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Seal A, McGrail MR, Bain-Donohue S, Fuller L, Kirke A, Garne D, Luscombe G, Allen P, Wright J, Burrows JM. Association between rural exposure/experience and practice location 10 years postgraduation, stratified by specialty: evidence from a cohort study of graduates from nine Australian universities. BMJ Open 2024; 14:e086850. [PMID: 38889942 PMCID: PMC11191762 DOI: 10.1136/bmjopen-2024-086850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE This study aims to determine the associations between specialty type and practice location at postgraduate year 10 (PGY10), matched with PGY5 and PGY8 work locations, and earlier rural exposure/experience. DESIGN AND SETTING A cohort study of medicine graduates from nine Australian universities. PARTICIPANTS 1220 domestic medicine graduates from the class of 2011. OUTCOME MEASURES Practice location recorded by the Australian Health Practitioner Regulation Agency in PGY10; matched graduate movement between PGYs 5, 8 and 10 as classified by the Modified Monash Model, stratified by specialty type (predominantly grouped as general practitioner (GP) or non-GP). RESULTS At PGY10, two-thirds (820/1220) had achieved fellowship. GPs were 2.8 times more likely to be in non-metropolitan practice (28% vs 12%; 95% CI 2.0 to 4.0, p<0.001) than graduates with non-GP (all other) specialist qualifications. More than 70% (71.4%) of GPs who were in non-metropolitan practice in PGY5 remained there in both PGY8 and PGY10 versus 29.0% of non-GP specialists and 36.4% of non-fellowed graduates (p<0.001). The proportion of fellowed graduates observed in non-metropolitan practice was 14.9% at PGY5, 16.1% at PGY8 and 19.0% at PGY10, with this growth predominantly from non-GP specialists moving into non-metropolitan locations, following completion of metropolitan-based vocational training. CONCLUSIONS There are strong differences in practice location patterns between specialty types, with few non-GP specialists remaining in non-metropolitan practice between PGY5 and PGY10. Our study reinforces the importance of rural training pathways to longer-term work location outcomes and the need to expand specialist vocational training which supports more rural training opportunities for trainees outside general practice.
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Affiliation(s)
- Alexa Seal
- School of Medicine Sydney, Rural Clinical School, The University of Notre Dame Australia, Wagga Wagga, New South Wales, Australia
| | - Matthew R McGrail
- Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia
| | - Suzanne Bain-Donohue
- Rural Clinical School, School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Lara Fuller
- Rural Community Clinical School, Deakin University Faculty of Health Medicine Nursing and Behavioural Sciences, Colac, Victoria, Australia
| | - Andrew Kirke
- Rural Clinical School of Western Australia, The University of Western Australia, Perth, Western Australia, Australia
| | - David Garne
- Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Georgina Luscombe
- The School of Rural Health, Sydney Medical School, The University of Sydney, Orange, New South Wales, Australia
| | - Penny Allen
- Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia
| | - Julian Wright
- Department of Rural Health, Rural Clinical School, The University of Melbourne, Shepparton, Victoria, Australia
| | - Julie M Burrows
- The University of Newcastle, Tamworth, New South Wales, Australia
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O'Sullivan BG, Rodda C. How can we attract more doctors to general practice training? Med J Aust 2024; 220:457-458. [PMID: 38699855 DOI: 10.5694/mja2.52292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/18/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Belinda G O'Sullivan
- Monash University School of Rural Health, Bendigo, VIC
- The University of Queensland Rural Clinical School, Toowoomba, QLD
| | - Christie Rodda
- Royal Australian College of General Practitioners, Beechworth, VIC
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Brundell K, Vasilevski V, Farrell T, Sweet L. Sustainability of rural Victorian maternity services: 'We can work together'. Women Birth 2024; 37:101596. [PMID: 38492507 DOI: 10.1016/j.wombi.2024.101596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/21/2024] [Accepted: 03/04/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Rural maternity service closures and service level reductions are continually increasing across Victoria. There is limited understanding of how rural board members and executives make decisions about their maternity service's operations and sustainability. AIM To examine perspectives of rural Victorian board members and executives on the sustainability of rural maternity services. METHODS This was a qualitative study. Interviews were conducted via Zoom™ with 16 rural Victorian hospital board members and executives. Data were thematically analysed. FINDINGS Severe shortages in the rural maternity workforce, primarily midwives, have contributed to service sustainability decisions. Challenges in offering midwifery workforce incentives cause difficulty in overcoming workforce shortages. A rural maternity workforce strategy harnessing connection with regional services was called for. Innovative models of maternity care were often actioned at the point of service suspension or closure. Participants requested a government policy position and funding for innovative, safe, and sustainable models of care in rural settings. DISCUSSION There is an opportunity for workforce planning to occur between regional and rural services to ensure the development of sustainable maternity models such as midwifery group practice and incentivise the workforce to address current deficits and sustain service provision. CONCLUSION Models of care developed with rural communities, in collaboration with regional services, have the potential to strengthen the delivery of safe, sustainable maternity services. Workforce modelling and centralised government policies aimed at arresting workforce deficits are suggested to provide rural health service leaders with strategic and operational directions to support the delivery of safe, sustainable maternity services.
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Affiliation(s)
- Kath Brundell
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Institute of Health and Wellbeing, Federation University, Victoria, Australia.
| | - Vidanka Vasilevski
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Victoria, Australia
| | - Tanya Farrell
- Centre for Quality and Patient Safety Research, Western Health Partnership, Victoria, Australia; School of Nursing and Midwifery, Latrobe University, Victoria, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Victoria, Australia
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McGrail M, Woolley T, Pinidiyapathirage J, Paton K, Smith D, Brumpton K, Teague PA. Exploring recent trends (2014-21) in preferencing and accepting Queensland medical internships in rural hospitals. BMC Health Serv Res 2024; 24:236. [PMID: 38395849 PMCID: PMC10885368 DOI: 10.1186/s12913-024-10683-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Medical internship is a key transition point in medical training from student to independent (junior) doctor. The national Regional Training Hubs (RTH) policy began across Australia in late 2017, which aims to build medical training pathways for junior doctors within a rural region and guide students, interns and trainees towards these. This study aims to explore preferencing and acceptance trends for rural medical internship positions in Queensland. Moreover, it focuses on internship preference and acceptance outcomes prior to and following the establishment of RTHs, and their association with key covariates such as rural training immersions offered by medical schools. METHODS Data from all applicants to Queensland Health intern positions between 2014-2021 were available, notably their preference order and location of accepted internship position, classified as rural or metropolitan. Matched data from Queensland's medical schools were added for rural training time and other key demographics. Analyses explored the statistical associations between these factors and preferencing or accepting rural internships, comparing pre-RTH and post-RTH cohorts. RESULTS Domestic Queensland-trained graduates first preferencing rural intern positions increased significantly (pre-RTH 21.1% vs post-RTH 24.0%, p = 0.017), reinforced by a non-significant increase in rural acceptances (27.3% vs 29.7%, p = 0.070). Rural interns were more likely to have previously spent ≥ 11-weeks training in rural locations within medical school, be rurally based in the year applying for internship, or enrolled in the rural generalist pathway. CONCLUSIONS The introduction of the RTH was associated with a moderate increase of graduates both preferencing and accepting a rural internship, though a richer understanding of the dominant reasons for and against this remain less clear. An expansion of graduates who undertook longer periods of undergraduate rural training in the same period did not diminish the proportion choosing a rural internship, suggesting there remains an appetite for these opportunities. Overall, domestic graduates are identified as a reliable source of intern recruitment and retention to rural hospitals across Queensland, with entry to the rural generalist pathway and extended rural placement experiences enhancing uptake of rural practice.
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Affiliation(s)
- Matthew McGrail
- The University of Queensland, Rural Clinical School, Rockhampton, QLD, 4700, Australia.
| | - Torres Woolley
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
| | - Janani Pinidiyapathirage
- Griffith University, School of Medicine and Dentistry, Southport, QLD, 4222, Australia
- Rural Medical Education Australia, Toowoomba, QLD, 4350, Australia
| | - Kath Paton
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
| | - Deborah Smith
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
| | - Kay Brumpton
- Griffith University, School of Medicine and Dentistry, Southport, QLD, 4222, Australia
- Rural Medical Education Australia, Toowoomba, QLD, 4350, Australia
| | - Peta-Ann Teague
- James Cook University, College of Medicine & Dentistry, Townsville, QLD, 4811, Australia
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Kimura K, Inoue K, Ando T, Ito M. Gender difference of geographic distribution of physicians in Japan: three-point analysis of 1994, 2004 and 2014. BMC Health Serv Res 2023; 23:1404. [PMID: 38093353 PMCID: PMC10720184 DOI: 10.1186/s12913-023-10258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 10/31/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Japan's medical education system produces 9,000 graduates annually. Despite the government's implementation of several strategies, including increasing the number of doctors trained, the country still struggles with a shortage of physicians in rural areas. This study examined this issue, focusing on gender and considering years of physician experience, demographic and geographic factors. METHODS We analyzed the Physician Census from 1994, 2004, and 2014, examining data on physicians' gender and the number of years since licensure. To correct the impact of municipal mergers, the analysis was aligned with the number of municipalities in 2014 (1741). We examined data from each physician (gender and years of medical experience) and analyzed the demographic and geographic distribution trend using Spearman correlation coefficients. We then used the Gini coefficient to evaluate the distribution change of physicians based on gender and years of experience. RESULTS The number of physicians increased 1.29-fold over the 20-year observation period (1.23-fold for male physicians and 2.17-fold for female physicians), and the percentage of female physicians increased from 13.4% to 20.4%. We found that 87.7% of physicians were concentrated in the top 1/3 municipalities in terms of population. The number of female physicians was higher at 91.8% compared to 86.8% for male physicians. The Gini coefficients were lower for veteran physicians of both sexes than for younger physicians. The Gini coefficient for all physicians was 0.315-0.298-0.298 (male physicians: 0.311-0.289-0.283, female physicians: 0.394-0.385-0.395) The Gini coefficients for female compared to male physicians were higher in all age groups, showing that The distribution of female physicians is skewed toward urban areas. CONCLUSION Female physicians are less distributed in rural areas than male physicians. In addition, despite the fact that the number of female physicians has increased more than male physicians over the past 20 years, the geographic ubiquity of female physicians has not improved. Since the trend of increasing the number of female physicians is expected to continue in the future, it is necessary to take some measures, such as providing a work-life balance suitable for female physicians.
