IDEAS home Printed from https://ideas.repec.org/p/cir/cirpro/2026rp-21.html

Effet des mesures incitatives et coercitives sur la rétention régionale des médecins de famille

Author

Listed:
  • Bernard Fortin
  • Josette Gbeto

Abstract

The long-term presence of general practitioners (GPs) in remote areas is key to ensuring access to primary care, continuity of service and the reduction of health inequalities. In a CIRANO study published in 2025, the authors showed that the incentives and coercive measures implemented by the Government of Quebec had succeeded in attracting more GPs to regional areas. But simply attracting them is not enough. Another challenge is to retain them. In this study, the authors analyze the effects of the main incentive-based and coercive measures on the regional retention and relocation of family physicians between 1975 and 2024. Using longitudinal data from the Canadian Institute for Health Information (CIHI), the study traces successive periods of practice among family physicians across three super-regions of Quebec: university or peripheral regions, intermediate regions, and remote or isolated regions. The descriptive analysis primarily highlights substantially lower retention in remote or isolated regions than in other regions. The econometric analysis estimates the effects of the main measures examined—differential remuneration, scholarships tied to a return-of-service obligation, and regional medical staffing plans (PREM)—on the risk of relocation and on physicians’ expected length of stay. The estimates suggest that differential remuneration and PREM have a positive and significant effect on the regional retention of physicians, particularly in remote or isolated regions. In contrast, the results regarding MSSS scholarships suggest that, once their service obligation has been fulfilled, these scholarships do not lead recipient physicians to remain longer in these regions. Overall, this study shows that the evaluation of policies aimed at improving the geographic distribution of physicians must take into account not only their effects on attracting physicians to different regions, but also their effects on retaining them in those regions over the longer term. → Read here the 2025 study on attracting GPs to remote areas La présence durable de médecins de famille en région conditionne l’accès aux soins de première ligne, la continuité des services et la réduction des inégalités de santé. Dans une étude CIRANO publiée en 2025, les auteurs ont montré que les mesures incitatives et coercitives mises en œuvre par le gouvernement du Québec ont permis d’attirer plus de médecins de famille en région. Mais il ne suffit pas de les attirer. Il faut aussi les retenir. Dans cette nouvelle étude, les auteurs analysent l’effet des principales mesures incitatives et coercitives sur la rétention régionale et les relocalisations des médecins de famille entre 1975 et 2024. À partir de données longitudinales de l’Institut canadien d’information sur la santé (ICIS), l’étude retrace les épisodes successifs de pratique des omnipraticiens dans trois super-régions du Québec : les régions universitaires ou périphériques, les régions intermédiaires et les régions éloignées ou isolées. L’analyse descriptive met surtout en évidence une rétention sensiblement plus faible dans les régions éloignées ou isolées que dans les autres régions. L’analyse économétrique permet d’estimer l’effet des principales mesures étudiées — la rémunération différente, les bourses d’études assorties d’une obligation de service et les plans régionaux d’effectifs médicaux (PREM) — sur les risques de relocalisation et sur la durée attendue des séjours des médecins. Les estimations suggèrent que la rémunération différente et les PREM ont un effet positif et significatif sur la rétention régionale des médecins, en particulier dans les régions éloignées ou isolées. En revanche, les résultats relatifs aux bourses du MSSS suggèrent que celles-ci n’ont pas pour conséquence de prolonger la durée de séjour des médecins boursiers dans ces régions, une fois leur obligation de service remplie. Dans l’ensemble, cette étude montre que l’évaluation des politiques de répartition géographique des médecins doit tenir compte non seulement de leurs effets sur l’attraction des médecins dans les différentes régions, mais également de leurs effets sur leur maintien à plus long terme dans ces régions. → Consulter ici l'étude de 2025 sur l'attraction des médecins en région

Suggested Citation

  • Bernard Fortin & Josette Gbeto, 2026. "Effet des mesures incitatives et coercitives sur la rétention régionale des médecins de famille," CIRANO Project Reports 2026rp-21, CIRANO.
    • Handle: RePEc:cir:cirpro:2026rp-21
    as

