Objective: To identify the determinants of practice location and of outreach consultation of recently graduated psychiatrists.
Methods: We surveyed 153 psychiatrists who graduated from the University of Toronto Department of Psychiatry between January 1990 and June 2002 (response rate 51%), on the basis of a self-administered mail questionnaire. The survey assessed factors that influenced practice location and outreach consultation, such as demographics, links to practice communities, and outreach experiences, including rural or northern electives as a resident.
Results: Professional variables were rated as the most important factors in choosing a practice location. Variables such as age or sex were not significantly associated with location. Nine percent reported working in communities of less than 100 000, and only 1% practised in Northern Ontario. Eighteen percent practised in the same location where they were born or raised. Forty-four percent had rural or northern experience as a resident but almost exclusively in the form of short, fly-in consultation electives. Twenty-four percent indicated that they provide outreach consultation. Psychiatry residents who participated in outreach electives were 10 times as likely as those who did not participate to continue outreach as a consultant.
Conclusion: Although early exposure to rural or northern medicine leads to significantly greater continued involvement in outreach activities after graduation, our findings suggest the need for more long-term, on-site residency training opportunities in rural and remote areas.
(Can J Psychiatry 2006;51:218-225)
Information on funding and support and author affiliations appears at the end of the article.
* The study results show that there is almost no movement of psychiatrists out of the large urban centres.
* The study illustrates the essential link between outreach service and early exposure to rural mental health.
* The study suggests the need to decentralize training to allow residents from underserviced areas to train in their home communities.
* The sample population is limited to only one institution.
* Owing to the small sample size, we cannot assume the same results across all institutions.
* There could potentially be a difference in responses between those who filled in the self-report survey and those who did not.
Key Words: psychiatrist, career choice, rural or remote, recruitment, professional practice locations, medically underserved areas, community outreach
The Romanow report noted that, although Canada has one of the world's best health care systems, there is a huge disparity of services between those living in urban areas and those residing in smaller or more remote areas of the country. Moreover, the report argued that geography has become a determinant of the level of health care, because these communities struggle to attract and retain health care professionals (1). Further, Strasser noted that, internationally, access to care is the number one rural health issue (2). Proposed solutions encompass a wide range of tactics, from recruitment campaigns, financial incentives, and early rural exposure to changes in both academic and social policies (3-9).
In 1996, Ontario called for greater attention to rural and northern training exposure during medical school and residency (10). The creation of the MOHLTC UAP also led to a source of support for northern and rural clinical service and education, particularly outreach consultation from larger centres to underserved areas. Finally, in the 198Os and 199Os, several university- and community-based organizations were created to support and encourage northern and rural education. This included the ECP at the University of Western Ontario, the Northern Ontario Francophone Psychiatric Program at the University of Ottawa, NOMP, NOMEC, and the Rural Ontario Medical Program. …