Evaluation of Physician Return-for-Service Agreements in Newfoundland and Labrador
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Bibliographic record
Abstract
INTRODUCTION: Despite the widespread use of physician return-for-service (RFS) programs in Canada, few have been evaluated. We examined two types of RFS agreements (Family Medicine Bursary and Special Funded Residency Position) and (a) describe the proportion of RFS physicians who complete their service obligation and identify the predictors of completion and (b) compare the retention of RFS physicians to that of non-RFS physicians. METHODS: Using administrative data on physicians with RFS agreements in Newfoundland and Labrador (NL), Memorial University's Postgraduate Medical Education Office and the Physician and Medical Practice Database, we calculated the proportion of RFS physicians (1997-2009) who fulfilled their service obligation and also identified predictors of completion. We then followed to 2010 a cohort of physicians who started practice in NL between 2000 and 2005 to compare the retention of RFS and non-RFS physicians. RESULTS: Ninety-six (71.6%) of 134 RFS physicians fulfilled the service obligation in full. Physicians who held Special Funding Residency Position RFS agreements were 11.1 times less likely (95% CI: 4.0-33.3) to complete their service commitment than physicians who held Family Medicine Bursary RFS agreements. In the cohort of 60 RFS and 67 non-RFS physicians, 16.9% of RFS versus 41.8% of non-RFS physicians left NL by 2010 (p=0.004). RFS physicians were 3.22 times less likely (95% CI: 1.41-7.14) than non-RFS physicians to leave the province. Four years after starting practice, roughly 90% of RFS versus 60% of non-RFS physicians remained in NL; after 10 years, 70% of RFS versus 60% of non-RFS physicians remained (p=0.006). CONCLUSION: The RFS program improves the retention of physicians in NL. Using RFS tied to bursaries rather than residency positions may increase service completion and retention rates.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it