    Download full text from publisher

    File URL: https://cirano.qc.ca/files/publications/2026RP-21.pdf
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Bernard Fortin & Justin Ndoutoumou & Josette Gbeto & Maude Laberge, 2025. "Impact des mesures incitatives et coercitives sur le lieu de pratique des nouveaux médecins de famille," CIRANO Project Reports 2025rp-02, CIRANO.
    2. Bijwaard, Govert, 2009. "Labour Market Status and Migration Dynamics," IZA Discussion Papers 4530, IZA Network @ LISER.
    3. Bolduc, Denis & Fortin, Bernard & Fournier, Marc-Andre, 1996. "The Effect of Incentive Policies on the Practice Location of Doctors: A Multinomial Probit Analysis," Journal of Labor Economics, University of Chicago Press, vol. 14(4), pages 703-732, October.
    4. Tom Lee & Carol Propper & George Stoye, 2019. "Medical Labour Supply and the Production of Healthcare," Fiscal Studies, John Wiley & Sons, vol. 40(4), pages 621-661, December.
    5. Mincer, Jacob, 1978. "Family Migration Decisions," Journal of Political Economy, University of Chicago Press, vol. 86(5), pages 749-773, October.
    6. Guy Lacroix & Dany Brouillette, 2011. "Assessing the impact of a wage subsidy for single parents on social assistance," Canadian Journal of Economics/Revue canadienne d'économique, John Wiley & Sons, vol. 44(4), pages 1195-1221, November.
    7. John Kennan & James R. Walker, 2011. "The Effect of Expected Income on Individual Migration Decisions," Econometrica, Econometric Society, vol. 79(1), pages 211-251, January.
    8. Liliane Bonnal & Denis Fougère & Anne Sérandon, 1997. "Evaluating the Impact of French Employment Policies on Individual Labour Market Histories," The Review of Economic Studies, Review of Economic Studies Ltd, vol. 64(4), pages 683-713.
    9. Pathman, D.E. & Konrad, T.R. & Dann, R. & Koch, G., 2004. "Retention of primary care physicians in rural health professional shortage areas," American Journal of Public Health, American Public Health Association, vol. 94(10), pages 1723-1729.
    10. Van den Berg, Gerard J., 2001. "Duration models: specification, identification and multiple durations," Handbook of Econometrics, in: J.J. Heckman & E.E. Leamer (ed.), Handbook of Econometrics, edition 1, volume 5, chapter 55, pages 3381-3460, Elsevier.
    11. Bernard Fortin & Marcelin Joanis & Safa Ragued, 2019. "Interruption des études secondaires et postsecondaires au Canada : une analyse dynamique," CIRANO Project Reports 2019rp-11, CIRANO.
    12. Isabel Correia & Paula Veiga, 2022. "Correction to: Geographic distribution of physicians in Portugal," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 23(7), pages 1257-1257, September.
    13. de Wreede, Liesbeth C. & Fiocco, Marta & Putter, Hein, 2011. "mstate: An R Package for the Analysis of Competing Risks and Multi-State Models," Journal of Statistical Software, Foundation for Open Access Statistics, vol. 38(i07).
    14. Govert Ewout Bijwaard, 2014. "Multistate event history analysis with frailty," Demographic Research, Max Planck Institute for Demographic Research, Rostock, Germany, vol. 30(58), pages 1591-1620.
    15. Holmes, George M., 2005. "Increasing physician supply in medically underserved areas," Labour Economics, Elsevier, vol. 12(5), pages 697-725, October.
    16. John Kennan & James R. Walker, 2013. "Modeling individual migration decisions," Chapters, in: Amelie F. Constant & Klaus F. Zimmermann (ed.), International Handbook on the Economics of Migration, chapter 2, pages 39-54, Edward Elgar Publishing.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Bernard Fortin & Justin Ndoutoumou & Josette Gbeto & Maude Laberge, 2025. "Impact des mesures incitatives et coercitives sur le lieu de pratique des nouveaux médecins de famille," CIRANO Project Reports 2025rp-02, CIRANO.
    2. Damien Echevin & Bernard Fortin & Aristide Houndetoungan, 2025. "Healthcare Quality by Specialists Under a Mixed Compensation System: An Empirical Analysis," Health Economics, John Wiley & Sons, Ltd., vol. 34(5), pages 972-991, May.
    3. repec:osf:socarx:hfa8s_v1 is not listed on IDEAS
    4. Francisco Costa & Letícia Nunes & Fabio Miessi Sanches, 2024. "How to Attract Physicians to Underserved Areas? Policy Recommendations from a Structural Model," The Review of Economics and Statistics, MIT Press, vol. 106(1), pages 36-52, January.
