Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE

What factors contribute most to the retention of general practitioners in rural and remote areas?

Deborah J. Russell A B E , Matthew R. McGrail B C , John S. Humphreys A B and John Wakerman B D
+ Author Affiliations
- Author Affiliations

A Office of Research, School of Rural Health, Monash University, PO Box 666, Bendigo, Vic. 3552, Australia.

B Centre of Research Excellence in Rural and Remote Primary Health Care, https://www.crerrphc.org.au/.

C Gippsland Medical School, Monash University, Northways Road, Churchill, Vic. 3842, Australia.

D Centre for Remote Health, Flinders University and Charles Darwin University, PO Box 4066, Alice Springs, NT 0871, Australia.

E Corresponding author. Email: deborah.russell@monash.edu

Australian Journal of Primary Health 18(4) 289-294 https://doi.org/10.1071/PY11049
Submitted: 21 April 2011  Accepted: 2 November 2011   Published: 22 December 2011

Abstract

The objectives of this study were to measure the relative strength, significance and contribution of factors associated with rural and remote medical workforce retention. Length of stay data from two Australian GP workforce datasets, the 2008 National Minimum Data Set (4223 GPs) and a subset of the 2008 Medicine in Australia: Balancing Employment and Life dataset (1189 GPs), were separately analysed using multiple linear regression models and the results compared. Length of employment in their current practice location was the outcome measure. Consistent results were obtained across both datasets. The most important factors associated with the retention of rural and remote GPs, after adjusting for GP age, were primary income source, registrar status, hospital work and restrictions on practice location (which are linked to geographic location). Practice ownership was associated with ~70% higher retention than average, whilst undertaking hospital work in addition to routine general practice was associated with at least 18% higher retention compared with if no hospital work was undertaken. Less important factors included geographic location, procedural skills, annual leave, workload and practice size. Our findings quantify a range of financial and economic, professional and organisational, and geographic factors contributing to the retention of rural GPs. These findings have important implications for future medical workforce policy, providing an empirical evidence base to support the targeting and ‘bundling’ of retention initiatives in order to optimise the retention of rural GPs.

Additional keywords: Australia, health manpower, primary health care, rural health services, workforce.


References

Access Economics (2002) ‘An analysis of the widening gap between community need and the availability of GP services.’ (Access Economics: Canberra)

Adhikari M, Calcino G, Dickinson J (1993) Geographic mobility of general practitioners. In ‘Second national rural health conference proceedings’. (Ed. K Malko) pp. 185–192. (University of New England: Armidale, NSW)

Australian Bureau of Statistics (2010) ‘Regional population growth, Australia 2008–09.’ Cat. no. 3218.0. (ABS: Canberra) Available at http://www.abs.gov.au/AUSSTATS/abs@.nsf/allprimarymainfeatures/733F4DA1E4F5B81ECA257863000E318A?opendocument [Verified October 2011]

Australian Medical Workforce Advisory Committee (1996) The medical workforce in rural and remote Australia. Report 1996.8. AMWAC, Sydney.

Australian Medical Workforce Advisory Committee (2005) The general practice workforce in Australia: supply and requirements to 2013. Report 2005.2. AMWAC, Sydney.

Buykx P, Humphreys JS, Wakerman J, Pashen D (2010) Systematic review of effective retention incentives for health workers in rural and remote areas: Towards evidence-based policy. The Australian Journal of Rural Health 18, 102–109.
Systematic review of effective retention incentives for health workers in rural and remote areas: Towards evidence-based policy.CrossRef | 20579020PubMed |

Department of Primary Industries and Energy (DPIE) Commonwealth Department of Human Services and Health (1994) ‘Rural, remote and metropolitan areas classification: 1991 Census Edition.’ (Australian Government Printing Service: Canberra).

