Determinants of first practice location: among Manitoba medical graduates.

Objective: To help understand physician movement out of Manitoba by determining the factors that influence Manitoba medical graduates' choices about practice locations.

Design: Cross-sectional, within-stage, mixed-model survey.

Setting: Manitoba.

Participants: All University of Manitoba medical graduates from classes 1998 to 2009 for whom we had valid contact information (N = 912 of 943 graduates) were invited in August 2009 to participate in a survey.

Main Outcome Measures: Demographic information; ratings, on a 5-point scale, of the importance when choosing first practice locations of 12 practice characteristics, 3 recruitment strategies, and 4 location characteristics listed in the survey; free-text narratives on unlisted factors; and estimates of likely practice location upon completion of training for recent graduates still in residency training.

Results: Completed surveys were received from 331 (35.1%) graduates of the surveyed classes, 162 (53.3%) of whom chose Manitoba for their first practice location. Multiple regression analyses indicated that graduates choosing Manitoba for their first practice location were significantly more likely to have done their residency training in Manitoba (P < .05), whether or not they gave a high rating to the importance of being near family and friends. Also, graduates choosing Manitoba were significantly more likely to be recent graduates (P = .007) and less likely to be members of a visible minority (P = .018). These associations were robust even when analyses were restricted to responses from practitioners without cause to estimate practice locations. Early self-selection of graduates during entry into specific residency programs, results of the residency match process, and "putting down roots" during residency years were 3 important interrelated themes identified through qualitative analyses.

Conclusion: Residency education in Manitoba is the overwhelming factor influencing graduates' choice of Manitoba as their first practice location, regardless of graduates' rating of the importance of being near family or friends. Graduates' narratives provided insights into the complexities of choosing practice locations and enhanced the interpretive and theoretical validity of the study findings. More extensive studies involving all Canadian residents could further define the role residency location plays in physician practice location.