Rural clinical school experience vital to retention of country doctors

13 April 2022

Medical graduates who spend an extended time in a rural clinical school are more likely to practice in rural and remote areas than those who have not, according to a study published in the Medical Journal of Australia.

The research team was led by University of Notre Dame Australia’s Dr Alexa Seal and included The University of Queensland’s Associate Professor Matthew McGrail.

“The Australian government has invested heavily in programs encouraging doctors to practise in rural and remote areas,” Dr Seal wrote.

“The inadequate level of the rural medical workforce, limited training opportunities, fears of social and professional isolation, and restricted employment opportunities for partners influence junior doctors when deciding where to train and practise.

“It is important to follow graduates over time to assess whether their early intentions about practice location are later realised.”

The team assessed associations between the geographic origin and extended rural clinical school (RCS) experience of 2011 domestic medical graduates from 10 Australian medical schools and practice location eight years after graduation, as well as with changes in practice location between postgraduate years five and eight.

“Eight years after graduation, rural origin graduates with extended RCS experience were more likely than metropolitan origin graduates without this experience to practise in regional or rural communities,” they reported.

“Concordance of location type five and eight years after graduation was 92.6 per cent for metropolitan practice (84 of 1136 graduates had moved to regional/rural practice, 7.4 per cent), 26 per cent for regional practice (56 of 95 had moved to metropolitan practice, 59 per cent), and 73 per cent for rural practice (20 of 100 had moved to metropolitan practice, 20 per cent).

“Metropolitan origin graduates with extended RCS experience were more likely than those without it to remain in rural practice or to move to rural practice.”

UQ’s Dr McGrail, Faculty of Medicine’s Head of Regional Training Hub Research, said the study notably focused on graduates’ work locations at set points over the eight years.

“It is important to not only count those working rurally at a point in time but also to observe longitudinally who stays in, leaves or returns to rural areas,” Dr McGrail said.

“Our study found that the rural clinical school experience, both of metropolitan origin and rural origin students, related to more continuing in rural areas and more moving from metropolitan to rural areas.”

The researchers suggested that early educational interventions such as the selection of medical students with rural backgrounds, and extended RCS placements continued to influence graduates’ choices up to 8 years after graduation.

“The net movement of doctors from metropolitan to rural practice could be augmented by recruiting more rural origin students and broadening opportunities for extended rural training.

The research team concluded the “findings reinforce the importance of developing and maintaining longitudinal rural and regional training pathways, and of the RCSs, regional training hubs, and the rural generalist training program in coordinating these initiatives.”

The research is published in the Medical Journal of Australia (DOI: 10.5694/mja2.51476)