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Affiliation(s)
- Kazuki Kimura
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima City, Japan, 1-2-3 Kasumi, Minami-ku, Hiroshima Prefecture.
| | - Kazuo Inoue
- Department of Community Medicine, Chiba Medical Center, Teikyo University School of Medicine, Chiba, Japan
| | - Takahito Ando
- Laboratory of Pharmaceutical Care and Community Medicine, Faculty of Pharma-Sciences, Teikyo University, Tokyo, Japan
| | - Masanori Ito
- Department of General Internal Medicine, Hiroshima University Hospital, Hiroshima City, Japan, 1-2-3 Kasumi, Minami-ku, Hiroshima Prefecture
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Ngoo A, Kwok M, Ong M, Perera M, Desai D, Wolanski P. A Prospective, Randomized Controlled Multicenter Trial Comparing the Bard Inlay Optima and the Cook Universa Soft Stent. Urology 2023; 181:38-44. [PMID: 37572885 DOI: 10.1016/j.urology.2023.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/14/2023]
Abstract
OBJECTIVE To determine if the Bard Inlay Optima with its anti-inflammatory pHreecoat stent coating had reduced stent-related symptoms at Week 1 (W1) and Week 3 (W3) post insertion compared to the Cook Universa Soft (CUS) using the validated Ureteral Stent Symptoms Questionnaire (USSQ). METHODS A prospective, double-blinded, randomized controlled trial was performed on patients receiving unilateral retrograde double-J stents for urolithiasis or pelviureteric junction obstruction at three public Urology services. One hundred forty patients that met inclusion criteria were randomized in a 1:1 ratio to each stent. Primary endpoints were the mean USSQ index scores for the urinary, pain, general, and sexual health domains at W1 and W3. Secondary endpoints were responses to individual USSQ questions, early stent removal, and postoperative opioid use. RESULTS No significant difference was found between the two stents in terms of index scores for all USSQ domains, early stent removal or postoperative opioid use. The CUS had worse symptom scores at W1 relating to self-reported urinary tract infection symptoms (3.1 ± 1.3 vs 2.6 ± 1.3, P = .05). The CUS was also associated with higher rate of representation to hospital at W1 (n = 10, 16% vs n = 1, 2%, P < .001) and W3 (n = 15, 25% vs n = 3, 5%, P < .001). This did not remain significant when adjusted to site of recruitment (W1 P = .27; W3 P = .22). CONCLUSION The Bard Inlay Optima's anti-inflammatory pHreecoat stent coating did not translate to any significant difference in overall postoperative symptoms across urinary, pain, general, and sexual health domains.
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Affiliation(s)
- Alexander Ngoo
- Department of Urology, Townsville University Hospital, Townsville, Queensland, Australia.
| | - Michael Kwok
- Department of Urology, Redcliffe Hospital, Brisbane, Queensland, Australia
| | - Michelle Ong
- Department of Urology, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Marlon Perera
- Department of Urology, Townsville University Hospital, Townsville, Queensland, Australia
| | - Devang Desai
- Department of Urology, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Phillipze Wolanski
- Department of Urology, Townsville University Hospital, Townsville, Queensland, Australia
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Elliott J, Luk M, Varshney K, Williams K, Wright J. Assessing medical student satisfaction with rural placement: The Australian Rural Clinical School Support Survey. Aust J Rural Health 2023; 31:957-966. [PMID: 37551553 DOI: 10.1111/ajr.13028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/18/2023] [Accepted: 07/26/2023] [Indexed: 08/09/2023] Open
Abstract
INTRODUCTION Australia has a doctor shortage in rural settings, and rural placements for medical students have an important role in increasing the likelihood of students staying in rural settings throughout their careers. However, to date there is limited research regarding medical student perceptions of rural placement quality. OBJECTIVE We aimed to determine factors that impact the overall medical student experience during rural placements. DESIGN Cross-sectional survey. SETTING Rural/remote clinical schools across Australia. PARTICIPANTS Medical students on rural/remote clinical placements for at least 6 months. MAIN OUTCOME MEASURES To assess factors impacting student experience on rural placements, we conducted a cross-sectional survey, known as the Australian Rural Clinical School Support Survey (ARCSSS) which was completed online by medical students across Australia. Demographic data were collected in addition to responses regarding academic teaching, extracurricular activities, and support services. Multiple choice and Likert scale questions were utilised. RESULTS A total of 107 responses to our survey were analysed. The majority of participants were female (66.4%), and in their middle years of clinical education (55.1%). Overall, respondents showed high levels of satisfaction with clinical school supervisors, and clinical education. A high proportion of respondents indicated minimal accessibility of health and other support services. While a large proportion of participants indicated satisfaction with the rural placements, it was demonstrated that students were generally dissatisfied with school wellness activities and extracurricular activities. Financial insecurity was noted. CONCLUSION The findings from our survey indicate there are numerous areas in which rural placements have been effective for medical students, and others in which improvement is needed. Furthermore, more research is required to better develop well-being initiatives that are effective in improving overall experience.
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Affiliation(s)
- Jasmine Elliott
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michelle Luk
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia
| | - Karan Varshney
- School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Kyle Williams
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Julian Wright
- Department of Rural Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Shepparton, Victoria, Australia
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McGrail MR, Doyle Z, Fuller L, Gupta TS, Shires L, Walters L. The pathway to more rural doctors: the role of universities. Med J Aust 2023; 219 Suppl 3:S8-S13. [PMID: 37544002 DOI: 10.5694/mja2.52021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 08/08/2023]
Affiliation(s)
| | - Zelda Doyle
- Lithgow Clinical School, University of Notre Dame Australia, Lithgow, NSW
| | - Lara Fuller
- School of Medicine, Deakin University, Geelong, VIC
| | - Tarun Sen Gupta
- College of Medicine and Dentistry, James Cook University, Townsville, QLD
| | - Lizzi Shires
- Rural Clinical School, University of Tasmania, Burnie, TAS
| | - Lucie Walters
- Adelaide Rural Clinical School, University of Adelaide, Mount Gambier, SA
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McGrail MR, Gurney T, Fox J, Martin P, Eley D, Nasir B, Kondalsamy-Chennakesavan S. Rural medical workforce pathways: exploring the importance of postgraduation rural training time. HUMAN RESOURCES FOR HEALTH 2023; 21:31. [PMID: 37081430 PMCID: PMC10120195 DOI: 10.1186/s12960-023-00819-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/12/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Inadequate distribution of the medical workforce in rural regions remains a key global challenge. Evidence of the importance of postgraduation (after medical school) rural immersion time and subsequent rural practice, particularly after accounting for other key factors, remains limited. This study investigated the combined impact of three key training pathway factors: (1) rural background, (2) medical school rural immersion, and (3) postgraduation rural immersion, and duration time of each immersion factor on working rurally. METHODS Data from a cross-sectional national survey and a single university survey of Australian doctors who graduated between 2000 to 2018, were utilised. Key pathway factors were similarly measured. Postgraduation rural training time was both broad (first 10 years after medical school, national study) and specific (prevocational period, single university). This was firstly tested as the dependent variable (stage 1), then matched against rural practice (stage 2) amongst consultant doctors (national study, n = 1651) or vocational training doctors with consultants (single university, n = 478). RESULTS Stage 1 modelling found rural background, > 1 year medical school rural training, being rural bonded, male and later choosing general practice were associated with spending a higher proportion (> 40%) of their postgraduation training time in a rural location. Stage 2 modelling revealed the dominant impact of postgraduation rural time on subsequent rural work for both General Practitioners (GPs) (OR 45, 95% CI 24 to 84) and other specialists (OR 11, 95% CI 5-22) based on the national dataset. Similar trends for both GPs (OR 3.8, 95% CI 1.6-9.1) and other specialists (OR 2.8, 95% CI 1.3-6.4) were observed based on prevocational time only (single university). CONCLUSIONS This study provides new evidence of the importance of postgraduation rural training time on subsequent rural practice, after accounting for key factors across the entire training pathway. It highlights that developing rural doctors aligns with two distinct career periods; stage 1-up to completing medical school; stage 2-after medical school. This evidence supports the need for strengthened rural training pathways after medical school, given its strong association with longer-term decisions to work rurally.
