Association between rural exposure/experience and practice location 10 years postgraduation, stratified by specialty: evidence from a cohort study of graduates from nine Australian universities

Abstract

Objective: This study aims to determine the associations between specialty type and practice location at postgraduate year 10 (PGY10), matched with PGY5 and PGY8 work locations, and earlier rural exposure/experience.

Design and setting: A cohort study of medicine graduates from nine Australian universities.

Participants: 1220 domestic medicine graduates from the class of 2011.

Outcome measures: Practice location recorded by the Australian Health Practitioner Regulation Agency in PGY10; matched graduate movement between PGYs 5, 8 and 10 as classified by the Modified Monash Model, stratified by specialty type (predominantly grouped as general practitioner (GP) or non-GP).

Results: At PGY10, two-thirds (820/1220) had achieved fellowship. GPs were 2.8 times more likely to be in non-metropolitan practice (28% vs 12%; 95% CI 2.0 to 4.0, p<0.001) than graduates with non-GP (all other) specialist qualifications. More than 70% (71.4%) of GPs who were in non-metropolitan practice in PGY5 remained there in both PGY8 and PGY10 versus 29.0% of non-GP specialists and 36.4% of non-fellowed graduates (p<0.001). The proportion of fellowed graduates observed in non-metropolitan practice was 14.9% at PGY5, 16.1% at PGY8 and 19.0% at PGY10, with this growth predominantly from non-GP specialists moving into non-metropolitan locations, following completion of metropolitan-based vocational training.

Conclusions: There are strong differences in practice location patterns between specialty types, with few non-GP specialists remaining in non-metropolitan practice between PGY5 and PGY10. Our study reinforces the importance of rural training pathways to longer-term work location outcomes and the need to expand specialist vocational training which supports more rural training opportunities for trainees outside general practice.

Keywords: health services accessibility; health workforce; medical education & training.

Figure 1

Flow of graduates over time between metropolitan and regional/rural areas in (a) GPs, (b) non-GP specialists and (c) non-fellowed graduates (GP: general practitioner; PGY: postgraduate year; purple represents a metropolitan practice location and green represents a non-metropolitan practice location in PGY5).

Figure 2

Practice location of graduates at postgraduate year 10 by graduate group and specialty (MO: metro origin; RCS: rural clinical school; RO: rural origin; percentage at the end of row represents total in non-metropolitan practice).