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Choosing a career in rural practice in Qld

R. B. Hayes, A. Nichols, A. Wise, P. Adkins, M. Craig and M. Mahony

The Australian Journal of Rural Health © Volume 3 Number 4, November 1995

Aust. J. Rural Health (199.5) 3, 171-174

Original Article

CHOOSINGACAREERINRURAL PRACTICEINQUEENSLAND

IGeneral Practice and Rural Health, North Queensland Clinical School, University of

Queensland, Townsuille, “Postgraduate Medical Education Committee2 University of

Queensland, Brisbane; and 3RACGP T raining Program, Brisbane, -Australia

ABSTRACT: As part of a broader investigation into the training needs of rural doctors, the

reasoning behind decisions of graduates to enter rural practice in i\;orth Queensland was explored.

North Queensland is a growing and diverse region that is home to 500 000 people but has had no

local production of medical graduates. FhiIe prior rural exposure xas found to be a powerful

injluence on the decision of some; a small number of those interviezced entered rural practice

almost by chance, liked it and t s aj.ed. Should this finding be conjirmed in more formal

investigation> zcorkforce planners zc;ozrld need to continue initiatives to recruit graduates who have

no prior connection to rural Eij%

KEY WORDS: recruitment, rural doctors: rural practice.

INTRODUCTION

During a recent meeting of medical students held

to discuss their future career options, one student

said quite sincerely that he could not imagine lil--

ing anywhere without a view of the ocean. Such

comments reflect the genuine fear of man!- city-

raised medical students that life axray from the

large coastal cities would be unbearable. It is

quite understandable that most would prefer to

work in an environment the)- understand: close to

family and friends. This is a concern to medical

workforce planners because the majorit!- of med-

ical students are raised and educated in large

cities. Medical school curricula are metropolitan-

Correspondence: R. B. Hays, PO Box 3394hIC, Townsville, Qld 4810, Australia.

Accepted for publication March 1995.

centred, yet the major workforce imbalance in

Australia is a shortage of doctors in rural and

remote communities, coupled with an oversupply

in the larger cities.1

The influence of prior rural experience in

choosing a career in rural medicine is well docu-

mented. Students with a rural background have

been shoxn to be fii\-e times more likely in the

USA’-4 and four times more likely in Australia”

than their urban background colleagues to enter

rural practice. Similarlv. students who have clini-

cal attachments in either their undergraduate or

postgraduate training are more likely to enter

rural practice.6-s It is not surprising, therefore,

that there haT-e been calls in Australia to increase

the recruitment of rural background students into

medical schools9 and to increase the length of

rural clinical attachments during the course.10

These issues are being addressed in Queensland

172 AUSTRALIAN JOURNAL OF RURAL HEALTH

through the establishment of academic general

practice units in Townsvillel” and in Toowoomba.

However, the importance of early rural experi-

ence in the career decisions of rural doctors in

Queensland is not known. The recent finding that

62% of the 4887 rural doctors in Queensland had

no rural connections prior to entering rural prac-

ticelz appears at odds with research elsewhere,

although this could be explained by the Queens-

land Health scholarship scheme. Since 1948, the

Government has recruited rural doctors through

this scheme, w-hich provides financial assistance

during undergraduate training in exchange for at

least 2 years service in rural practice after gradu-

ation. Although scholarship holders do not neces-

sarily have any long term commitment to rural

practice, the scheme has had moderate success in

staffing rural hospitals and some doctors remain

in rural practice for substantial periods of time. A

similar scheme was introduced in New South

Wales in 1990.

This paper reports on an investigation of the

reasoning behind the decisions of graduates cur-

rently practising in rural North Queensland to

enter rural practice, in order to improve initia-

tives to recruit medical graduates to a distant,

predominantly rural region such as North

Queensland.

METHODS

Following on from previous research into the

training needs of rural doctors in Queensland,l”J3

a stratified sample (according to the Rural and

Remote Areas Classification)14 of 23 out of

approximately 140 rural doctors in North Queens-

land was selected for further investigation

through the use of a structured interview. All doc-

tors who were approached for an interview

accepted. Interviews took place in the communi-

ties of the selected doctors. All questions and

probes were designed to explore, in greater depth,

issues emerging from the earlier questionnaire

stage. 13 Interviews were audiotaped and tran-

scribed for analysis.

