1. Physician retention in Norways northernmost county: How effective has the tailored internship strategy been? Margrete Gaski National Centre of Rural Medicine University of Tromsø – The Arctic University of Norway

2. Internship in Norway 1. March 2014 Medical education in Norway: 6 years Internship in Norway 1.5 years of training after completing medical education: 1 year in hospital + ½ year in primary health care Regular internship: Allocation by raffle Tailored internship strategy: Students in 10th term can sign up for internship in Finnmark, in advance of raffle: –Category 1: geographical affiliation to Finnmark –Category 2: others Intension: to recruit and retain more doctors to Finnmark Period of tailored internship strategy: 1. August 2009 – 1. March 2014

3. Finnmark County - Rural and Remote Area Population of 75 000 19 municipalities: o 4 major municipalities o ( 6000) o 15 remote municipalities (<6000) 2 hospitals Comparison area: Another vulnerable area (Sogn og Fjordane county), Population of 109 000 25 municipalities: o 5 major municipalities ( 6000) o 20 remote municipalities (<6000) 3 hospitals

4. Finnmark Comparison area

5. How effective is the tailored internship strategy? Figure: Share of doctors still working in and outside their internship county (N=388) Employment today:

6. Tailored Internship Strategy: Not very effective for the 15 remote municipalities Doctors completing tailored internship 75 % chose the 4 major municipalities Internship in primary health care 1. August 2009-1. March 2014: o Tailored internship: All 10 of the remaining GPs work in the 4 major municipalities o Regular internship in Finnmark: 8 of the 13 remaining GPs, work in major municipalities o Comparison area: 3 of the remaining 9 GPs, work in major municipalities. VS

7. Significance of geographical affiliation to Finnmark among doctors* working in Finnmark * internship in primary health care 1. August 2009-1. March 2014 N=23 N=18

8. Possible Explanations The tailored internship strategy is effective -The rural background effect Other possible explanations of the results: The labour market Different education models The Hawthorne effect (the observer effect) Other recruit and retain- measures: –The Action Zone for Finnmark and Northern Troms –Doctor recruitment project in hospitals in Finnmark (2005 -)

9. Internships in the Future What about the significance of local affiliation as a qualification?