Dupont WD (2009) ‘Statistical modeling for biomedical researchers: a simple introduction to the analysis of complex data.’ (Cambridge University Press: New York)

Gardiner M, Sexton R, Kearns H, Marshall K (2006) Impact of support initiatives on retaining rural general practitioners. The Australian Journal of Rural Health 14, 196–201.
Impact of support initiatives on retaining rural general practitioners.CrossRef | 17032295PubMed |

Garnett S, Coe K, Golebiowska K, Walsh H, Zander K, Guthridge S, Li S, Malyon R (2008) ‘Attracting and keeping nursing professionals in an environment of chronic labour shortage: a study of mobility among nurses and midwives in the Northern Territory of Australia.’ (Charles Darwin University Press: Darwin) Available at http://cdupress.cdu.edu.au/books/documents/NTnurseandmidwifeturnover.pdf [Verified October 2011]

Hays RB, Veitch PC, Cheers B, Crossland L (1997) Why doctors leave rural practice. The Australian Journal of Rural Health 5, 198–203.
Why doctors leave rural practice.CrossRef | 1:STN:280:DyaK1c7gs1GhsQ%3D%3D&md5=233a72938a412ea43ea81d188d48a6e3CAS | 9444118PubMed |

Health Workforce Queensland, New South Wales Rural Doctors Network (2009) ‘Medical practice in rural and remote Australia: combined Rural Workforce Agencies National Minimum Data Set report as at 30th November 2008.’ (Health Workforce Queensland: Brisbane) Available at http://www.healthworkforce.com.au/downloads/Publications/MDS%20Report%202008_final_Cover_rev1.pdf [Verified October 2011]

Hoyal FM (1995) Retention of rural doctors. The Australian Journal of Rural Health 3, 2–9.
Retention of rural doctors.CrossRef |

Humphreys JS, Jones MP, Jones JA, Mara PR (2002) Workforce retention in rural and remote Australia: determining the factors that influence length of practice. The Medical Journal of Australia 176, 472–476.

Joyce CM, Scott A, Jeon S, Humphreys J, Kalb G, Witt J, Leahy A (2010) The ‘Medicine in Australia: Balancing Employment and Life (MABEL)’ longitudinal survey - protocol and baseline data for a prospective cohort study of Australian doctors’ workforce participation. BMC Health Services Research 10, 50
The ‘Medicine in Australia: Balancing Employment and Life (MABEL)’ longitudinal survey - protocol and baseline data for a prospective cohort study of Australian doctors’ workforce participation.CrossRef | 20181288PubMed |

Kamien M (1998) Staying or leaving rural practice: 1996 outcomes of rural doctors’ 1986 intentions. The Medical Journal of Australia 169, 318–321.

McGlone SJ, Chenoweth IG (2001) Job demands and control as predictors of occupational satisfaction in general practice. The Medical Journal of Australia 175, 88–91.

Mueller CW, Price JL (1990) Economic, psychological, and sociological determinants of voluntary turnover. The Journal of Behavioral Economics 19, 321–335.
Economic, psychological, and sociological determinants of voluntary turnover.CrossRef |

Murrow J, Nowak P, Hurst WS (2007) To protect and preserve: can switching costs help the physician shortage? Marketing Health Services 27, 22–25.

Ozolins IZ, Greenwood G, Beilby J (2004) Keeping women doctors in the country. Rural and Remote Health 4, 268. Available at http://www.rrh.org.au/articles/showarticlenew.asp?ArticleID=268 [Verified October 2011]

Perkins D, Larsen K, Lyle D, Burns P (2007) Securing and retaining a mental health workforce in Far Western New South Wales. The Australian Journal of Rural Health 15, 94–98.
Securing and retaining a mental health workforce in Far Western New South Wales.CrossRef | 17441817PubMed |

Productivity Commission (2005) Economic implications of an ageing Australia. Productivity Commission research report. Productivity Commission, Canberra.

Ulmer B, Harris M (2002) Australian GPs are satisfied with their job: even more so in rural areas. Family Practice 19, 300–303.
Australian GPs are satisfied with their job: even more so in rural areas.CrossRef | 11978724PubMed |

World Health Organization (2009) Increasing access to health workers in remote and rural areas through improved retention. Background paper. World Health Organization, Geneva.



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