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

Authors

Alexa Seal, The University of Notre Dame Australia
Matthew R. McGrail, The University of Queensland
Suzanne Bain-Donohue, School of Medicine and Psychology
Lara Fuller, Deakin University
Andrew Kirke, The Rural Clinical School of WA
David Garne, School of Medicine
Georgina Luscombe, The University of Sydney School of Medicine
Penny Allen, University of Tasmania
Julian Wright, Department of Rural Health
Julie M. Burrows, The University of Newcastle, Australia

Publication Name

BMJ 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.

Open Access Status

This publication may be available as open access

Volume

14

Issue

6

Article Number

e086850