First practice: family physicians initially locating in rural areas

Introduction: This paper quantifies the proportion of family physicians in rural practice and, in particular, initial rural practice. It examines differences between graduates of Canadian and international medical schools. Methods: The Canadian Medical Association postal code master file was used to determine the distribution in rural practice of Canadian and international medical school graduates for every other year from 2000 to 2011. The master file maps practice postal codes into a census metropolitan area or census agglomeration; physicians practising outside these areas are considered rural. Initial practices were estimated based on year of undergraduate medical degree. Results: Two-thirds of family physicians practising rural medicine in 2011 were graduates of Canadian medical schools. However, between 2000 and 2011, a greater proportion of international medical graduates were practising in rural areas than graduates of Canadian medical schools. International graduates were more likely to initially locate in a rural area, but the drop-off rate was greater among them than with graduates of Canadian medical schools. The proportion of international medical graduates setting up rural practices was decreased among more recent graduation cohorts. The proportion of Canadian medical school graduates initially practising in rural areas was steady. Conclusion: The results of this study suggest that graduates of international and Canadian medical schools treat rural practice differently. International graduates may decide on a rural location as a means to set up practice in Canada or fulfill a return-ofservice obligation, whereas graduates of Canadian medical schools may make a conscious choice to practise in rural locations. Decreasing proportions of international medical graduates in rural practice may be a result of increased opportunities for Canadian postgraduate training and full licensure.