Exploring indicators of experiential place integration in a sample of Queensland rural practitioners: a research note

Abstract

Until recently, the focus on the universal problem of insufficient medical practitioners in rural areas had been on training and recruitment. Many of the rural workforce strategies in Australia targeted selection of medical students, medical curricula, postgraduate training and retraining experienced urban graduates. To date, there is little consistent evidence that the rural workforce situation in Australia is improving. The decision to remain in rural practice appears to be a dynamic equilibrium of positive and negative factors, and issues such as overwork and poor adaptation to role changes easily upset this equilibrium. To perform a scoping exploratory post facto review of interview data with a view to establishing the potential for a dedicated prospective study of rural GP retention. Theoretical construct of 'dimensions of integration' was used in a post facto review of in-depth interview transcripts of 17 medical practitioners who had left rural practice. The construct posited integration as an active developmental process based on three 'principles'--security, freedom and identity--which together form the basis of practitioner retention. A series of 'dimensions' (n = 27) exists within each of these principles. Many of the 27 dimensions were found to be absent, particularly for practitioners who left before they originally intended. In some cases, apparently well-established practitioners (in terms of numbers of dimensions present) left because of some external 'pulling factor'. Dimensions related to practitioner security were generally most often missing. The potential for a dedicated prospective study was established.