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Affiliation(s)
- Matthew R. McGrail
- Rural Clinical School, The University of Queensland, Rockhampton, QLD 4700 Australia
| | - Tiana Gurney
- Rural Clinical School, The University of Queensland, Toowoomba, QLD 4350 Australia
| | - Jordan Fox
- Rural Clinical School, The University of Queensland, Rockhampton, QLD 4700 Australia
| | - Priya Martin
- Rural Clinical School, The University of Queensland, Toowoomba, QLD 4350 Australia
| | - Diann Eley
- Academy for Medical Education, The University of Queensland, Herston, QLD 4006 Australia
| | - Bushra Nasir
- Rural Clinical School, The University of Queensland, Toowoomba, QLD 4350 Australia
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Davison R, Hobbs M, Quirk F, Guppy M. General practitioners' perspectives on the management of refugee health: a qualitative study. BMJ Open 2023; 13:e068986. [PMID: 36963788 PMCID: PMC10039989 DOI: 10.1136/bmjopen-2022-068986] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023] Open
Abstract
OBJECTIVE To explore general practitioners' (GPs) perceptions of the challenges and facilitators to managing refugee healthcare needs in regional Australia. SETTING A regional community in Australia involved in the resettlement of refugees. PARTICIPANTS Nine GPs from five practices in the region. DESIGN A qualitative study based on semistructured interviews conducted between September and November 2020. RESULTS The main challenges identified surrounded language and communication difficulties, cultural differences and health literacy and regional workforce shortages. The main facilitators were clinical and community supports, including refugee health nurses and trauma counselling services. Personal benefits experienced by GPs such as positive relationships, satisfaction and broadening scope of practice further facilitated ongoing healthcare provision. CONCLUSIONS Overall, GPs were generally positive about providing care to refugees. However, significant challenges were expressed, particularly surrounding language, culture and resources. These barriers were compounded by the regional location. This highlights the need for preplanning and consultation with healthcare providers in the community both prior to and during the settlement of refugees as well as ongoing support proportional to the increase in settlement numbers.
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Affiliation(s)
- Rachel Davison
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
| | - Megan Hobbs
- New England Institute of Healthcare and Research, University of New England, Armidale, New South Wales, Australia
| | - Frances Quirk
- New England Institute of Healthcare and Research, University of New England, Armidale, New South Wales, Australia
- Fife, University of St Andrews School of Medicine, St Andrews, Fife, UK
| | - Michelle Guppy
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia
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McGrail MR, Nasir BF, Chater AB, Sangelaji B, Kondalsamy-Chennakesavan S. The value of extended short-term medical training placements in smaller rural and remote locations on future work location: a cohort study. BMJ Open 2023; 13:e068704. [PMID: 36707116 PMCID: PMC9884882 DOI: 10.1136/bmjopen-2022-068704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To investigate the effects of extended short-term medical training placements in small rural and remote communities on postgraduate work location. DESIGN AND SETTING Cohort study of medical graduates of The University of Queensland, Australia. PARTICIPANTS Graduating medical students from 2012 to 2021 who undertook a minimum of 6 weeks training in a small rural or remote location. Some participants additionally undertook either or both an extended short-term (12-week) placement in a small rural or remote location and a long-term (1 or 2 years) placement in a large regional centre. PRIMARY OUTCOME MEASURE Work location was collected from the Australian Health Practitioner Regulation Agency in 2022, classified as either rural, regional or metropolitan and measured in association with rural placement type(s). RESULTS From 2806 eligible graduates, those participating in extended small rural placements (n=106, 3.8%) were associated with practising rurally or regionally postgraduation (42.5% vs 19.9%; OR: 2.2, 95% CI: 1.1 to 4.6), for both those of rural origin (50% vs 30%; OR: 4.9, 95% CI: 2.6 to 9.2) or metropolitan origin (36% vs 17%; OR: 2.8, 95% CI: 1.7 to 4.8). Those undertaking both an extended small rural placement and 2 years regional training were most likely to be practising in a rural or regional location (61% vs 16%; OR: 8.6, 95% CI: 4.5 to 16.3). Extended small rural placements were associated with practising in smaller rural or remote locations in later years (15% vs 6%, OR: 2.7, 95% CI: 1.3 to 5.3). CONCLUSION This work location outcome evidence supports investment in rural medical training that is both located in smaller rural and remote settings and enables extended exposure with rural generalists. The evaluated 12-week programme positively related to rural workforce outcomes when applied alone. Outcomes greatly strengthened when the 12-week programme was combined with a 2-year regional centre training programme, compared with either alone. These effects were independent of rural origin.
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Affiliation(s)
- Matthew R McGrail
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Rockhampton, Queensland, Australia
| | - Bushra F Nasir
- Rural Clinical School, The University of Queensland Faculty of Medicine, Toowoomba, Queensland, Australia
- Mayne Academy of Rural and Remote Medicine, The University of Queensland Faculty of Medicine, Theodore, Queensland, Australia
| | - Alan Bruce Chater
- Mayne Academy of Rural and Remote Medicine, The University of Queensland Faculty of Medicine, Theodore, Queensland, Australia
| | - Bahram Sangelaji
- Mayne Academy of Rural and Remote Medicine, The University of Queensland Faculty of Medicine, Theodore, Queensland, Australia
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Parajuli DR, Ullah S, McGrail M, McLachlan CS, Isaac V. Work-related, socio-cultural, and personal factors associated with locus of control among Australian general practitioners. J Psychiatr Res 2022; 155:589-595. [PMID: 36206603 DOI: 10.1016/j.jpsychires.2022.09.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/29/2022] [Accepted: 09/24/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Locus of control (LoC) is a social cognition, that relates to the level of self-control that people have over their personal environment that influences their life. In this context, LoC is frequently associated with work-related behavioral outcomes, ranging from job attitudes, career behaviors, stress, and burnout. OBJECTIVE To investigate the association between LoC, and work-related behavioral factors, socio-cultural factors, and personal factors among Australian General Practitioners (GPs). METHODS This study utilized data from the 2010 Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors. Locus of control (LoC) was measured by a 7-point Likert scale based on Pearlin-Schooler Mastery/Self-efficacy 7-item Scale. Higher score indicated lower internal LoC. Multivariate linear regression model was performed to determine the independent predictors of LoC. RESULTS Of 3,664 GP participants, LoC did not differ by gender. Poor/fair self-rated health, working in urban location, running a stressful practice, poor balance of professional and personal commitments, poor support network, financial circumstances after retirement, and perception of unrealistic expectation by patients were significant predictors for a lower Internal LoC in a multivariate linear regression model. Adjusted R2 explained 22.4% of variation in predicting the LoC in our models. CONCLUSIONS LoC of Australian GPs is negatively affected by poor work-life balance, inadequate support, and unrealistic patient expectation. These work-place specific factors could be targeted by interventions to improve GPs wellbeing.
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Affiliation(s)
- Daya Ram Parajuli
- Flinders Rural and Remote Health, College of Medicine and Public Health, Flinders University, Ral Ral Avenue, Renmark, Australia
| | - Shahid Ullah
- Flinders Rural and Remote Health, College of Medicine and Public Health, Flinders University, Ral Ral Avenue, Renmark, Australia
| | - Matthew McGrail
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Australia
| | - Craig S McLachlan
- Health Vertical, Centre for Healthy Futures, Torrens University, Sydney, NSW, Australia
| | - Vivian Isaac
- Flinders Rural and Remote Health, College of Medicine and Public Health, Flinders University, Ral Ral Avenue, Renmark, Australia.
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Fielding A, Moad D, Tapley A, Davey A, Holliday E, Ball J, Bentley M, FitzGerald K, Kirby C, Turnock A, Spike N, van Driel ML, Magin P. Prevalence and associations of rural practice location in early-career general practitioners in Australia: a cross-sectional analysis. BMJ Open 2022; 12:e058892. [PMID: 35473723 PMCID: PMC9045092 DOI: 10.1136/bmjopen-2021-058892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To: (1) establish the prevalence of urban, regional, rural and remote practice location of early-career general practitioners (GPs); and (2) examine demographic and training-related characteristics associated with working in regional, rural or remote areas post attainment of vocational general practice qualifications. DESIGN Cross-sectional, questionnaire-based study, combined with contemporaneously collected data from participants' prior vocational training. SETTING Australian general practice. PARTICIPANTS Newly vocationally qualified GPs (ie, within 6 months-2 years post fellowship) who had completed vocational training with regional training organisations in New South Wales, Australian Capital Territory, eastern Victoria, and Tasmania between January 2016 and July 2018. PRIMARY OUTCOME MEASURE Rurality of post-fellowship practice location, as defined by Modified Monash Model (MMM) geographical classifications, based on current practice postcode. Prevalence of regional/rural/remote ('rural') practice was described using frequencies, and associations of rural practice were established using multivariable logistic regression, considering a range of demographic factors and training characteristics as independent variables. RESULTS A total of 354 participants completed the questionnaire (response rate 28%) with 319 providing information for their current practice location. Of these, 100 (31.4%) reported currently practising in a rural area (MMM2-7). Factors most strongly associated with practising in a rural area included having undertaken vocational GP training in a rural location OR 16.0 (95% CI 6.79 to 37.9); p<0.001; and undertaking schooling in rural area prior to university OR 4.21 (1.98, 8.94); p<0.001. CONCLUSIONS The findings suggest that vocational training experience may have a role in rural general practice location post fellowship, attenuating the previously demonstrated 'leakage' from the rural practice pipeline.
