Trainees who entered into special RFS agreements were 0.09 times more likely (11.1 times less likely) to meet their duty to serve than physicians who had received a scholarship (Table 3).3). Other types of fellows were just as likely as family medicine fellows to complete their service commitment. Employees who do not comply with the return obligation are required to repay the unpaid financial assistance. The deputy director may waive the obligation to return if circumstances beyond the control of the employee make it impossible to perform the obligation. More than 80% of RFS physicians in Newfoundland and Labrador fulfill their RFS contract (either through work or reimbursement). The vast majority of RFS physicians who do so (96 out of 108, 89.0%) complete their service commitment in its entirety. These results support our hypothesis that the majority of RFS physicians fulfill their duty to serve (rather than purchase their obligation or default). The FSR implementation rate of 80.6% is lower than the rates reported by RFS program managers in Nova Scotia (89%) and Quebec (90% to 95%), but these programs have not been formally evaluated at the time of this study (Neufeld and Mathews, 2012). The service completion rate of 89% in Newfoundland and Labrador is higher than the 50% to 60% found in the 1980s Reviews of the Disadvantaged Areas Program – Rural Ontario (Copeman, 1979, 1987). A meta-analysis found that 71% of RFS participants were fully meeting their service obligations or were in the process of fulfilling their obligations (Bärnighausen and Bloom, 2009). If we calculated completion rates using the methods used in these studies (including the 53 RFS doctors who are in the process of fulfilling their assignment), the completion rate for NL is 86.1% (161 out of 187 RFS doctors). Despite the widespread use of physician return-to-work programs (FRS) in Canada, few have been evaluated.
We examined two types of SRF agreements (Family Medicine Fellowship and Specially Funded Residency Position) and (a) describe the proportion of SRF physicians who meet their service commitment and identify predictors of completion, and (b) compare the retention of SRF physicians with those of physicians who are not SRFs. Return to Employment Programs (FRS) are a commonly used strategy to encourage physicians to practice in rural or underserved communities, with the long-term goal of improving physician retention in these communities (Bärnighausen and Bloom, 2009). RFS agreements require physicians to work in underfunded communities in exchange for financial assistance that can be provided in the form of scholarships (for tuition and other tuition fees), student loan waivers, funded training spaces, or unrestricted funds (Mason, 1971; Pathman et al., 2000; Sempowski, 2004). RFS programs can address physicians at various stages of their undergraduate or postgraduate studies (or both) and typically require a one-year service commitment for each year of financial assistance. RFS agreements typically have a “buy-back option” where participants can repay funding (with penalties or minimum interest) if they are unwilly or unable to work in an underfunded community. Performance obligations are generally expected to be met after completion of postgraduate studies. Potential covariates included gender, medical school, year of graduation from medical school, type of RFS funding, number of years of scholarship received, specialty, and community in which physicians began to practice. The nature of the RFS agreement reflected whether physicians had specially funded scholarships or RFS agreements. In the first case, the type of scholarship was also identified (p.B family medicine, psychiatry, other specialist or travel). Two doctors had received a combination of scholarships (other specialist and travel grants). They were coded as “other specialist” scholarships. The number of years of scholarships was divided into two groups (1 to 3 years and 4 years or more).