Impact of the workforce distribution on the viability of the osteopathic profession in Australia: results from a national survey of registered osteopaths.

Background: Workforce distribution has an important influence on the quality of healthcare delivered in a region, primarily because it impacts access to health services in the community and overall health equity in the population. Distribution of osteopaths in Australia does not appear to follow the Australian population with the majority of osteopaths located in Victoria. The implications of this imbalance on the osteopathic workforce have not yet been explored. Methods: A secondary analysis of data from a survey of 1531 members of Osteopathy Australia in 2013. The analysis focused on the practice and occupational characteristics associated with practice locality. Results: The survey was completed by a representative sample of 432 osteopaths. Respondents practicing outside Victoria were more likely to report higher income across all income brackets, and were less likely to report a preference for more patients. Conclusions: The Australian osteopathic profession should examine the issue of imbalanced workforce distribution as a priority. The results of this study are worth considering for all stakeholders as part of a coordinated approach to ensure the ongoing health of the Australian osteopathic workforce.

A Comparison of the J-1 Visa Waiver and Loan Repayment Programs in the Recruitment and Retention of Physicians in Rural Nebraska.

PURPOSE: There is a dearth of literature evaluating the effectiveness of programs aimed at recruiting and retaining physicians in rural Nebraska. Taking advantage of the Nebraska Health Professional Tracking System, this study attempts to comparatively assess the effectiveness of the J-1 visa waiver and state loan repayment programs in the recruitment and retention of physicians in rural Nebraska. METHODS: A mixed methods approach was used. We tracked 240 physicians who enrolled in the J-1 visa waiver and state loan repayment programs between 1996 and 2012 until 2013. In addition, key informant interviews were conducted to obtain perspectives on the recruitment and retention of physicians in rural Nebraska through the 2 programs. FINDINGS: Results from multilevel survival regression analysis indicated that physicians enrolled in the J-1 visa waiver program were more likely to leave rural Nebraska when compared with those enrolled in the state loan repayment program. Participants in the qualitative study, however, cautioned against declaring one program as superior over the other, given that the 2 programs addressed different needs for different communities. In addition, results suggested that fostering the integration of physicians and their families into rural communities might be a way of enhancing retention, regardless of program. CONCLUSION: The findings from this study highlight the complexity of recruitment and retention issues in rural Nebraska and suggest the need for more holistic and family-centered approaches to addressing these issues.

The economic contribution of the Northern Ontario School of Medicine to communities participating in distributed medical education.

INTRODUCTION: The economic contribution of medical schools to major urban centres can be substantial, but there is little information on the contribution to the economy of participating communities made by schools that provide education and training away from major cities and academic health science centres. We sought to assess the economic contribution of the Northern Ontario School of Medicine (NOSM) to northern Ontario communities participating in NOSM's distributed medical education programs. METHODS: We developed a local economic model and used actual expenditures from 2007/08 to assess the economic contribution of NOSM to communities in northern Ontario. We also estimated the economic contribution of medical students or residents participating in different programs in communities away from the university campuses. To explore broader economic effects, we conducted semistructured interviews with leaders in education, health care and politics in northern Ontario. RESULTS: The total economic contribution to northern Ontario was $67.1 million based on $36.3 million in spending by NOSM and $1.0 million spent by students. Economic contributions were greatest in the university campus cities of Thunder Bay ($26.7 million) and Sudbury ($30.4 million), and $0.8-$1.2 million accrued to the next 3 largest population centres. Communities might realize an economic contribution of $7300-$103 900 per pair of medical learners per placement. Several of the 59 interviewees remarked that the dollar amount could be small to moderate but had broader economic implications. CONCLUSION: Distributed medical education at the NOSM resulted in a substantial economic contribution to participating communities.

INTRODUCTION: Les écoles de médecine peuvent apporter des avantages économiques importants aux grands centres urbains. On n'en sait guère toutefois sur l'apport économique, pour les communautés participantes, des écoles qui offrent des cours et de la formation hors des grandes villes et loin des centres universitaires des sciences de la santé. Nous avons voulu évaluer la contribution économique de l'École de médecine du Nord de l'Ontario (EMNO) aux communautés qui participent à ses programmes d'apprentissage distribué. MÉTHODES: Nous avons créé un modèle économique local et utilisé les dépenses réelles de 2007/08 pour évaluer l'apport économique de l'EMNO aux communautés du Nord de l'Ontario. Nous avons aussi estimé l'apport économique des étudiants en médecine ou des médecins résidents qui participent aux divers programmes offerts dans les communautés éloignées des campus de l'université. Enfin, pour explorer les répercussions économiques plus vastes, nous avons effectué des entrevues semi-structurées auprès de chefs de file des milieux de l'éducation, des soins de santé et de la politique dans le Nord de l'Ontario. RÉSULTATS: L'apport économique total de l'EMNO s'est chiffré à 67,1 millions de dollars (dépenses de l'École, 36,3 millions; dépenses des étudiants, 1,0 million). L'apport économique a été le plus important pour les villes qui hébergent un campus de l'université, soit Thunder Bay (26,7 millions) et Sudbury (30,4 millions), les 3 centres suivants en importance bénéficiant d'un apport de 0,8 à 1,2 million de dollars. Les communautés peuvent réaliser des bénéfices économiques de 7 300 $ à 103 900 $ par paire d'apprenants en médecine par placement. Plusieurs des 59 personnes interviewées ont souligné que le montant des contributions, en argent, peut être assez petit ou moyen, mais que les répercussions économiques se font sentir à plus grande échelle. CONCLUSION: L'éducation médicale distribuée à l'EMNO a apporté une contribution économique substantielle aux communautés participantes.

What is the financial state of medical students from rural backgrounds during tuition fee deregulation?

INTRODUCTION: We sought to examine the financial state of medical students from rural backgrounds during a time of tuition fee deregulation. METHODS: We surveyed incoming classes from 2007 to 2011 at the University of Calgary. Community background, expected educational debt at graduation, educational debt at entry to medical school and parental income were collected for analysis. Data were analyzed using the Χ² test, analysis of variance and the Newman-Keuls multiple comparison test. RESULTS: The overall response rate was 95.3%. Of the 571 (93.5%) respondents who supplied data on their background and debt, 94.4% expected to have educational debt at graduation. The mean projected educational debt at graduation by medical students from both rural ($107 226 [95% confidence interval (CI) $98 030-$116 423]) and regional ($99 456 [95% CI $91 905-$107 006]) backgrounds was significantly greater than the debt projected by students from metropolitan ($88 565 [95% CI $83 607-$93 524]) backgrounds. Medical students who came from rural backgrounds had the highest mean debt at entry to medical school ($33 053 [95% CI $25 715-$40 391]) compared with their peers from regional ($23 253 [95% CI $16 621-$29 885]) and metropolitan ($22 053 [95% CI $17 344-$26 762]) backgrounds. Students of rural origin also had parents whose mean income ($104 024 [95% CI $75 976-$132 173]) was significantly lower than the mean parental income of their peers who originated from regional ($143 167 [95% CI $119 898-$166 435]) and metropolitan ($150 339 [95% CI $135 241-165 438]) centres. CONCLUSION: Rising tuition and subsequent debt may be affecting the diversity of medical students' backgrounds. Financial programs dedicated to rural-background students and their interest in medicine may become necessary.