Rural physician supply and retention: factors in the Canadian context

Introduction: Millions of Canadians are without a primary care provider, with rural areas being most affected. The primary objective of this article was to explore the factors surrounding the retention of rural physicians in Canada. Methods: We conducted a critical literature review on rural physician retention. We searched PubMed, Embase, CINAHL and ERIC for relevant articles and completed a narrative synthesis. Results: National challenges in physician supply have taken a disproportionate toll on Canadians living in rural regions and provinces. Nearly 75% of patients lack access to a regular physician in some areas. Current challenges in rural physician supply include prior reduced enrolment at Canadian schools, increased competition for international medical graduates in urban centres, longer postgraduate training times and migration from rural to more urban areas. Several evidence-based strategies exist to improve retention, such as early exposure to rural medicine during training and recruitment incentives. Cohort studies suggest that increasing enrolment for local medical students results in increased provincial physician supply. Conclusion: Nationally there is both a shortage and maldistribution of the physician supply, with rural Canadians being disproportionately affected. Enhanced, forward-thinking retention strategies, including early rural exposure for trainees and training local students, will improve community health and help correct rural disparities for Canadians. Introduction : Des millions de Canadiens n'ont pas de fournisseur de soins primaires, en particulier dans les regions rurales. Le but principal de cet article etait d'examiner les facteurs de maintien en poste des medecins en milieu rural au Canada. Methodes : Nous avons effectue une recension critique de la litterature sur le maintien en poste des medecins en milieu rural. Nous avons interroge les bases de donnees PubMed, Embase, CINAHL et ERIC afin de trouver des articles pertinents, et nous avons fait une synthese narrative. Resultats : Les defis lies a l'offre de medecins au Canada ont eu un effet negatif disproportionne sur les habitants des provinces et regions rurales. Pres de 75% des patients n'ont pas acces a un medecin attitre dans certaines regions. En milieu rural, les defis comprennent la reduction anterieure du taux d'inscription dans les facultes de medecine canadiennes; la concurrence accrue pour les diplomes internationaux en medecine dans les centres urbains; la