    5. Cockx, Bart & Robin, Stéphane R. & Goebel, Christian, 2006. "Income Support Policies for Part-Time Workers: A Stepping-Stone to Regular Jobs? An Application to Young Long-Term Unemployed Women in Belgium," IZA Discussion Papers 2432, IZA Network @ LISER.
    6. Angel Calderon Madrid, 2006. "Revisiting the Employability Effects of Training Programs for the Unemployed in Developing Countries," Research Department Publications 3224, Inter-American Development Bank, Research Department.
    7. Hujer, Reinhard & Zeiss, Christopher, 2007. "The effects of job creation schemes on the unemployment duration in Eastern Germany," Zeitschrift für ArbeitsmarktForschung - Journal for Labour Market Research, Institut für Arbeitsmarkt- und Berufsforschung (IAB), Nürnberg [Institute for Employment Research, Nuremberg, Germany], vol. 40(4), pages 383-398.
    8. Kim, Jun Sung & Lee, Jongkwan, 2019. "The role of intergenerational mobility in internal migration," Economic Modelling, Elsevier, vol. 81(C), pages 1-15.
    9. Cobb-Clark, Deborah A. & Herault, Nicolas & Scutella, Rosanna & Tseng, Yi-Ping, 2016. "A journey home: What drives how long people are homeless?," Journal of Urban Economics, Elsevier, vol. 91(C), pages 57-72.
    10. van Ours, Jan C., 2004. "The locking-in effect of subsidized jobs," Journal of Comparative Economics, Elsevier, vol. 32(1), pages 37-55, March.
    11. Stéphanie Truchet & Nicolas Mauhe & Marie Herve, 2017. "Veterinarian shortage areas: what determines the location of new graduates?," Review of Agricultural, Food and Environmental Studies, Springer, vol. 98(4), pages 255-282, December.
    12. Konstantinos Tatsiramos, 2009. "Unemployment Insurance in Europe: Unemployment Duration and Subsequent Employment Stability," Journal of the European Economic Association, MIT Press, vol. 7(6), pages 1225-1260, December.
    13. Gagliarducci, Stefano, 2005. "The dynamics of repeated temporary jobs," Labour Economics, Elsevier, vol. 12(4), pages 429-448, August.
    14. Jessica Sauve‐Syed, 2026. "The impacts of shortage area designations on mortality," Contemporary Economic Policy, Western Economic Association International, vol. 44(1), pages 90-104, January.
    15. Christine Braun & Charlie Nusbaum & Peter Rupert, 2021. "Labor Market Dynamics and the Migration Behavior of Married Couples," Review of Economic Dynamics, Elsevier for the Society for Economic Dynamics, vol. 42, pages 239-263, October.
    16. NAGORE GARCIA Amparo & VAN SOEST Arthur, 2016. "Unemployment Exits Before and During the Crisis," LISER Working Paper Series 2016-14, Luxembourg Institute of Socio-Economic Research (LISER).
    17. Abi Adams & Oğuz Bayraktar & Thomas H. Jørgensen & Hamish Low & Alessandra Voena, 2025. "Joint Child Custody and Interstate Migration," NBER Working Papers 34571, National Bureau of Economic Research, Inc.
    18. Bijwaard, Govert, 2011. "Unobserved Heterogeneity in Multiple-Spell Multiple-States Duration Models," IZA Discussion Papers 5748, IZA Network @ LISER.
    19. Seema Jayachandran & Lea Nassal & Matthew J. Notowidigdo & Marie Paul & Heather Sarsons & Elin Sundberg, 2024. "Moving to Opportunity, Together," NBER Working Papers 32970, National Bureau of Economic Research, Inc.
    20. Mougeot, Michel & Naegelen, Florence, 2018. "Achieving a fair geographical distribution of health-care resources," Regional Science and Urban Economics, Elsevier, vol. 70(C), pages 384-392.
    21. McVicar, D. & Podivinsky, J.M., 2007. "Does the impact of active labor market programs depend on the state of the labor market? The case of the UK new deal for young people," Discussion Paper Series In Economics And Econometrics 0704, Economics Division, School of Social Sciences, University of Southampton.

    More about this item

    Keywords

    ;
    ;
    ;
    ;
    ;
    ;

    Statistics

    Access and download statistics

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:cir:cirpro:2026rp-21. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Webmaster (email available below). General contact details of provider: https://edirc.repec.org/data/ciranca.html .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.