Educated for the region? A register-based sequence analysis modelling medical doctors’ career trajectories

Recruiting and retaining medical doctors in rural and primary healthcare remains a global challenge. Norway and its Northern region are no exception. The medical education programme at UiT The Arctic university of Norway, established to educate for Northern Norway, addressed this challenge early, through initiatives like preferential admission for Northern residents and practice-oriented learning in Northern rural areas. However, previous studies on these interventions have been limited to cross-sectional data, offering little insight into long-term trends. This study leverages longitudinal registry data to map the career trajectories of UiT medical graduates. Using sequence analysis, we modelled doctors' career paths over a decade by analysing yearly updates on work states based on location (Northern or Southern Norway), area type (rural or urban), and healthcare sector (primary or specialist). Cluster analysis identified typical career trajectories, while multinomial logistic regression analysis explored how graduates' background characteristics were associated with these trajectories. We identified seven distinct career trajectories combining work location, area type and health sector in various ways. Northern-origin doctors largely remained in the North, and those from rural backgrounds were more likely to work in rural areas over time. However, the majority (53.7%) gravitated towards work in urban specialist services, while only 12.8%, dominated by Northern-origin (90%) and rural (83%) backgrounds, pursued careers in Northern rural primary healthcare. These findings underscore the need for targeted educational interventions that account for geographical origins for addressing healthcare personnel recruitment and retention challenges.