Abstract
Australia is one of many countries to rely on International Medical Graduates (IMGs) to fill general practitioner (GP) positions throughout its regional, rural, and remote (RRR) communities. Current government initiatives requiring IMGs to work for specified periods in RRR areas offer only short-term solutions. The need to improve the long-term retention of IMGs practising in RRR areas has motivated this research to improve our understanding of how IMGs make decisions about where to practise. Specifically, this study sought to: (a) identify the factors that influence an IMG’s decision to remain working in RRR areas, and (b) develop a theory, grounded in the data, to explain how these factors are prioritised, evaluated and used to inform a decision to remain working in RRR areas. This study adopted a qualitative approach and employed grounded theory methods. Data collection and analysis occurred concurrently, using constant, comparative analysis, guided by theoretical sampling and data saturation. Data sources were transcripts from semi-structured interviews with IMG registrars (n = 20) and supervisors (n = 5), interviewers’ notes and analytic memos. Interviewees were all currently working in RRR areas of Queensland, Australia. The analysis involved a three-phase coding process, progressing from specific, inductive coding to abstract, abductive coding. The analysis revealed that the IMG decision-making process involves a complex, dynamic, and iterative process of balancing life goals based on life stage. Many factors are considered when assessing the balance of three main life goals: satisfaction with work, family, and lifestyle. The prioritisation and balance of these life goals can vary as the IMG moves through varying work-, family-, and age-related life stages. It is hoped that having this understanding of the complexity of the IMG decision-making process, will better equip medical educators, policy makers and support service providers to tailor services to encourage IMGs to continue practising in these regions.
Highlights
The recruitment and retention of general practitioners (GPs) to work in regional, rural and remote (RRR) communities remains a challenge for many countries [1]
This study took an exploratory, interpretivist, and qualitative approach, using grounded theory methods for data collection and analysis. This approach was appropriate because (a) little is known about the substantive area of International medical (IMG) deciding to remain working in RRR areas, (b) the aim is to describe a decision-making process, and (c) the outcomes from this study will provide invaluable insights to further improve support services for IMGs working in RRR areas [23,24,25]
At the time of the interviews, all IMGs had placements working in RRR communities in Queensland, Australia
Summary
The recruitment and retention of general practitioners (GPs) to work in regional, rural and remote (RRR) communities remains a challenge for many countries [1]. IMGs practicing in Australia benefit from government policies that facilitate their immigration to Australia, if they agree to work for a specified period of time in communities with a workforce shortage, known as the ‘tenyear moratorium’ rule [2, 11] Those who re-train as GPs are required to undertake all GP placements in RRR communities as part of this commitment. Longer-term solutions are more elusive, but could be enhanced by addressing the factors IMGs consider when choosing where to work after their period of compulsory service has ended [2] Understanding these factors may assist medical educators to tailor educational support services to facilitate IMGs’ decisions to continue practising in RRR areas, where they are needed most
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