Choice or chance! The influence of decentralised training on GP retention in the Bogong region of Victoria and New South Wales

Abstract

Attracting, training and retaining GPs in rural communities has long been the subject of intense interest and debate in medical and political circles. Government reviews and policy decisions, including the introduction of the ten-year moratorium (a strategy to place overseas-trained doctors in rural locations), have been implemented to address workforce shortages in rural Australia. In a landmark decision in 1998, a government assessment of GP training recommended dissolution of centralised general practice education and, in 2003, regional training providers began training GP registrars in a decentralised environment. This study examines the impact of the decentralised model of GP training on the retention of GPs who trained with Bogong Regional Training Network between 2004 and 2009. The study also explores the differences in perspectives of Australian and overseas-born GPs as these relate to remaining in rural practice. Registrar file data were examined and socio-demographic profiles of GPs compiled. Of a total sample of 61 doctors who had completed their GP training with Bogong, 30 agreed to participate in semi-structured interviews to discuss career path decisions. Each doctor was offered a small honorarium for participating. A response rate of 58.8% was achieved for those doctors who could be contacted. The data sets were then analysed to identify and examine themes associated with GP career path decision choices. At the end of 2009, more than 42% (n=24) of the doctors who had completed their vocational training were in rural general practice; 32% (n=18) remaining in the Bogong region. There was a significant relationship between the place of birth and remaining in rural practice, with almost three-quarters (73% n=16) of the Australian-born respondents and almost one-quarter (23% n=8) of the overseas-born respondents remaining in rural practice after fellowship (χ² = 13.68 p<0.001); but of the nine overseas-born, Australian-trained medical graduates, only one has remained in rural practice. The decentralised training model has had a positive influence on retention rates in rural practice in the Bogong region. There are cultural and regulatory differences between Australian and overseas-born doctors that profoundly influence the decision to locate and remain in rural communities with Australian-born doctors significantly more likely to remain in rural practice after the completion of training. For Australian-born doctors, informed choice draws them to rural general practice, while for overseas-born doctors, chance is a major contributing factor that influences their decisions to locate in the region. This study supports the continued development of decentralised and rural specific training pathways for Australian doctors as an effective method for attracting and retaining doctors in rural Australia during and after general practice training.