1. Do Northern Ontario School of Medicine medical graduates practice close to home?
John C. Hogenbirk, Patrick Timony, Elizabeth Wenghofer & Joshua Osika
Centre for Rural and Northern Health Research
CAHSPR May 10-12, Toronto, ON

2. Acknowledgements and Disclosure
We thank the Ontario Ministry of Health and Long- Term Care for their support of the NOSM Tracking Study through a grant administered by the Northern Ontario School of Medicine. We thank the medical learners who have participated in our research and we thank members of the NOSM TS Advisory Committee for their advice and support of our study.
The views expressed in this presentation are those of the authors and do not necessarily reflect that of the MOHLTC nor the NOSM.
John works part-time as a Research Tutor in the NOSM PG Family Medicine Program. 2

3. .[1-4]
Context
Proportionally fewer physicians practise in rural and remote (medically underserved) areas
In Northern Ontario, 29% of family physicians’ practices are in rural areas compared with 39% of the population [1-4] 3

4. .[1-4]
Context
Positive association / predictive of rural practice location [5-9]
Rural background
Medical education in Rural areas
Weak association / sparse evidence
Growing up in the region
Ethnicity / cultural / linguistic background 4

5. Context
Northern Ontario School of Medicine has a social accountability mandate [10] to address medical underservice:
in N. Ontario
among cultural / linguistic minorities
Indigenous people: 14% in N. Ont. v 2% in province
Francophone people: 18% in N. Ont. v 5% in province 5

6. Research Programme
To assess the influence of NOSM medical education on practice location and practice characteristics.
Previous work examined…
Family Physicians practice location
Rural/Urban
Northern Ontario/Other Regions
Socio-demographic and educational factors associated with practice location category
Age, sex, etc.
Results have been published in Canadian Family Physician 2016 [11] 6

7. Research Questions
Other attributes may be associated with / predictive of practice location:
proximity to family, culture / linguistic ties, sense of obligation.
Specific Research Questions addressed in this presentation:
How far is it from the Family Physicians’ practice location to their hometown?
Does it differ for Indigenous and / or Francophone FPs?
Does it differ by FP medical education training, background, gender?
How far is it from practice location to the closest community with a sizeable (a) Francophone or (b) Indigenous population?
Compare distribution of distances. 7

8. Participant Flow & Data Sources
Other UG
Other PG
NOSM UG
NOSM PG
In practice
Entry Mid Exit
Surveys
NOSM Admin. data
Entry Exit
College Admin. Data
e.g., CPSO
Methods described in BMJ Open 2015 [12] 8

9. Sample: 220 FPs in practice for 1-5 years
Includes 176 CMGs (80%) and 44 Canadian-born IMGs
Cultural / Linguistic Attribute
Yes No
Total
[Missing]
Indigenous Status 15
153
168 [52]
French Language Ability 55
108
163 [57]
French-language competency CPSO 28
158
186 [34] 9

10. Distance to Hometown Self-reported survey response,
and/ or NOSM UG administrative data:
Able to speak fluently or
Anticipate being able to practice in French
Hometown: 0-18 years of age, community with most years, only 6.3% lived </=9 years. 55% had lived 19 years.
Kolmogorov-Smirnov p=0.68 10
Road

11. Distance to Hometown
FPs report to the College of Physicians and Surgeons of Ontario that they are able to provide medical services in French.
Kolmogorov-Smirnov p=0.34 11
Road

12. Distance to Hometown Other Attributes K-S P-value Closer to Hometown
UG/PG
<0.01
NOSM UG
+ NOSM PG
Northern / Non-northern
Non-northern
Rural / Urban
Urban
Gender
0.72 - 12

13. Distance to Francophone Community
25% or more of the population indicated French as their only official language.
Kolmogorov-Smirnov p=0.03
Road 13

14. Distance to Francophone Community
CPSO French
25% or more of the population indicated French as their only official language.
Kolmogorov-Smirnov p<0.01
Road 14

15. Distance to Francophone community
Other Attributes
K-S P-value
Closer to Francophone community
UG/PG
<0.01
NOSM UG
+ NOSM PG
Northern / Non-northern
Non-northern
Rural / Urban
0.56 -
Gender
0.20 15

16. Closer to Francophone community Closer to Indigenous community
Summary
FP Attribute
Closer to home
Closer to Francophone community
Closer to Indigenous community
Indigenous status (n=11-15) -
French Ability or
CPSO French
(French Ability)
UG/PG
NOSM UG
+ NOSM PG
Northern / Non-northern
Non-northern
Rural / Urban
Urban
Gender 16

17. Discussion
Many FPs stay in the province where they complete their PG training:
37-97% who completed PG training in 2001 in a Canadian Medical school were still practising in the same province after 2 years.[13]
NOSM medical learners – Practice close to home?
50% of these FPs practice within…
260 km of their hometown
200 km of a Francophone community (≥25% of the population)
31 km of an Indigenous community (≥25% of the population) 17

18. Limitations Sparse data for some groups (e.g., Indigenous FPs)
Additional year of data coming soon
FP practice located near to Francophone (or Indigenous) communities does not necessarily mean that these populations are being served, but speaks to potential access.
Mapping location of FP practice and Indigenous/Francophone communities may identify service area coverage / gaps. 18

19. Next Steps Different definitions of hometown: Further Analyses:
Weight by number of years lived in the community
Use specific time periods: (a) 0-6; (b) 7-12; (c) years
Further Analyses:
UG/PG school combination
Hometown attributes
e.g., Francophone FP could have grown up in a community with no sizeable Francophone population 19

20. Conclusions
Distance to hometown is not associated with cultural / linguistic characteristics of FPs (caveat – few Indigenous FPs)
Distance to Indigenous community is not associated with FP attributes measured in this study. (caveat)
Distance to Francophone community is associated with CPSO French and, to some extent, with French language ability.
FPs who completed both UG and PG at NOSM are practicing closer to home and closer to Francophone communities. 20

21. References Coyte et al. Can Fam Physician 1997;43(4):677-83, 733.
Tepper, et al ICES Atlas report.
Wenghofer et al. Rural Remote Health 2011;11:1591.
Statistics Canada
Brooks et al. Acad Med 2002;77(8):790-8.
Grobler et al. Cochrane Database of Systematic Reviews 2009;(1):CD
Wilson et al. Rural Remote Health 2009; 9:1060.
Verma et al. BMC HSR 2016; 16:126.
Farmer et al. Human Resources for Health 2015; 13:27.
NOSM’s Strategic Plan.
Hogenbirk et al BMJ Open 2015;5:e008246
Hogenbirk et al Canadian Family Physician 62(3):e138-e145
Pong CAPER.
Tepper URL:
Sta Can URL:
NOSM’s strategic plan URL:
BMJ Open
Canadian Family Physician 62(3):e138-e145URL:
Pong URL: 21

22. Thank you For more information, please contact:
John C. Hogenbirk, Senior Research Associate
Centre for Rural and Northern Health Research - Laurentian