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Affiliation(s)
- Alison Fielding
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Dominica Moad
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Amanda Tapley
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Andrew Davey
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS), University of Newcastle Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Michael Bentley
- Australian General Practice Training, General Practice Training Tasmania (GPPT), Regional Training Organisation, Hobart, Tasmania, Australia
| | - Kristen FitzGerald
- Australian General Practice Training, General Practice Training Tasmania (GPPT), Regional Training Organisation, Hobart, Tasmania, Australia
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Catherine Kirby
- Australian General Practice Training, Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation, Hawthorn, Victoria, Australia
| | - Allison Turnock
- Tasmanian School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Department of Health, Australian Government, Hobart, Tasmania, Australia
| | - Neil Spike
- Australian General Practice Training, Eastern Victoria General Practice Training (EVGPT), Regional Training Organisation, Hawthorn, Victoria, Australia
- Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Victoria, Australia
| | - Mieke L van Driel
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Parker Magin
- NSW & ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Mayfield West, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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Beks H, Walsh S, Alston L, Jones M, Smith T, Maybery D, Sutton K, Versace VL. Approaches Used to Describe, Measure, and Analyze Place of Practice in Dentistry, Medical, Nursing, and Allied Health Rural Graduate Workforce Research in Australia: A Systematic Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1438. [PMID: 35162455 PMCID: PMC8834932 DOI: 10.3390/ijerph19031438] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 01/20/2022] [Accepted: 01/25/2022] [Indexed: 01/06/2023]
Abstract
Redressing the maldistribution of the health workforce in regional, rural, and remote geographical areas is a global issue and crucial to improving the accessibility of primary health care and specialist services. Geographical classification systems are important as they provide an objective and quantifiable measure of access and can have direct policy relevance, yet they are not always consistently applied in rural health research. It is unclear how research focusing on the graduate health workforce in Australia has described, measured, and analyzed place of practice. To examine approaches used, this review systematically scopes Australian rural studies focusing on dentistry, medicine, nursing, and allied health graduates that have included place of practice as an outcome measure. The Joanna Brigg's Institute Scoping Review Methodology was used to guide the review. Database searches retrieved 1130 unique citations, which were screened, resulting in 62 studies for inclusion. Included studies were observational, with most focusing on the practice locations of medical graduates and predicators of rural practice. Variations in the use of geographical classification approaches to define rurality were identified and included the use of systems that no longer have policy relevance, as well as adaptations of existing systems that make future comparisons between studies challenging. It is recommended that research examining the geographical distribution of the rural health workforce use uniform definitions of rurality that are aligned with current government policy.
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Affiliation(s)
- Hannah Beks
- School of Medicine, Deakin University, Geelong 3220, Australia; (H.B.); (L.A.)
| | - Sandra Walsh
- Department of Rural Health, University of South Australia, Whyalla 5608, Australia; (S.W.); (M.J.)
| | - Laura Alston
- School of Medicine, Deakin University, Geelong 3220, Australia; (H.B.); (L.A.)
| | - Martin Jones
- Department of Rural Health, University of South Australia, Whyalla 5608, Australia; (S.W.); (M.J.)
| | - Tony Smith
- Department of Rural Health, University of Newcastle, Taree 2430, Australia;
| | - Darryl Maybery
- Department of Rural Health & Indigenous Health, Monash University, Warragul 3820, Australia; (D.M.); (K.S.)
| | - Keith Sutton
- Department of Rural Health & Indigenous Health, Monash University, Warragul 3820, Australia; (D.M.); (K.S.)
| | - Vincent L Versace
- School of Medicine, Deakin University, Geelong 3220, Australia; (H.B.); (L.A.)
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O’Sullivan B, McGrail M, Gurney T, Martin P. Barriers to getting into postgraduate specialty training for junior Australian doctors: An interview-based study. PLoS One 2021; 16:e0258584. [PMID: 34673790 PMCID: PMC8530333 DOI: 10.1371/journal.pone.0258584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 10/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Medical training is a long process that is not complete until doctors finish specialty training. Getting into specialty training is challenging because of strong competition for limited places, depending on doctors' chosen field. This may have a negative impact on doctor well-being and reduce the efficiency of the medical training system. This study explored the barriers of pre-registrar (junior) doctors getting into specialty training programs to inform tailored support and re-design of speciality entry systems. METHODS From March to October 2019, we conducted 32 semi-structured interviews with early-career doctors in Australia, who had chosen their specialty field, and were either seeking entry, currently undertaking or had recently completed various fields of specialty training. We sought reflections about barriers and major influences to getting into specialty training. In comparing and contrasting generated themes, different patterns emerged from doctors targeting traditionally non-competitive specialty fields like General Practice (GP) and other specialties (typically more competitive fields). As a result we explored the data in this dichotomy. RESULTS Doctors targeting entry to GP specialties had relatively seamless training entry and few specific barriers. In contrast, those pursuing other specialties, regardless of which ones, relayed multiple barriers of: Navigating an unpredictable and complex system with informal support/guidance; Connecting to the right people/networks for relevant experience; Pro-actively planning and differentiating skills with recurrent failure of applications. CONCLUSIONS Our exploratory study suggests that doctors wanting to get into non-GP specialty training may experience strong barriers, potentially over multiple years, with the capacity to threaten their morale and resilience. These could be addressed by a clearinghouse of information about different speciality programs, broader selection criteria, feedback on applications and more formal guidance and professional supports. The absence of challenges identified for doctors seeking entry to GP could be used to promote increased uptake of GP careers.
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Affiliation(s)
- Belinda O’Sullivan
- Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
| | - Matthew McGrail
- Rural Clinical School, The University of Queensland, Rockhampton, Queensland, Australia
| | - Tiana Gurney
- Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
| | - Priya Martin
- Rural Clinical School, The University of Queensland, Toowoomba, Queensland, Australia
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O'Sullivan B, McGrail M, May J. Responsive policies needed to secure rural supply from increasing female doctors: A perspective. Int J Health Plann Manage 2021; 37:40-49. [PMID: 34655110 PMCID: PMC9292163 DOI: 10.1002/hpm.3363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/21/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
Around the world, the supply of rural health services to address population health needs continues to be a wicked problem. Adding to this, an increasing proportion of female doctors is graduating from medical courses but gender is not accounted for within rural workforce policy and planning. This threatens the future capacity of rural medical services. This perspective draws together the latest evidence, to make the case for industry and government action on responsive policy and planning to attract females to rural medicine. We find that the factors that attract female doctors to rural practice are not the same as males. We identify female-tailored policies require a re-visioning of rural recruitment, use of employment arrangements that attract females and re-thinking issues of rural training and specialty choice. We conceptualise a roadmap that includes co-designing rural jobs within supportive teams, allowing for capped hours which align with childcare along with boosting of female peer support and mentorship. There is also a need to enhance flexible rural postgraduate training options in a range of specialties (at a time when many women are establishing families) and to consider viable partner employment (including for female doctors with university trained partners) and advertising specific rural attractors to women, including the chance to connect with communities and make a difference.
