ. 1992 May 1;146(9):1549-54
references: 1571866
references: Med J Aust. 2006 Dec 4-18;185(11-12):654-60
references: 17181515
references: N Engl J Med. 2005 Oct 27;353(17):1810-8
references: 16251537
references: CMAJ. 2000 Mar 21;162(6):801-3
references: 10750470
references: Can J Rural Med. 2006 Fall;11(4):271-6
references: 17054827
references: CMAJ. 2000 Mar 21;162(6):795-6
references: 10750469