Effects of a regional-rural immersion program in Northland, New Zealand, on returning to work in that region

Abstract

Introduction: It is well established that rural workforce outcomes are more likely among medical graduates who spend time training in non-urban areas; however, fewer studies have assessed whether graduates are more likely to return to the specific area where they undertook rural training.

Objective: This study aimed to determine whether graduates who had undertaken a regional-rural immersion program in Northland, NZ, were more likely to have returned to work in Northland as of mid-2021, relative to peers who did not participate.

Design: This prospective cohort study used longitudinal tracking survey responses, medical school administrative data and workforce outcome information. A multinomial model, accounting for other covariates, was built to determine the association between graduates practising in Northland (population ⟨ 100 000), which encompasses both rural (population ⟨ 25 000) and regional (25 000 ⟩ population ⟨ 100 000) areas, and having participated in a Northland-based immersion program during medical school. The study population was University of Auckland domestic medical students graduating between 2009 and 2018, inclusive. Immersion program participants who responded to longitudinal career tracking surveys were included in the study sample.

Findings: The final sample size was 1320 students (80% of population of interest). Graduates who undertook the Northland immersion program (n = 169) were more likely than non-participants (n = 1151) to be working in Northland as of 2020-2021 (relative risk: 3.2).

Discussion and conclusion: Regional-rural immersion programs might preferentially build workforces in that specific region; however, further research is required to understand whether these findings are generalizable, and the main reasons for this effect.

Keywords: career choice; curriculum; health workforce; medical education; rural health.

FIGURE 1

Map of NZ highlighting the Northland regional–rural area, other regional–rural areas of NZ, urban areas and University of Auckland main clinical training hubs (•). Panel (a) Map of the North Island of New Zealand showing: the Northland regional–rural area where Pūkawakawa was based; other areas of the North Island considered to be ‘other regional–rural’ (population < 100 000) and the major ‘urban’ areas. Panel (b) Map of the South Island of New Zealand showing areas considered to be ‘other regional–rural’ areas or ‘urban’ areas (named in capitals). This map does not show all the general practice placement sites

FIGURE 2

Flow diagram of study sample