RESULTS

Most of the 23 rural doctors interviewed nomi-

nated experience of rural life prior to their pre-

sent position as being important to their decision

to practise medicine in a rural location. However,

this was not always in the formative years (up to

the age of 18). Nine of the 23 doctors were raised

and educated in a rural community and regarded

this as the reason why they felt comfortable living

and working in a small community. This was par-

ticularly so for the doctors in smaller, more

remote communities (see Table 1).

These comments support the view that early

exposure to rural life appears to have an influ-

ence on either the choice of, or the satisfaction

with, a rural career. These early impressions are

deep, and an affinity with the bush frequently

comes from a history of family association with a

particular area. This kind of orientation provides

an emotional connection with, an understanding

of, and a firm commitment to, the welfare of the

rural community.

Undergraduate clinical attachments did not

appear to have been as important to those inter-

viewed. This appears at first to conflict with find-

ings elsewhere,6-8 although undergraduate rural

attachments were rare at the time that most inter-

viewees were medical students.

For those who had no rural life experience

before entering medical school, non-metropolitan

clinical attachments after graduation appear to

have been an important influence (see Table 2).

Early postgraduate work in a non-

metropolitan area was also rated as important. For

some the important non-metropolitan clinical

experience was not rural, but in the provincial

cities which serve a rural hinterland. In most

cases, the rural doctors entered rural practice in

the hinterland of the provincial city where they

had completed their intern and/or RMO years.

This finding reinforces the value of encouraging

provincial city hospitals to be primary employers

of junior medical staff and to actively recruit

recent graduates, as an important step in increas-

ing the number of doctors in their service area.

CAREERS IN QLD RL’R;\L PRACTICE: R. B. H;\l-5 ET .-IL. 173

TABLE 1: Doctors’ comments regarding their decisions to practise in a rural area (with rural 1zjk e.yerierzce)

Doctor 9 I’ve been in and out of the back countrx- el-er since I was nine years old. MJ~ father xas on the land and

his before him, I’m steeped in it, and even though I grew LIP in the city and was trained there. I went

back as often as I could and lived with these people, mustered with them I haI-e no difficulty

feeling very comfortable here, I know the tough times. I know the boom times. I knox the drought

times.

Doctor 4 . . my parents come from Indonesia. I like the tropics.. . I wanted to be a resort doctor in an isolated

area rather than a city area.

Doctor 10 I like the country lifestyle (because of earl? influences).

Doctor 16 . . I was born in Innisfail, went Lo school here in m! primary school !-ears and hadn’t really made up

my mind to end LIP here but it was alwal~s in the back of my mind.

Doctor 14, Probably because I leas born and bred in Innisfail. Before I went to medical school this xas the place

I wanted to practise.

Doctor 20 My grandfather practised in a rural commnnit!-.

Doctor 19 I xas born in the countq and it seemed the xay to go.

Doctor 17 MI!- rvife did come from the counts>-. She \\-a~ born in the Darling Dor+-ns area. but I haT-e also spent a

bit of time in the counts?- during uni\~eraity holidays, working in various fields of the countlT - cotton

picker, kangaroo shooter and x arious other things. I enjoy the bush and rras happl~ to go out there.

Doctor 22 (The most important thing T\-as) being bwm in the bush and Ii\ ing in the bush. (I jt~as raised in) North

Queensland and did all my schooling here and left to go to uni.

Doctor 21 I am very parochial, I’m from North Queensland.

TABLE 2: Doctors’ comments regarding their decisions to mrk in u rural awn (zriihout rural life experience)

Doctor 13 I did three or four locums in A!-r . three different loc~uns in Innisfail __ I uanted a quiet life.

Doctor 7 . . .the opportunit>j came LIP to be the rural reliever at the one doctor hospital in Cape 1-ork. four days a

month . , that \vas quite an interesting job and I was happy with that.

Doctor 6 I went to SIackal- as a resident. liked Mackay, liked Queensland. and sta!-ed.

