A systematic review of strategies to recruit and retain primary care doctors

Background There is a workforce crisis in primary care. Previous research has looked at the reasons underlying recruitment and retention problems, but little research has looked at what works to improve recruitment and retention. The aim of this systematic review is to evaluate interventions and strategies used to recruit and retain primary care doctors internationally. Methods A systematic review was undertaken. MEDLINE, EMBASE, CENTRAL and grey literature were searched from inception to January 2015.Articles assessing interventions aimed at recruiting or retaining doctors in high income countries, applicable to primary care doctors were included. No restrictions on language or year of publication. The first author screened all titles and abstracts and a second author screened 20%. Data extraction was carried out by one author and checked by a second. Meta-analysis was not possible due to heterogeneity. Results 51 studies assessing 42 interventions were retrieved. Interventions were categorised into thirteen groups: financial incentives (n=11), recruiting rural students (n=6), international recruitment (n=4), rural or primary care focused undergraduate placements (n=3), rural or underserved postgraduate training (n=3), well-being or peer support initiatives (n=3), marketing (n=2), mixed interventions (n=5), support for professional development or research (n=5), retainer schemes (n=4), re-entry schemes (n=1), specialised recruiters or case managers (n=2) and delayed partnerships (n=2). Studies were of low methodological quality with no RCTs and only 15 studies with a comparison group. Weak evidence supported the use of postgraduate placements in underserved areas, undergraduate rural placements and recruiting students to medical school from rural areas. There was mixed evidence about financial incentives. A marketing campaign was associated with lower recruitment. Conclusions This is the first systematic review of interventions to improve recruitment and retention of primary care doctors. Although the evidence base for recruiting and care doctors is weak and more high quality research is needed, this review found evidence to support undergraduate and postgraduate placements in underserved areas, and selective recruitment of medical students. Other initiatives covered may have potential to improve recruitment and retention of primary care practitioners, but their effectiveness has not been established

Occurrence of the autofluorescent pigment lipofuscin in polar crustaceans and its potential as age marker

The lack of reliable methods for age determination often complicates the determination of individual age which is a fundamental parameter for estimating growth in population dynamics. In crustaceans, the quantification of the autofluorescent age pigment lipofuscin has recently revealed more promising results in boreal and tropical species than traditional methods. The presence of morphological lipofuscin and its possible application as an age marker in polar species was assessed in brain sections of five Arctic and five Antarctic species comprising decapods, amphipods and a euphausiid. Lipofuscin granules were located using confocal fluorescence microscopy and quantified (as % lipofuscin area fraction) from digital images. The pigment was found in 94 of 100 individuals and in all ten species, and granules occurred in easily detectable amounts in five species. Two scavenging amphipod species, the Antarctic Waldeckia obesa and the Arctic Eurythenes gryllus, revealed the most conspicuous and numerous granules. There was a broad, though weak, correlation with individual body size within a species, but not with absolute body size of one species compared to another. In larvae of the decapod Chorismus antarcticus, lipofuscin accumulation was quantified over the first four months after larval release. Factors potentially influencing lipofuscin formation and their relevance for polar species are discussed. Factors explaining the pronounced differences in lipofuscin content between species for the moment remain unknown. The possibility for application of morphological lipofuscin as an index of age is encouraging for those investigated species with a sufficient accumulation rate of the pigment, and further studies will therefore be conducted