We found that many doctors educated at the University of Tromsø worked centrally in the North Norway region. They worked as GPs either in Tromsø and district, or in the specialist health service at the University Hospital of North Norway, whose activities are mainly based in Tromsø. We also found that in 2013, altogether 30 % of the Tromsø doctors worked in rural municipalities. The equivalent percentage for GPs in Norway as a whole was 19 %. We did not find a corresponding rural profile for doctors educated at the University of Tromsø who worked in health trusts (throughout Norway).
A strength of the article is that we possess data on all doctors educated at the University of Tromsø. Compared with all members of the Norwegian Medical Association, we found that the share of doctors educated at the University of Tromsø and employed in health trusts was of equal magnitude (17). In contrast, the share of GPs/district medical officers was larger (30 %) among those educated at the University of Tromsø compared with the country as a whole (27 %) (17). The exclusion of 186 doctors educated at the University of Tromsø who neither worked as GPs nor in a health trust (including private specialists) does not detract from our conclusions.
A weakness of the study is that our categorisation of hospitals was only twofold, and we cannot distinguish between large and small units within the same trust. The data we use as a reference standard contains only aggregated data about doctors educated at other universities, including universities abroad.
The results confirm findings from previous follow-up studies that have revealed that doctors tend to work in the region where they were educated (13), (20–23). Around half of all the doctors educated at the University of Tromsø worked in North Norway at the time of the survey. This applied to a greater degree to doctors who had grown up and attended school in North Norway, with three out of four doctors working in the region (19–22).
Labour market studies of various programmes of health and social studies confirm that both the place where you grow up and the place of study affect where you take a job (23). Over 90 % of those who grew up and studied in the same region later worked in this region. In comparison, between 50 – 60 % of those who had grown up in another region, worked in the region where they had studied (23). Our study confirms and further elucidates this picture by showing solid recruitment in the North Norway region as well as a regional centralisation.
We wondered why we did not observe the same rural profile among the hospital doctors as among the GPs. Even although the rural placement lasts longer than at other Norwegian study institutions, nevertheless the University Hospital of North Norway is the educational institution that medical students have longest and most continuous contact with throughout their programme of study (5, 24). This entails longer exposure and promotes relationship building. With regard to the sustainability of the programme of medical studies and the health service in North Norway, it is vital that the University Hospital of North Norway has strong appeal and is successful in recruitment. However, it may be problematic that the University of Tromsø does not educate more doctors for the local hospitals.
We do not know in which municipality the doctors in our study who graduated in the period 1979 – 2013 grew up. However, we do know that of those who were admitted to medical studies at the University of Tromsø in the years from 2006 – 2015, altogether 39 % had grown up in rural municipalities as against 11 % studying medicine at other Norwegian universities (25). We have no strong reason to believe that this has changed markedly between 1979 – 2013 and 2006 – 2015. It is therefore natural to interpret the results as supporting the hypothesis that growing up in a rural community influences the likelihood of practising as a doctor in such an area after graduation. Studies from other countries support this conclusion (6–11).
All Tromsø doctors had practice placements at local hospitals and GP surgeries throughout one consecutive year of study. This was originally a characteristic feature of medical studies in Tromsø, and it remains the case (5, 26). As a result, Tromsø doctors have overall more exposure to rural communities than doctors educated at other institutions in Norway or abroad. Therefore, it is natural to interpret the results as originating from the University of Tromsø's practice profile. Other studies of exposure to medical practice in rural communities in the course of one's education have shown that the longer the period of practice there, the greater the impact and the greater the interest in practising as a doctor in a rural community in the future (27).
A growing number of programmes of medical studies in Canada are attempting to augment recruitment to rural communities by establishing sub-departments at smaller locations in order to give students practical experience of working in a variety of conditions (2).
The new curriculum for the medical studies programme at the University of Tromsø that is currently being introduced (24) will extend the use of decentralised teaching. The most radical change is that 30 – 40 % of the students throughout their fifth and sixth year of study will have teaching, including clinical training, at hospitals and in the primary health service in Nordland and Finnmark (the Bodø and Finnmark model). Research on why students choose the University of Tromsø, why they choose a decentralised study model and their later career path will help to shed further light on the challenges involved in recruitment to rural communities.