Doctor 1 Probabl!- the single most important factor in what’s determined m!- career was the fact that I did my

intern J-ear in a base hospital xhich is smaller than the usual size hospital. a non-teaching hospital

and that happened in Darwin that proyoked interest ._. and I think that fact more than anything

else has led me to sta!- in or come back to rural practice.

Doctor 2 . I went to Cairns because I Lnex I would be going to the country _. halming m!- internship in a

provincial centre . x$-as a good prepardtion.

The interviews also shed some light on other

circumstances that led doctors to enter rural

practice. One doctor with no prior iural experi-

ence was a State Scholarship holder and had

stayed in a remote practice for 7 !~ears. He stated:

‘I was told to come, I was bonded and therefore I

came for twelve months . . . and 1.1-e liked the

lifestyle, I’ve liked the work I do and decided to

stay’ (Doctor 15).

Others were in frustrating city positions and

harboured a desire to do something different, for

example: -I’d been worI;ing overseas and came

back and xas doing some administration at (a

Brisbane hospital) which I found particularly

depressing and I decided to go back to general

practice _. . I’T-e alrral-s had horses . . . so I’ve got

an interest in the country’ (Doctor 11); and ‘I

worked in Glasgow and spent my time writing

prescriptions and referral letters.. .’ (Doctor 18).

174 AUSTRALIANJOURNALOFRURALHEALTH

CONCLUSION 4

These findings, although based on statements by

a small sample of rural doctors, indicate that a

larger and more formal study should be con-

ducted to investigate pathways to a rural career.

The role of the State Scholarship scheme as both

a confounding variable and a strategy for address-

ing the problem requires further exploration. Pos-

itive experiences in a rural community during

postgraduate training (or even later) may still be

influential in subsequent career choice. More

postgraduate training positions should be offered

in provincial cities and rural centres. Initiatives

to attract graduates without a rural background

should continue.

5

Stratton TD, Geller JM, Ludtke RL, Fickenscher

KM. Effects of an expanded medical curriculum

on the number of graduates practising in a rural

state. Academic Medicine 1991; 66: 101-105.

Kamien M. Report of the ministerial inquiry into

the recruitment and retention of country doctors in

W&tern Australia. Perth: University of Western

Australia, 1987.

6 Ebbesson SOE. The Alaska WAMI program: A

preliminary study of factors affecting specialty

choice and practice location. Alaska Medicine

1988; 30: 55-60.

7

8

ACKNOWLEDGEMENTS

The authors gratefully acknowledge the funding

provided by the Research and Development

Grants Advisory Committee.

REFERENCES

1 Committee of Inquiry into Medical Workforce and

Medical Education into the Zlst Century. Aus-

tralian Medical Education and Workforce into the

21st Century. Canberra: AGPS, 1988.

2 Whitcomb ME, Myers WW. Physician manpower

for rural America: Summary of a WAMI region

conikrence. Academic Medicine 1990; 65: 729-

732.

9

10

11

12

13

14

Norris TE, Norris SB. The effect of a rural precep-

torship during residency on practice site selection

and interest in rural practice. The Journal of

Family Practice 1988; 27: 541-544.

Verby JE. The Minnesota rural physician associ-

ate program for medical students. Journal of Med-

ical Education 1988; 63: 427-437.

Kamien M, Buttfield IH. Some solutions to the

shortage of general practitioners in rural Aus-

tralia. Part 1. Medical school selection. Medical

Journal of Australia 1990; 153: 105-107.

Kamien M, Buttfield IH. Some solutions to the

shortage of general practitioners in rural Aus-

tralia. Part 2. Undergraduate education. Medical

.Journal ofAustralia 1990; 153: 107-112.

Mudge l? A clinical school for North Queensland.

Medical Journal ofAustralia 1993; 159: 501..

Hays RB, Wise A, Craig ML et al. A sampling

framework for rural and remote doctors. Aus-

tralian Journal of Public Health 1994; 18:

273-276.

3 Rabinowitz HK. Relationship between US med-

ical school admission policy and graduates enter-

ing family practice. Family Practice 1988; 5:

142-144.

Wise A, Hays RB, Adkins P et al. Training for

rural practice. Medical Journal of Australia 1994;

161:314-318.

Department of Human Services and Health. Rural

and Remote Areas Classijication. Canberra:

Department of Human Services and Health, 1992.