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

Alexa Seal; Matthew R McGrail; Suzanne Bain-Donohue; Lara Fuller; Andrew Kirke; David Garne; Georgina Luscombe; Penny Allen; Julian Wright; Julie M Burrows

doi:10.1136/bmjopen-2024-086850

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 Jun 17;14(6):e086850. doi: 10.1136/bmjopen-2024-086850.

Authors

Affiliations

¹ School of Medicine Sydney, Rural Clinical School, The University of Notre Dame Australia, Wagga Wagga, New South Wales, Australia Alexa.seal@nd.edu.au.
² Rural Clinical School, University of Queensland, Rockhampton, Queensland, Australia.
³ Rural Clinical School, School of Medicine and Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia.
⁴ Rural Community Clinical School, Deakin University Faculty of Health Medicine Nursing and Behavioural Sciences, Colac, Victoria, Australia.
⁵ Rural Clinical School of Western Australia, The University of Western Australia, Perth, Western Australia, Australia.
⁶ Graduate School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia.
⁷ The School of Rural Health, Sydney Medical School, The University of Sydney, Orange, New South Wales, Australia.
⁸ Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia.
⁹ Department of Rural Health, Rural Clinical School, The University of Melbourne, Shepparton, Victoria, Australia.
¹⁰ The University of Newcastle, Tamworth, New South Wales, Australia.

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.

Keywords: health services accessibility; health workforce; medical education & training.

MeSH terms

Adult
Australia
Career Choice
Cohort Studies
Education, Medical, Graduate / statistics & numerical data
Female
General Practitioners / education
Humans
Male
Professional Practice Location* / statistics & numerical data
Rural Health Services
Specialization / statistics & numerical data
Universities