title: Retention of specialist physicians in Newfoundland and Labrador.
abstract: BACKGROUND
  Although specialist physicians comprise nearly half of the physician workforce in Newfoundland and Labrador (NL), relatively little is known about their retention patterns. We compared 2 cohorts of physicians who were initially licensed to practise in NL between 1993 and 1997 and between 2000 and 2004, to examine whether retention had changed over time. Additionally, we examined the retention of 4 groups of physicians in each cohort: (1) fully licensed medical graduates of Memorial University, (2) fully licensed medical graduates of other Canadian universities, (3) provisionally licensed international medical graduates (IMGs) and (4) fully licensed IMGs. Provisional licences allow physicians who have not received Canadian certification to practise while obtaining credentials. We hypothesized that fully licensed physicians (largely physicians who are locally trained) would remain in NL longer than provisionally licensed physicians (largely IMGs).
  
  
  METHODS
  Using data from the provincial medical registrar and Memorial University's office of postgraduate medical education, we used survival analysis (Cox regression) to compare the retention of the 2 cohorts and the 4 groups of physicians within each cohort.
  
  
  RESULTS
  After 48 months, roughly 60% of the physicians in the 2000-04 cohort and 45% of the physicians in the 1993-97 cohort remained in NL. Medical graduates of Memorial University comprised 61/180 (33.9%) of the 2000-04 cohort and 38/211 (18.0%) of the 1993-97 cohort.Physicians in the 2000-04 cohort were 1.6 (95% confidence interval [CI] 1.23-2.08) times less likely to leave NL than physicians in the 1993-97 cohort. In the 2000-04 cohort, medical graduates of Canadian universities, provisionally licensed IMGs and fully licensed IMGs were 3.19 (95% CI 1.47-6.89), 1.85 (95% CI 1.09-3.17) and 4.39 (95% CI 1.91-10.10) times more likely to leave NL than medical graduates of Memorial University. In the 1993-97 cohort, IMGs with provisional licences were 2.16 (95% CI 1.37-3.42) times more likely to leave NL than medical graduates of Memorial University. There was no significant difference in retention between medical graduates of Memorial University and other Canadian universities or IMGs with full licences in the 1993-97 cohort.
  
  
  CONCLUSIONS
  The improvement in the retention of specialist physicians in NL since the 1990s may be attributable to the increase in the relative proportion of medical graduates of Memorial University. Although provisional licensing enables IMGs to begin practice in NL, it does not lead to long-term retention.
authors.affiliation: Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Fleming
authors.forename: Maria
authors.initials: M
authors.lastname: Mathews
mesh_terms: D000328:Adult; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine / Q000458:organization & administration*; D008875:Middle Aged; D015999:Multivariate Analysis; D009523:Newfoundland and Labrador; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D010820:Physicians / Q000600:supply & distribution*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies