Internship at the ends of the earth - a way to recruit physicians?

CONTEXT: The recruitment of sufficient health workers in rural and remote areas has been a constant challenge in many countries for decades. This article describes how medical internship (18 months of mandatory practical training, including 6 months in primary care, after graduation but before granted full license as a doctor) is used in Norway as one method of recruiting young doctors. Finnmark, the most northern and remote county, offers the most challenging medical practice and is also the area most dependent on interns as medical workforce, and later as licensed doctors. ISSUE: Providing adequate professional and social support for the interns during this challenging service is regarded as a prerequisite to retaining them for further service after internship. To accomplish this, a special tutorial program has been implemented since 1997. The scope of this study is to examine whether internship in Finnmark, accompanied by the group tutelage, enhances recruitment and, if so, what are the main predictors for taking their first voluntary job in the north. LESSONS LEARNED: Twice as many interns as were expected from their background chose their first job in the north. Those brought up in the region and the graduates from the (northern) University of Tromsø, were most likely to make this choice. However, graduates from Oslo were also much more likely to choose a job in the north after internship in Finnmark than had been predicted in their last term in medical school. Internship in Finnmark also increased the probability of choosing primary care, which is a political priority in Norway. This indicates that internship in remote areas, given the appropriate professional and social support, contributes to improved recruitment of doctors to underserved areas.