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Affiliation(s)
- Belinda O'Sullivan
- Faculty of Medicine, The University of Queensland Rural Clinical School, Toowoomba, Queensland, Australia
| | - Matthew McGrail
- Faculty of Medicine, The University of Queensland Rural Clinical School, Rockhampton, Queensland, Australia
| | - Jennifer May
- Department of Rural Health (UONDRH), The University of Newcastle, Tamworth, New South Wales, Australia
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Ostini R, McGrail MR, Kondalsamy-Chennakesavan S, Hill P, O'Sullivan B, Selvey LA, Eley DS, Adegbija O, Boyle FM, Dettrick Z, Jennaway M, Strasser S. Building a sustainable rural physician workforce. Med J Aust 2021; 215 Suppl 1:S5-S33. [PMID: 34218436 DOI: 10.5694/mja2.51122] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 05/14/2021] [Indexed: 11/17/2022]
Abstract
CHAPTER 1: CHARACTERISING AUSTRALIA'S RURAL SPECIALIST PHYSICIAN WORKFORCE: THE PROFESSIONAL PROFILE AND PROFESSIONAL SATISFACTION OF JUNIOR DOCTORS AND CONSULTANTS: Objective: To assess differences in the demographic characteristics, professional profile and professional satisfaction of rural and metropolitan junior physicians and physician consultants in Australia. DESIGN, SETTING AND PARTICIPANTS Cross-sectional, population level national survey of the Medicine in Australia: Balancing Employment and Life longitudinal cohort study (collected 2008-2016). Participants were specialist physicians from four career stage groups: pre-registrars (physician intent); registrars; new consultants (< 5 years since Fellowship); and consultants. MAIN OUTCOME MEASURES Level of professional satisfaction across various job aspects, such as hours worked, working conditions, support networks and educational opportunities, comparing rural and metropolitan based physicians. RESULTS Participants included 1587 pre-registrars (15% rural), 1745 physician registrars (9% rural), 421 new consultants (20% rural) and 1143 consultants (13% rural). Rural physicians of all career stages demonstrated equivalent professional satisfaction across most job aspects, compared with metropolitan physician counterparts. Some examples of differences in satisfaction included rural pre-registrars being less likely to agree they had good access to support and supervision from qualified consultants (odds ratio [OR], 0.6; 95% CI, 0.3-0.9) and rural consultants being more likely to agree they had a poorer professional support network (OR, 1.9; 95% CI, 1.2-2.9). In terms of demographics, relatively more rural physicians had a rural background or were trained overseas. Although most junior physicians were women, female consultants were less likely to be working in a rural location (OR, 0.6; 95% CI, 0.4-0.8). CONCLUSION Junior physicians in metropolitan or rural settings have a similar professional experience, which is important in attracting future trainees. Increased opportunities for rural training should be prioritised, along with addressing concerns about the professional isolation and poorer support network of those in rural areas, not only among junior doctors but also consultants. Finally, making rural practice more attractive to female junior physicians could greatly improve the consultant physician distribution. CHAPTER 2: GENERAL PHYSICIANS AND PAEDIATRICIANS IN RURAL AUSTRALIA: THE SOCIAL CONSTRUCTION OF PROFESSIONAL IDENTITY: Objective: To explore the construction of professional identity among general physicians and paediatricians working in non-metropolitan areas. DESIGN, SETTING AND PARTICIPANTS In-depth qualitative interviews were conducted with general physicians and paediatricians, plus informants from specialist colleges, government agencies and academia who were involved in policy and programs for the training and recruitment of specialists in rural locations across three states and two territories. This research is part of the Training Pathways and Professional Support for Building a Rural Physician Workforce Study, 2018-19. MAIN OUTCOME MEASURES Individual and collective descriptors of professional identity. RESULTS We interviewed 36 key informants. Professional identity for general physicians and paediatricians working in regional, rural and remote Australia is grounded in the breadth of their training, but qualified by location - geographic location, population served or specific location, where social and cultural context specifically shapes practice. General physicians and paediatricians were deeply engaged with their local community and its economic vulnerability, and they described the population size and dynamics of local economies as determinants of viable practice. They often complemented their practice with formal or informal training in areas of special interest, but balanced their practice against subspecialist availability, also dependent on demographics. While valuing their professional roles, they showed limited inclination for industrial organisation. CONCLUSION Despite limited consensus on identity descriptors, rural general physicians and paediatricians highly value generalism and their rural engagement. The structural and geographic bias that preferences urban areas will need to be addressed to further develop coordinated strategies for advanced training in rural contexts, for which collective identity is integral. CHAPTER 3: SUSTAINABLE RURAL PHYSICIAN TRAINING: LEADERSHIP IN A FRAGILE ENVIRONMENT: Objectives: To understand Royal Australasian College of Physicians (RACP) training contexts, including supervisor and trainee perspectives, and to identify contributors to the sustainability of training sites, including training quality. DESIGN, SETTING AND PARTICIPANTS A cross-sectional mixed-methods design was used. A national sample of RACP trainees and Fellows completed online surveys. Survey respondents who indicated willingness to participate in interviews were purposively recruited to cover perspectives from a range of geographic, demographic and training context parameters. MAIN OUTCOME MEASURES Fellows' and trainees' work and life satisfaction, and their experiences of supervision and training, respectively, by geographic location. RESULTS Fellows and trainees reported high levels of satisfaction, with one exception - inner regional Fellows reported lower satisfaction regarding opportunities to use their abilities. Not having a good support network was associated with lower satisfaction. Our qualitative findings indicate that a culture of undermining rural practice is prevalent and that good leadership at all levels is important to reduce negative impacts on supervisor and trainee availability, site accreditation and viability. Trainees described challenges in navigating training pathways, ensuring career development, and having the flexibility to meet family needs. The small number of Fellows in some sites poses challenges for supervisors and trainees and results in a blurring of roles; accreditation is an obstacle to provision of training at rural sites; and the overlap between service and training roles can be difficult for supervisors. CONCLUSION Our qualitative findings emphasise the distinctive nature of regional specialist training, which can make it a fragile environment. Leadership at all levels is critical to sustaining accreditation and support for supervisors and trainees. CHAPTER 4: PRINCIPLES TO GUIDE TRAINING AND PROFESSIONAL SUPPORT FOR A SUSTAINABLE RURAL SPECIALIST PHYSICIAN WORKFORCE: Objective: To draw on research conducted in the Building a Rural Physician Workforce project, the first national study on rural specialist physicians, to define a set of principles applicable to guiding training and professional support action. DESIGN We used elements of the Delphi approach for systematic data collection and codesign, and applied a hybrid participatory action planning approach to achieve consensus on a set of principles. RESULTS Eight interconnected foundational principles built around rural regions and rural people were identified: FP1, grow your own "connected to" place; FP2, select trainees invested in rural practice; FP3, ground training in community need; FP4, rural immersion - not exposure; FP5, optimise and invest in general medicine; FP6, include service and academic learning components; FP7, join up the steps in rural training; and FP8, plan sustainable specialist roles. CONCLUSION These eight principles can guide training and professional support to build a sustainable rural physician workforce. Application of the principles, and coordinated action by stakeholders and the responsible organisations, are needed at national, state and local levels to achieve a sustainable rural physician workforce.
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May JA, Scott A. The road less travelled: supporting physicians to practice rurally. Med J Aust 2021; 215:29-30. [PMID: 34218434 DOI: 10.5694/mja2.51125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jennifer A May
- Department of Rural Health, University of Newcastle, Tamworth, NSW
| | - Anthony Scott
- Melbourne Institute: Applied Economic and Social Research, University of Melbourne, Melbourne, VIC
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Coyle M, Sandover S, Poobalan A, Bullen J, Cleland J. Meritocratic and fair? The discourse of UK and Australia's widening participation policies. MEDICAL EDUCATION 2021; 55:825-839. [PMID: 33346380 DOI: 10.1111/medu.14442] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 12/10/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Globally, people with the academic and personal attributes to successfully study medicine experience disadvantages associated with sociodemographic factors. Governments have attempted to address this issue via macrolevel policies aimed at widening participation (WP) to medicine. These policies differ by country, suggesting much can be learned from examining and comparing international policy discourses of WP. Our question was: How are discourses of WP to higher and medical education positioned in the UK and Australia? METHODS A systematic search strategy was guided by five a priori themes inspired by United Nations Sustainability Goals (2015). Seventeen policy documents (UK n = 9, Australia n = 8) published between 2008 and 2018 were identified. Analysis involved two over-arching, iterative stages: a document analysis then a Foucauldian critical discourse analysis, the latter with the aim of unveiling the power dynamics at play within policy-related discourses. RESULTS Discourses of social mobility and individual responsibility within a meritocracy are still paramount in the UK. In contrast, the dominant discourse in Australia is social accountability in achieving equity and workforce diversity, prioritising affirmative action and community values. Similarities between the two countries in terms of WP policy and policy levers have changed over time, linked to the divergence of internal drivers for societal change. Both nations recognise tensions inherent in striving to achieve both local and global goals, but Australia appears to prioritise community values in working towards 'nation building' whereas in the UK the focus on individuality and meritocracy at times seems at odds with achieving parity for disadvantaged individuals. DISCUSSION WP policies and practices are situated and contextual so caution must be taken when extrapolating lessons from one context to another. The history of a country and the nature of marginalisation in that country must be scrutinised when trying to understand what drives WP policy.
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Affiliation(s)
- Maeve Coyle
- Institute of Education in Medical and Dental Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Amudha Poobalan
- Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - Jennifer Cleland
- Nanyang Technological University Singapore, Singapore, Singapore
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La Forgia A, Williams M, Williams S, Walters L, McArthur L, Gonzalez-Chica D. Are Australian rural clinical school students' career choices influenced by perceived opinions of primary care? Evidence from the national Federation of Rural Australian Medical Educators survey. Aust J Rural Health 2021; 29:373-381. [PMID: 34081368 DOI: 10.1111/ajr.12750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/12/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate whether perceived opinions of primary care are associated with student career preferences after graduation among a rural clinical school cohort and whether the preferred location of practice moderates these relationships. DESIGN Cross-sectional study using data from the national Federation of Rural Australian Medical Educators survey. PARTICIPANTS/SETTING Medical students across 18 Australian universities who completed a clinical year in a rural setting in 2019. MAIN OUTCOME MEASURE(S) Career preference in primary care after graduation. RESULTS The survey was completed by 624 students (response rate = 69.9%). A preference for primary care was reported by 35.5% (95% CI: 29.4-42.0) of students and was more likely among those age 30+ years, with a rural background, or preferring to practise rurally after graduation. Students reported that primary care was more commonly respected by medical academics (66.8%) than peers (24.0%) or junior/hospital doctors (24.0%). In adjusted analysis, none of the perceived opinions were associated with student career preferences. However, among students aiming to work in small rural locations, a career in primary care was associated with more frequent reports that peers had poor opinions of primary care (P = .004). CONCLUSION Rural clinical school students perceive negative opinions of primary care, particularly among peers and junior/hospital doctors. Students aiming to work in small towns after graduation are more likely to report negative opinions among their peers, suggesting they may be more attuned to negative attitudes. This points to the need for a community of practice of like-minded peers and clinicians to preserve the career interest of these students.
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Affiliation(s)
- Adina La Forgia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - Millie Williams
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - Susan Williams
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - Lucie Walters
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia
| | - Lawrie McArthur
- General Practice Training, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - David Gonzalez-Chica
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, SA, Australia.,Discipline of General Practice, Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
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Fuller L, Beattie J, Versace V. Graduate rural work outcomes of the first 8 years of a medical school: What can we learn about student selection and clinical school training pathways? Aust J Rural Health 2021; 29:181-190. [PMID: 33982843 DOI: 10.1111/ajr.12742] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the student characteristics and clinical school training pathways that are associated with postgraduate rural practice. DESIGN A cross-sectional observational study. SETTING Deakin University's School of Medicine, encompassing 3 rural and 2 metropolitan clinical schools, including a rural longitudinal integrated clerkship (LIC) year. PARTICIPANTS A total of 948 School of Medicine medical graduates (2011-2018) who had an Australian Health Practitioners Regulation Agency registered work location in Australia (September 2019). MAIN OUTCOME MEASURE(S) Graduates' work locations were linked with admission and clinical school training data and analysed for significant associations. RESULTS Graduates completing a rural LIC year and a regional rural clinical school year were 7 times more likely to be working rurally than metropolitan trainees. A small number of rural background (RB) students completed a rural LIC and rural clinical school year, 66.7% of whom were practising rurally. Further associations with rural practice were attending a rural clinical school for 2 years or a rural LIC for 1 year, student having a RB, rurally bonded course placement and being an international student. CONCLUSION The significant influence of a rural LIC year on graduate rural work location is noteworthy, especially when undertaken by students from a RB in combination with a second regional rural clinical school year. These findings support the strategic alignment of rural student selection with rural clinical school training pathways to achieve the greatest impact on rural graduate workforce outcomes.
