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Physician retention in Norway’s northernmost county : How effective has the tailored internship strategy been ?. Margrete Gaski National Centre of R ural Medicine University of Tromsø – The Arctic University of Norway. Internship in Norway → 1. M arch 2014 .

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Margrete Gaski National Centre of R ural Medicine

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Margrete gaski national centre of r ural medicine

Physicianretention in Norway’s northernmost county: How effective has thetailoredinternshipstrategybeen?

Margrete Gaski

National Centre of Rural Medicine

University of Tromsø – The Arctic University of Norway


Internship in norway 1 m arch 2014

Internship in Norway → 1. March 2014

Medical education in Norway:

6 years

Internshipin Norway

1.5 years of training after completing medical education:

1 year in hospital

+ ½ year in primary health care

Regular internship:

Allocation by raffle

Tailored internship strategy:

Students in 10th term can sign up for internship in Finnmark,

in advance of raffle:

  • Category 1: geographical affiliation to Finnmark

  • Category 2: others

    Intension: to recruit and retain more doctors to Finnmark

    Period of tailored internship strategy:

    1. August 2009 – 1. March 2014


Finnmark county rural and remote area

Finnmark County - Rural and Remote Area

  • Population of 75 000

  • 19 municipalities:

    • 4 major municipalities

    • (≥ 6000)

    • 15 remote municipalities (<6000)

  • 2 hospitals

Comparison area:

Another vulnerable area (Sogn og Fjordane county),

  • Population of 109 000

  • 25 municipalities:

    • 5 major municipalities (≥ 6000)

    • 20 remote municipalities (<6000)

  • 3 hospitals


Margrete gaski national centre of r ural medicine

Finnmark

Comparison area


How effective is the tailored internship strategy

How effective is the tailored internship strategy?

Employment today:

Figure: Share of doctors still working in and outside their “internship county” (N=388)


T ailored i nternship s trategy not very effective for the 15 remote municipalities

Tailored Internship Strategy:Not very effective for the 15 remote municipalities

Doctors completing tailored internship

► 75 % chose the 4 major municipalities

Internship in primary health care 1. August 2009-1. March 2014:

  • Tailored internship: All 10 of the remaining GPs work in the 4 major municipalities

  • Regular internship in Finnmark: 8 of the 13 remaining GPs, work in major municipalities

  • Comparison area: 3 of the remaining 9 GPs , work in major municipalities.

VS


Significance of geographical affiliation to finnmark among doctors working in finnmark

Significance of geographical affiliation to Finnmark among doctors* working in Finnmark

N=23

N=18

* internship in primary health care 1. August 2009-1. March 2014


Possible explanations

Possible Explanations

The tailored internship strategy is effective

-The rural background effect

Other possible explanations of the results:

  • The labour market

  • Different education models

  • The Hawthorne effect (the observer effect)

  • Other recruit and retain-measures:

    • The Action Zone for Finnmark and Northern Troms

    • Doctor recruitment project in hospitals in Finnmark (2005 -)


Internships in the future

Internships in the Future

What about the significance of local affiliation as a qualification?


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