Electronic Thesis and Dissertation Repository

Thesis Format



Master of Science


Epidemiology and Biostatistics


Mathews, Maria


Did physician retention bonuses improve retention in Newfoundland and Labrador (NL)?

Data from the Medical Practice Registry from the Newfoundland and Labrador Department of Health and the Canadian Institute for Health Information (CIHI) were analyzed to 1) describe the physicians who work in NL, 2) examine physician length of practice (retention) in a community, and 3) examine community level retention.

1701 physicians who worked in NL between 2000 and 2015 were included in the study. We conducted ARIMA analyses to assess the effectiveness of the retention bonus programs and found no significant impact of the 2003 retention bonus. We found a significant increase in physician retention for specialists in Category 2 communities and a decrease in Category 3 communities following the 2009 retention bonus.

Retention bonuses in NL did not improve physician- or community-level retention. Study findings suggest that resources could be better invested in other supports to increase physician retention.

Summary for Lay Audience

Physician shortages are an ongoing issue in many Canadian provinces. In 2021, 17.1% of Canadians did not have a regular health care provider, and 40% lived in areas where no providers were available, or none were taking new patients. Shortages can lead to the closure of emergency rooms or other services. Physician shortages are an ongoing issue particularly in rural areas. 20% of Canadians live in rural areas, while only 10% of physicians practice in those regions. Retaining physicians in communities not only allows for improved access to healthcare but also limits the costs of repeated recruitment and training. Canadian provinces use financial retention bonuses to encourage physicians to remain in certain locations, but there is very little evidence to demonstrate that they are effective at improving retention.

Retention bonuses were first implemented in NL in 2003 for salaried physicians. This program was expanded in 2009 to include all salaried physicians and fee for service physicians who practice outside of St. John’s. The bonuses are divided into four categories with Category 0 communities receiving the highest bonus and the highest need, and Category 3 communities receiving the lowest bonuses. The objective of this thesis was to evaluate the effectiveness of the retention bonus programs. We used administrative data to describe the physicians who worked in NL, the average work period length in a community (physician retention), and community-level retention between 2000 and 2015.

We found that retention did not improve following the introduction of the retention bonuses. We saw a small improvement, equal to about 6 months, in physician-level retention for specialists in Category 2 communities, and a decrease in retention for specialists in Category 3 communities. We also found that the proportion of international medical graduates (IMGs) working as family physicians in rural areas increased substantially throughout the study period. We found that financial retention bonuses were not effective in improving retention in NL at the physician or community level. NL should re-evaluate the program and consider reinvesting resources in programs to address other factors impacting retention.

Available for download on Wednesday, January 01, 2025