title: Strengthening the rural dietetics workforce: examining early effects of the Northern Ontario Dietetic Internship Program on recruitment and retention.
abstract: As with other allied health professions, recruitment and retention of dietitians to positions in rural and isolated positions is challenging. The aim of this study was to examine the early effects of the Northern Ontario Dietetic Internship Program (NODIP) on recruitment and retention of dietitians to rural and northern dietetics practice. The program is unique in being the only postgraduate dietetics internship program in Canada that actively selects candidates who have a desire to live and work in northern and rural areas. Objectives of the survey were to track the early career experiences of the first five cohorts (2008-2012) of NODIP graduates, with an emphasis on employment in underserviced rural and northern areas of Ontario.
  
  
  
  NODIP graduates (62) were invited to complete a 27-item, self-administered, mailed questionnaire approximately 22 months after graduation. The survey, reflecting issues identified in the rural allied health and dietetics literature, documented their work history, practice locations, employment settings, roles, future career intentions and rural background. Aggregated data were analyzed descriptively to assess their early work experiences, with a focus on their acceptance of positions in rural and northern communities. Items also assessed professional and personal factors influencing their most recent decisions concerning practice locations.
  
  
  
  Three-quarters of graduates chose organizations serving rural or northern communities for their first employment positions and two-thirds were practicing in rural and underserviced areas when surveyed. Most worked as clinical, community health or public health dietitians, in diverse settings including clinics, hospitals and diabetes care programs. Although most had found permanent positions, working for more than one employer at a time was not uncommon. Factors affecting practice choices included prior awareness of employers, prospects for full-time employment, flexible working conditions, access to interprofessional practice and continuing education, as well as community and family concerns. Intentions to remain in current positions were also shaped by a mixture of professional and personal considerations. Some would relocate in search of opportunities for specialization; a few would leave due to dissatisfaction with employment conditions and disinterest in work; others would move due to personal and family commitments.
  
  
  
  This study provides early evidence that the NODIP distributed and community-engaged learning model has been very successful in its goal of augmenting the rural and northern dietetics workforce, with a majority of graduates accepting and remaining in rural positions during their first 2 years of practice. Whether graduates remain in rural practice, however, depends on a number of other factors, including career aspirations, availability of professional supports and personal commitments. This suggests that additional supports, above and beyond the NODIP internship, may be needed to encourage graduate dietitians to stay in rural and northern practice locations over the longer term.
authors.affiliation: Centre for Rural & Northern Health Research, Lakehead University, Thunder Bay, Ontario, Canada. mehill1@lakeheadu.ca.
authors.forename: Mary Ellen
authors.initials: ME
authors.lastname: Hill
authors.affiliation: Northern Ontario School of Medicine, Sudbury, Ontario, Canada. draftis@nosm.ca.
authors.forename: Denise
authors.initials: D
authors.lastname: Raftis
authors.affiliation: Centre for Rural and Northern Health Research, Lakehead University, Thunder Bay, Ontario, Canada. pwakewic@lakeheadu.ca.
authors.forename: Pamela
authors.initials: P
authors.lastname: Wakewich
mesh_terms: D000488:Allied Health Personnel / Q000706:statistics & numerical data*; D004046:Dietetics / Q000193:education*; D005260:Female; D006293:Health Promotion / Q000458:organization & administration; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D009864:Ontario; D011361:Professional Competence; D011365:Professional Practice Location / Q000706:statistics & numerical data*; D019035:Rural Health Services; D000078329:Workforce
keywords: Allied Health; Education; North America; Postgraduate; Workforce