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Affiliation(s)
- Lara Fuller
- School of Medicine, Deakin University, Geelong, Vic., Australia
| | - Jessica Beattie
- School of Medicine, Deakin University, Warrnambool, Vic., Australia
| | - Vincent Versace
- Deakin Rural Health, Deakin University, Warrnambool, Vic., Australia
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McGrail M, O'Sullivan B, Gurney T. Critically reviewing the policies used by colleges to select doctors for specialty training: A kink in the rural pathway. Aust J Rural Health 2021; 29:272-283. [DOI: 10.1111/ajr.12707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Matthew McGrail
- University of Queensland Rural Clinical School Rockhampton QLD Australia
| | | | - Tiana Gurney
- University of Queensland Rural Clinical School Toowoomba QLD Australia
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Yeomans ND, Sewell JR, Pigou P, Macintyre S. Demographics and performance of candidates in the examinations of the Australian Medical Council, 1978–2019. Med J Aust 2021; 214:54. [DOI: 10.5694/mja2.50800] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
| | - Jillian R Sewell
- University of Melbourne Melbourne VIC
- Centre for Community Child Health Royal Children's Hospital Melbourne VIC
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O’Sullivan B, McGrail M, Gurney T, Martin P. A Realist Evaluation of Theory about Triggers for Doctors Choosing a Generalist or Specialist Medical Career. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228566. [PMID: 33218189 PMCID: PMC7699208 DOI: 10.3390/ijerph17228566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 01/29/2023]
Abstract
There is a lack of theory about what drives choice to be a generalist or specialist doctor, an important issue in many countries for increasing primary/preventative care. We did a realist evaluation to develop a theory to inform what works for whom, when and in what contexts, to yield doctors’ choice to be a generalist or specialist. We interviewed 32 Australian doctors (graduates of a large university medical school) who had decided on a generalist (GP/public health) or specialist (all other specialties) career. They reflected on their personal responses to experiences at different times to stimulate their choice. Theory was refined and confirmed by testing it with 17 additional doctors of various specialties/career stages and by referring to wider literature. Our final theory showed the decision involved multi-level contextual factors intersecting with eight triggers to produce either a specialist or generalist choice. Both clinical and place-based exposures, as well as attributes, skills, norms and status of different fields affected choice. This occurred relative to the interests and expectations of different doctors, including their values for professional, socio-economic and lifestyle rewards, often intersecting with issues like gender and life stage. Applying this theory, it is possible to tailor selection and ongoing exposures to yield more generalists.
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Affiliation(s)
- Belinda O’Sullivan
- Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia; (T.G.); (P.M.)
- Correspondence: ; Tel.: +61-4-2740-5030
| | - Matthew McGrail
- Faculty of Medicine, The University of Queensland Rural Clinical School, 78 on Canning St, Rockhampton 4700, Queensland, Australia;
| | - Tiana Gurney
- Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia; (T.G.); (P.M.)
| | - Priya Martin
- Faculty of Medicine, The University of Queensland, Rural Clinical School, Locked Bag 9009, Toowoomba 4350, DC Queensland, Australia; (T.G.); (P.M.)
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Holloway P, Bain-Donohue S, Moore M. Why do doctors work in rural areas in high-income countries? A qualitative systematic review of recruitment and retention. Aust J Rural Health 2020; 28:543-554. [PMID: 33197109 DOI: 10.1111/ajr.12675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/09/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To identify and assess the drivers and barriers to recruiting and retaining doctors in rural communities of high-income countries. DESIGN A systematic review and thematic analysis. SETTING Publications were sourced from medical and scientific databases online. PARTICIPANTS Qualitative, mixed-methods and review studies from peer-reviewed journals published since 2000 that discussed recruitment or retention of doctors to rural areas in high-income countries. MAIN OUTCOME MEASURES Identification and assessment of themes in the literature pertaining to recruitment and retention of rural doctors. Recurrent themes were assessed for relevance and applicability to current rural shortages. RESULTS A thematic analysis was completed on 41 papers assessed as in scope of the review. Papers were scrutinised for relevance to established rural recruitment and retention strategies. Key themes were rural background, education and training, personal and professional circumstances, and integration with the community. CONCLUSION While rural origin has long been promoted as the key factor for recruiting rural doctors, initiatives targeting only these individuals ignore a potentially larger cohort of future rural doctors. Rurally focused medical education and training need to encompass students and doctors from all backgrounds. The major barriers to rural recruitment are family-unit considerations for partners and children, concerns over isolation and a poor perception of rural practice. Attracting doctors to practise rurally is only half the challenge however, and strategies to retain rural doctors need a greater focus on personal and professional support networks and community integration. Additional strategies are needed to retain international and bonded doctors restricted to rural areas.
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Affiliation(s)
- Patrick Holloway
- Medical School - Australian National University (ANU) Medical School, ANU College of Health and Medicine, Canberra, ACT, Australia.,Rural Clinical School, Australian National University (ANU) Medical School, ANU College of Health and Medicine, Canberra, ACT, Australia
| | - Suzanne Bain-Donohue
- Rural Clinical School, Australian National University (ANU) Medical School, ANU College of Health and Medicine, Canberra, ACT, Australia
| | - Malcolm Moore
- Rural Clinical School, Australian National University (ANU) Medical School, ANU College of Health and Medicine, Canberra, ACT, Australia
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26
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Kim C, Ngo H, Playford D. Gender equity at last: a national study of medical students considering a career in rural medicine. BMC MEDICAL EDUCATION 2020; 20:432. [PMID: 33198731 PMCID: PMC7667784 DOI: 10.1186/s12909-020-02355-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 11/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The rural medical workforce internationally suffers from a significant imbalance between male- and female- identifying practitioners. Not only do male doctors outnumber female doctors, but additionally female doctors work fewer hours than their male counterparts. This has health implications for rural communities. In response, In Australia, Rural Clinical Schools (RCSs) are a national training strategy to increase the number of graduates entering the rural medical workforce. It has been observed that RCSs attract a greater number of female students than male students. However, the future work intentions of male versus female RCS students is not known. This paper therefore asked whether male and female RCS students have equivalent intent for future rural practice. METHODS Participants were all students who attended RCSs from 2015 to 2017, who completed an exit survey that gathered data on demographic, experiential and intentional variables. Univariate analyses examined differences between the sexes. A multivariate model was constructed to determine the independent predictors for rural intention. RESULTS There were 2017 respondents across the 3 years, of whom 937 identified as male, and 1138 identified as female. In univariate analysis, female-identifying students had significantly higher rural intention than male-identifying students. There were no other sex-based differences in age, rural background, overall perception of support, and overall excellence of clinical education whilst in RCS. However, in multivariate analysis, sex was not a significant predictor for rural work intention, whereas older age, rural background, and first preference for RCS were all predictive of increased rural intent, as expected from the literature. There were no differences between male and female students in their perceptions of the overall support and the clinical education provided by RCS. CONCLUSION We conclude from this national study that sex is not an independent predictor for future rural work intention among RCS students. Considering the disproportionate number of female students entering RCS, this is reassuring for ultimately achieving rural workforce gender equity.
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Affiliation(s)
- Caleb Kim
- Rural Clinical School of WA, School of Medicine, UWA, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Hanh Ngo
- Rural Clinical School of WA, School of Medicine, UWA, 35 Stirling Highway, Crawley, WA 6009 Australia
| | - Denese Playford
- Rural Clinical School of WA, School of Medicine, UWA, 35 Stirling Highway, Crawley, WA 6009 Australia
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27
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McGrail MR, O'Sullivan BG, Russell DJ, Rahman M. Exploring preference for, and uptake of, rural medical internships, a key issue for supporting rural training pathways. BMC Health Serv Res 2020; 20:930. [PMID: 33032604 PMCID: PMC7543036 DOI: 10.1186/s12913-020-05779-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 09/30/2020] [Indexed: 11/12/2022] Open
Abstract
Background Improved medical care access for rural populations continues to be a major concern. There remains little published evidence about postgraduate rural pathways of junior doctors, which may have strong implications for a long-term skilled rural workforce. This exploratory study describes and compares preferences for, and uptake of, rural internships by new domestic and international graduates of Victorian medical schools during a period of rural internship position expansion. Methods We used administrative data of all new Victorian medical graduates’ location preference and accepted location of internship positions for 2013–16. Associations between preferred internship location and accepted internship position were explored including by rurality and year. Moreover, data were stratified between ‘domestic graduates’ (Australian and New Zealand citizens or permanent residents) and ‘international graduates’ (temporary residents who graduated from an Australian university). Results Across 2013–16, there were 4562 applicants who filled 3130 internship positions (46% oversubscribed). Domestic graduates filled most (69.7%, 457/656) rural internship positions, but significantly less than metropolitan positions (92.2%, p < 0.001). Only 20.1% (551/2737) included a rural location in their top five preferences, less than for international graduates (34.4%, p < 0.001). A greater proportion of rural compared with metropolitan interns accepted a position not in their top five preferences (36.1% versus 7.4%, p < 0.001). The proportion nominating a rural location in their preference list increased across 2013–2016. Conclusions The preferences for, and uptake of, rural internship positions by domestic graduates is sub-optimal for growing a rural workforce from local graduates. Current actions that have increased the number of rural positions are unlikely to be sufficient as a stand-alone intervention, thus regional areas must rely on international graduates. Strategies are needed to increase the attractiveness of rural internships for domestic students so that more graduates from rural undergraduate medical training are retained rurally. Further research could explore whether the uptake of rural internships is facilitated by aligning these positions with protected opportunities to continue vocational training in regionally-based or metropolitan fellowships. Increased understanding is needed of the factors impacting work location decisions of junior doctors, particularly those with some rural career intent.
