Abstract
Medical graduates’ early career is known to be disorienting, and career decision-making is influenced by a complex set of factors. There is a strong association between rural background and rural undergraduate training and rural practice, and personal and family factors have been shown to influence workplace location, but the interaction between interest, training availability, and other work-relevant factors has not yet been fully explored. A qualitative study conducted by the Rural Clinical School of Western Australia (RCSWA) and WA Country Health Service (WACHS) explored factors influencing the decision to pursue rural work among junior doctors. Data collection and analysis was iterative. In total, 21 junior doctors were recruited to participate in semi-structured telephone interviews. Two main themes relating to the systems of influence on career decision-making emerged: (1) The importance of place and people, and (2) the broader context. We found that career decision-making among junior doctors is influenced by a complex web of factors operating at different levels. As Australia faces the challenge of developing a sustainable rural health workforce, developing innovative, flexible strategies that are responsive to the individual aspirations of its workforce whilst still meeting its healthcare service delivery needs will provide a way forward.
Highlights
The provision of adequate healthcare to rural populations is a global issue [1]
An urban location was generally perceived as being more accommodating of the demands of two careers, and there was evidence that this had resulted in some junior doctors with a rural background and rural intentions opting for an urban-based career, as this quote reveals: When I was in medical school, I was definitely thinking about going rural
‘miss out’ in terms of case exposure compared with their urban counterparts, and that this hinders their chances of being accepted into a vocational training program. This perception was reinforced by advice reportedly received from non-general practice (GP) specialist consultants and resulted in some junior doctors with strong rural intentions making the decision to remain in an urban location during their pre-vocational years, and rural-based doctors planning to relocate to the city ahead of starting to apply for their preferred training program
Summary
The provision of adequate healthcare to rural populations is a global issue [1]. In Australia, despite government initiatives implemented in recent years, including increased funding to support medical rural medical training [2], medical workforce shortages and maldistribution between urban and rural locations are ongoing issues [3]. Despite the program’s success, evidence shows that at best, 50% of rural background RCS alumni end up in rural and regional areas [7]. It is not yet known whether this relatively modest uptake is due to lack of interest or lack of opportunity. The model consists of two parts: A central part representing students’ career choice pathways, and an outer part representing the different systems of influence on career decision-making. The central part of the model broadly draws from social cognitive theory as applied to career choice [13], with students entering their training with their personal characteristics and initial interests in primary care, emerging at graduation with a choice for their future career. The study findings may contribute towards informing more effective ways to provide tailored career advice and develop career and training pathways to junior doctors and support those intending to pursue a rural career
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