A new, Australian-led, US study has suggested training strategies to support the growth of general practice in regional areas.
The research, published August 16th in the American Journal of Graduate Medical Education, was inspired by data coming out of Canada and Australia, and focussed on the urgent need to understand how to increase the number of new doctors choosing to practice as GPs in rural or remote areas.
The team from Menzies School of Health Research, found that family medicine (or GP) residency training in rural areas was associated with a 5- to 6-fold increase in participants deciding to go on to work in a rural practice, with a positive dose effect for greater degrees of exposure.
Yet less than 10% of US graduates underwent any rural training during their residencies, and only 5% of training programs had residents working mostly in rural settings or community-based clinics.
Lead author, Menzies Senior Research Fellow Dr Deborah Russell, said that this left enormous scope for government policy to increase rural training opportunities for junior doctors.
“The findings suggest that greater investment in rural training programs – especially investments that target current gaps in rural primary care training such as during the prevocational period – could help address forecast shortages in the rural primary care workforce, which in turn could lead to more equitable health outcomes for rural populations,” Dr Russell said.
“Although Canadian and Australian studies have reported associations between duration of rural FM GME and subsequent rural practice, contemporary peer reviewed US evidence was lacking.
“We found the odds of rural practice among GP residents experiencing at least 50% rural training time were at least 5-fold higher than those who did no rural training. Equally important, even spending only a small fraction (1%-9%) of FM residency training in rural areas was associated with substantially increased odds of being in rural practice.”
Dr Russell said that the results were also relevant for ensuring that enough Australian GPs choose to work in rural and remote areas of Australia.
“Currently, Australian government policy mandates that about half of the doctors training to be GPs do their training in rural areas, which is a much greater proportion than in the US,” she said.
“However, training pathways for junior doctors are slightly different in Australia compared to the US.
“In Australia, junior doctors don’t enter specialty training pathways (such as GP training) for at least two years after graduating, and this creates a gap in their training whereby Australian junior doctors remain in hospitals, largely in metropolitan areas, and seldom have exposure to rural and remote general practice.”
The findings resonate with the lived experience of the president of the Australian Medical Students’ Association (AMSA), Jasmine Davis, who spoke about her plans to be a rural generalist and the drivers which have contributed to this choice of career, at the AMA’s National Conference, held July 29 – 31 in Sydney.
She highlighted her own regional background and the common experience of students returning to rural Australia to practice.
“Australia needs to do more to create rural doctors and that at present training is still focused entirely around metropolitan areas and universities,” Ms Davis said.
“Increased investment in medical student training and rural exposure would ensure that more students would want to go rural.”
The latest data available from the AIHW shows that in 2018 the number of GPs per 1000 people in rural and remote Australia was 2.5, compared to 4.1 per 1000 in cities, and that same year, the Australian government announced the Stronger Rural Health Strategy to build capacity in regional areas.
Further investments were made in 2021-22, expanding the Allied Health Rural Generalist Pathway to support more training in regional Australia, including additional rural primary care training rotations, and, from 1 January 2022, eliminating or all or part of the HELP debt for eligible junior doctors who chose to work in the bush after graduation.
Yet despite these steps, on 17 March 2022, the Senate Community Affairs References Committee Hearing on General practitioner and related primary health services to outer metropolitan, rural and regional Australians, heard testimony from the Chair of AMA’s Council of Rural Doctors, Dr Marco Giuseppin, and the AMA Tasmania’s Vice President and GP Council Representative, Dr John Saul, that more funding was needed to support general practice in regional Australia, including the expansion of community based rural training for junior doctors.
Dr Giuseppin co-presented with Ms Davis at the AMA National Conference, where The Council of Rural Doctors suggested that the unreliability of current data collection methods made it impossible to develop policies and programs to support the right number of GPs in rural areas.