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Affiliation(s)
- Matthew R McGrail
- Rural Clinical School, The University of Queensland, Cnr Cambridge & Canning Street, Rockhampton, Queensland, 4700, Australia.
| | - Belinda G O'Sullivan
- School of Rural Health, Monash University, PO BOX 666, Bendigo, Victoria, 3550, Australia.,Rural Clinical School, The University of Queensland, 152 West St, South Toowoomba, Queensland, 4350, Australia
| | - Deborah J Russell
- Menzies School of Health Research, PO BOX 4066, Alice Springs, Northern Territory, 0870, Australia
| | - Muntasirur Rahman
- Rural Clinical School, The University of Queensland, 152 West St, South Toowoomba, Queensland, 4350, Australia
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O'Sullivan BG, McGrail MR. Effective dimensions of rural undergraduate training and the value of training policies for encouraging rural work. MEDICAL EDUCATION 2020; 54:364-374. [PMID: 32227376 DOI: 10.1111/medu.14069] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 05/05/2023]
Abstract
CONTEXT The implementation of rural undergraduate medical education can be improved by collecting national evidence about the aspects of these programmes that work well and the value of investing in national policies. OBJECTIVES This study aimed to explore how different durations, degree of remoteness and number of rural undergraduate medical training placements relate to working rurally, and to investigate differences after the introduction of formal national training policies that fund short- and long-term rural training experiences for medical students. METHODS A cohort of 6510 Australian-trained doctors who completed the Medicine in Australia: Balancing Employment and Life survey recalled their participation in rural undergraduate medical training. Responses were categorised by duration, remoteness as defined by the Modified Monash Model levels 3-4 and 4-7 compared with 1, and total number of placements. Multivariate regression was used to test associations with working rurally in 2017, and differences between cohorts of students who graduated pre- and post-2000, of which the latter were exposed to formal national training policies. RESULTS Any rural undergraduate training was associated with working rurally (odds ratio [OR] 1.6, 95% confidence interval [CI] 1.3-1.9) with incrementally stronger associations for longer duration (>1 year: OR 3.0, 95% CI 2.3-4.0), greater remoteness (OR 1.8, 95% CI 1.5-2.1) and three placements (OR 2.4, 95% CI 1.9-3.0) compared with none. Rural background (OR 2.6, 95% CI 2.3-3.0) and general practice (OR 2.6, 95% CI 2.2-2.9) were independently associated with working rurally; being female was negatively associated with rural work (OR 0.7, 95% CI 0.6-0.8). The cohort of doctors who trained in a period when national rural training policies had been implemented included more graduates with a rural background and experience of undergraduate rural training but returned equivalent proportions of rural doctors to pre-policy cohorts, and included proportionally more women and fewer general practitioners. CONCLUSIONS Rural undergraduate training should focus on multiple dimensions of duration, remoteness and number of rural undergraduate training experiences to grow the rural medical workforce. Formal national rural training policies may be an important part of the broader system for rural workforce development, but they rely on the uptake of general practice and the participation of female doctors in rural medicine.
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Affiliation(s)
- Belinda G O'Sullivan
- Rural Clinical School, University of Queensland, Toowoomba DC, Queensland, Australia
| | - Matthew R McGrail
- Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia
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Xu RH, Zhou L, Li Y, Wang D. Doctor's Preference in Providing Medical Service for Patients in the Medial Alliance: A pilot Discrete Choice Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2215. [PMID: 32224902 PMCID: PMC7177240 DOI: 10.3390/ijerph17072215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 11/16/2022]
Abstract
This cross-sectional survey study explored whether doctors in Guangdong, China preferred to provide extra healthcare services within the context of their medical alliances (MAs). Specifically, a discrete choice experiment (DCE) was conducted to investigate whether doctors preferred to provide extra services at low-tier hospitals within their MAs. A literature review, focus group interview, and expert group discussion resulted in three main attributes (i.e., working time, income, and hospital location) and corresponding levels, which were combined to create 24 profiles that were randomly presented to participants. A conditional logit model was then employed to calculate utility scores for all profiles. A total of 311 doctors completed the DCE questionnaire. The coefficients for each level within the three attributes were ordered and found to be statistically significant. Working time had the greatest influence on utility scores, increasing by one hour per week (beta = 1.4, odds ratio (OR) = 4.07, p < 0.001), followed by income, which increased by 30% per month (beta = 1.19, OR = 3.3, p < 0.001). The utility scores for all profiles ranged between -0.27 and 3.07. Findings indicated that participants made trade-offs with respect to providing extra services within their MAs. Furthermore, utility varied between different subpopulations.
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Affiliation(s)
- Richard Huan Xu
- Jockey Club School of public health and primary care, the Chinese University of Hong Kong, Hong Kong, China;
| | - Lingming Zhou
- School of Health Management, Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.)
| | - Yong Li
- School of Health Management, Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.)
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou 510515, China; (L.Z.); (Y.L.)
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30
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McGrail MR, O’Sullivan BG, Russell DJ. Rural Work and Specialty Choices of International Students Graduating from Australian Medical Schools: Implications for Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E5056. [PMID: 31835846 PMCID: PMC6950190 DOI: 10.3390/ijerph16245056] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/09/2019] [Accepted: 12/09/2019] [Indexed: 11/21/2022]
Abstract
Almost 500 international students graduate from Australian medical schools annually, with around 70% commencing medical work in Australia. If these Foreign Graduates of Accredited Medical Schools (FGAMS) wish to access Medicare benefits, they must initially work in Distribution Priority Areas (mainly rural). This study describes and compares the geographic and specialty distribution of FGAMS. Participants were 18,093 doctors responding to Medicine in Australia: Balancing Employment and Life national annual surveys, 2012-2017. Multiple logistic regression models explored location and specialty outcomes for three training groups (FGAMS; other Australian-trained (domestic) medical graduates (DMGs); and overseas-trained doctors (OTDs)). Only 19% of FGAMS worked rurally, whereas 29% of Australia's population lives rurally. FGAMS had similar odds of working rurally as DMGs (OR 0.93, 0.77-1.13) and about half the odds of OTDs (OR 0.48, 0.39-0.59). FGAMS were more likely than DMGs to work as general practitioners (GPs) (OR 1.27, 1.03-1.57), but less likely than OTDs (OR 0.74, 0.59-0.92). The distribution of FGAMS, particularly geographically, is sub-optimal for improving Australia's national medical workforce goals of adequate rural and generalist distribution. Opportunities remain for policy makers to expand current policies and develop a more comprehensive set of levers to promote rural and GP distribution from this group.
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Affiliation(s)
- Matthew R. McGrail
- Rural Clinical School, The University of Queensland, Rockhampton 4700, Australia;
| | - Belinda G. O’Sullivan
- Rural Clinical School, The University of Queensland, Rockhampton 4700, Australia;
- School of Rural Health, Monash University, Bendigo, 3550, Australia
| | - Deborah J. Russell
- Northern Territory Medical Program, Flinders University, Darwin 800, Australia;
- Menzies School of Health Research, Darwin 800, Australia
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31
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Worley PS, O'Sullivan B, Ellis R. From locum-led outposts to locally led continuous rural training networks: the National Rural Generalist Pathway. Med J Aust 2019; 211:57-59.e1. [PMID: 31250926 DOI: 10.5694/mja2.50225] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Paul S Worley
- Office of the National Rural Health Commissioner, Adelaide, SA.,Prideaux Centre for Research in Health Professions Education, Flinders University, Adelaide, SA
| | - Belinda O'Sullivan
- Office of the National Rural Health Commissioner, Adelaide, SA.,School of Rural Health, Monash University, Bendigo, VIC
| | - Rose Ellis
- Office of the National Rural Health Commissioner, Adelaide, SA
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32
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O’Sullivan B, Russell DJ, McGrail MR, Scott A. Reviewing reliance on overseas-trained doctors in rural Australia and planning for self-sufficiency: applying 10 years' MABEL evidence. HUMAN RESOURCES FOR HEALTH 2019; 17:8. [PMID: 30670027 PMCID: PMC6341566 DOI: 10.1186/s12960-018-0339-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 12/20/2018] [Indexed: 05/05/2023]
Abstract
BACKGROUND The capacity for high-income countries to supply enough locally trained doctors to minimise their reliance on overseas-trained doctors (OTDs) is important for equitable global workforce distribution. However, the ability to achieve self-sufficiency of individual countries is poorly evaluated. This review draws on a decade of research evidence and applies additional stratified analyses from a unique longitudinal medical workforce research program (the Medicine in Australia: Balancing Employment and Life survey (MABEL)) to explore Australia's rural medical workforce self-sufficiency and inform rural workforce planning. Australia is a country with a strong medical education system and extensive rural workforce policies, including a requirement that newly arrived OTDs work up to 10 years in underserved, mostly rural, communities to access reimbursement for clinical services through Australia's universal health insurance scheme, called Medicare. FINDINGS Despite increases in the number of Australian-trained doctors, more than doubling since the late 1990s, recent locally trained graduates are less likely to work either as general practitioners (GPs) or in rural communities compared to local graduates of the 1970s-1980s. The proportion of OTDs among rural GPs and other medical specialists increases for each cohort of doctors entering the medical workforce since the 1970, peaking for entrants in 2005-2009. Rural self-sufficiency will be enhanced with policies of selecting rural-origin students, increasing the balance of generalist doctors, enhancing opportunities for remaining in rural areas for training, ensuring sustainable rural working conditions and using innovative service models. However, these policies need to be strongly integrated across the long medical workforce training pathway for successful rural workforce supply and distribution outcomes by locally trained doctors. Meanwhile, OTDs substantially continue to underpin Australia's rural medical service capacity. The training pathways and social support for OTDs in rural areas is critical given their ongoing contribution to Australia's rural medical workforce. CONCLUSION It is essential for Australia to monitor its ongoing reliance on OTDs in rural areas and be considerate of the potential impact on global workforce distribution.
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Affiliation(s)
- Belinda O’Sullivan
- Monash University School of Rural Health, Office of Research, PO Box 666, Bendigo, VIC 3550 Australia
| | - Deborah J. Russell
- Flinders University Northern Territory, PO Box 4066, Alice Springs, NT 0871 Australia
| | - Matthew R. McGrail
- University of Queensland, Rural Clinical School, 78 on Canning Street, Rockhampton, Queensland 4700 Australia
| | - Anthony Scott
- Melbourne Institute of Applied Economic and Social Research, The University of Melbourne, Alan Gilbert Building, Parkville, 3010 Australia
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McGrail MR, O’Sullivan BG, Russell DJ. Rural training pathways: the return rate of doctors to work in the same region as their basic medical training. HUMAN RESOURCES FOR HEALTH 2018; 16:56. [PMID: 30348164 PMCID: PMC6198494 DOI: 10.1186/s12960-018-0323-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/10/2018] [Indexed: 05/28/2023]
Abstract
BACKGROUND Limited evidence exists about the extent to which doctors are returning to rural region(s) where they had previously trained. This study aims to investigate the rate at which medical students who have trained for 12 months or more in a rural region return to practice in that same region in their early medical career. A secondary aim is to investigate whether there is an independent or additional association with the effect of longer duration of rural exposure in a region (18-24 months) and for those completing both schooling and training in the same rural region. METHODS The outcome was rural region of work, based on postcode of work location in 2017 for graduates spanning 1-9 years post-graduation, for one large medical program in Victoria, Australia. Region of rural training, combined with region of secondary schooling and duration of rural training, was explored for its association with region of practice. A multinomial logistic regression model, accounting for other covariates, measured the strength of association with practising in the same rural region as where they had trained. RESULTS Overall, 357/2451 (15%) graduates were working rurally, with 90/357 (25%) working in the same rural region as where they did rural training. Similarly, 41/170 (24%) were working in the same region as where they completed schooling. Longer duration (18-24 vs 12 months) of rural training (relative risk ratio, RRR, 3.37, 1.89-5.98) and completing both schooling and training in the same rural region (RRR: 4.47, 2.14-9.36) were associated with returning to practice in the same rural region after training. CONCLUSIONS Medical graduates practising rurally in their early career (1-9 years post-graduation) are likely to have previous connections to the region, through either their basic medical training, their secondary schooling, or both. Social accountability of medical schools and rural medical workforce outcomes could be improved by policies that enable preferential selection and training of prospective medical students from rural regions that need more doctors, and further enhanced by longer duration of within-region training.
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Affiliation(s)
- Matthew R. McGrail
- University of Queensland, Rural Clinical School, 78 on Canning Street, Rockhampton, QLD 4700 Australia
| | - Belinda G. O’Sullivan
- Monash Rural Health, Monash University, 26 Mercy Street, Bendigo, VIC 3550 Australia
| | - Deborah J. Russell
- Flinders University, Northern Territory, PO Box 41326, Casuarina, NT 0815 Australia
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34
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Walters LK, McGrail MR, Carson DB, O'Sullivan BG, Russell DJ, Strasser RP, Hays RB, Kamien M. Where to next for rural general practice policy and research in Australia? Med J Aust 2018; 207:56-58. [PMID: 28701121 DOI: 10.5694/mja17.00216] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 05/26/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Dean B Carson
- Northern Institute, Charles Darwin University, Darwin, NT
| | | | | | - Roger P Strasser
- Northern Ontario School of Medicine, Laurentian University and Lakehead University, Sudbury, Canada
| | - Richard B Hays
- Mount Isa Centre for Rural and Remote Health, James Cook University, Mt Isa, QLD
| | - Max Kamien
- University of Western Australia, Perth, WA
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Lim JC, Papanastasiou C, Moore K. New Fellows Early Career Survey 2014-2017: Shift of trends in emergency medicine workforce. Emerg Med Australas 2018; 31:247-252. [PMID: 30009558 DOI: 10.1111/1742-6723.13132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Within the complex and dynamic emergency medicine workforce setting, the Australasian College for Emergency Medicine (ACEM) New Fellows (FACEMs) Early Career Survey was established in 2014 to capture information on the work profiles, future career plans and challenges experienced among new FACEMs. METHODS The voluntary online survey is distributed twice yearly to new FACEMs who gained their Fellowship the preceding 6-12 months. Eligible new FACEMs were contacted by email and invited to participate. RESULTS A representative sample of 348 (53%) of 660 eligible new FACEMs responded to the survey from 2014 to 2017. New Fellows in the 2017 cohort were less likely to have secured a specialist position at attainment of Fellowship or 6-12 months later. Compared with new FACEMs in earlier cohorts, they were significantly more likely to be working in regional areas, across multiple workplaces and in more than one area of clinical/professional practice. The proportion of new FACEMs working part-time or in casual positions (42%) remained reasonably consistent across the 4 years. Finding a specialist position and securing a permanent position were among the main challenges experienced by new FACEMs after attaining their Fellowship. CONCLUSION A shift in the employment profile of early career Fellows was observed between 2014 and 2017, with the potential push factor of limited specialist positions in metropolitan areas now starting to result in an increase in new FACEMs choosing to work in regional and rural areas and in the number working across multiple workplaces.
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Affiliation(s)
- Jolene Cj Lim
- Policy and Research Department, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia
| | - Cerissa Papanastasiou
- Policy and Research Department, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia
| | - Katie Moore
- Policy and Research Department, Australasian College for Emergency Medicine, Melbourne, Victoria, Australia
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McGrail MR, Russell DJ, O’Sullivan BG. Family effects on the rurality of GP's work location: a longitudinal panel study. HUMAN RESOURCES FOR HEALTH 2017; 15:75. [PMID: 29052504 PMCID: PMC5649059 DOI: 10.1186/s12960-017-0250-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/11/2017] [Indexed: 05/19/2023]
Abstract
BACKGROUND Reduced opportunities for children's schooling and spouse's/partner's employment are identified internationally as key barriers to general practitioners (GPs) working rurally. This paper aims to measure longitudinal associations between the rurality of GP work location and having (i) school-aged children and (ii) a spouse/partner in the workforce. METHODS Participants included 4377 GPs responding to at least two consecutive annual surveys of the Medicine in Australia: Balancing Employment and Life (MABEL) national longitudinal study between 2008 and 2014. The main outcome, GP work location, was categorised by remoteness and population size. Five sequential binary school-age groupings were defined according to whether a GP had no children, only preschool children (aged 0-4 years), at least one primary-school child (aged 5-11 years), at least one child in secondary school (aged 12-18 years), and all children older than secondary school (aged ≥ 19). Partner in the workforce was defined by whether a GP had a partner who was either currently working or looking for work, or not. Separate generalised estimating equation models, which aggregated consecutive annual observations per GP, tested associations between work location and (i) educational stages and (ii) partner employment, after adjusting for key covariates. RESULTS Male GPs with children in secondary school were significantly less likely to work rurally (inclusive of > 50 000 regional centres through to the smallest rural towns of < 5000) compared to male GPs with children in primary school. In contrast, female GPs' locations were not significantly associated with the educational stage of their children. Having a partner in the workforce was not associated with work location for male GPs, whereas female GPs with a partner in the workforce were significantly less likely to work in smaller rural/remote communities (< 15 000 population). CONCLUSIONS This is the first systematic, national-level longitudinal study showing that GP work location is related to key family needs which differ according to GP gender and educational stages of children. Such non-professional factors are likely to be dynamic across the GP's lifespan and should be regularly reviewed as part of GP retention planning. This research supports investment in regional development for strong local secondary school and partner employment opportunities.
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Affiliation(s)
- Matthew R. McGrail
- Monash Rural Health, Monash University, Northways Road, Churchill, VIC 3842 Australia
| | - Deborah J. Russell
- Monash Rural Health, Monash University, 26 Mercy Street, Bendigo, VIC 3550 Australia
| | - Belinda G. O’Sullivan
- Monash Rural Health, Monash University, 26 Mercy Street, Bendigo, VIC 3550 Australia
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