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GENERAL practitioners’ decisions to work in rural areas are significantly influenced by the educational stages of their children and whether their spouses or partners are in the workforce.
A recently published study has found that GPs who are partnered and have children are influenced by their families’ needs, regarding whether to live and work in rural centres.
Much has been written about the need for rural retention of doctors, including initiatives such as increasing rural medical education, bonded placements, and compulsory rural rotations for GP and specialist trainees. Financial incentives are also offered to doctors who take up rural positions. It is always tricky to entice doctors to rural and remote areas, especially when they haven’t originated from there.
This most recent study looked at how family requirements influenced rurality of GP work location and the differences by GP gender and educational stage of their children. It is the first systematic, national longitudinal study looking at non-professional factors playing roles in GP practice location choices. Data were obtained from the first seven annual waves of the MABEL survey (Medicine in Australia: Balancing Employment and Life, 2008–2014) and analysed responses of 4377 GPs who completed at least two consecutive surveys, 18 333 observations overall.
They found that male GPs were significantly less likely to work in rural centres if their children were of secondary school age than if they were single, childless or had primary school-aged children (estimated odds ratios [ORs] ranging between 0.83 and 0.90; P < 0.05). These findings perhaps reflect the rural reality of fewer secondary schools and teachers, less educational opportunities and reduced literacy compared with metropolitan areas. It’s no secret that doctors are generally high achievers and tertiary education is often a priority. Parents aspiring for their children to attend competitive tertiary institutions to enhance their future career prospects naturally will be influenced by the perceived quality of secondary school education. Male rural GPs outnumber females. As traditional “breadwinners”, male GPs might be returning to the city to support their children through the all-important secondary school years. However, these moves did not reverse upon their children’s school completion, reflecting that it’s unlikely for ageing GPs to relocate rurally.
Interestingly, the work locations of female GPs were not significantly affected by their children’s school age. Female GPs who were mothers were less likely to work rurally than female GPs without children, but the difference was not statistically significant. It was suggested that female GPs with children perhaps choose to live in larger regional centres and cities when their children are of preschool age, for better connection to family and other supports, and to enable more employment opportunities for their partners. It may be stereotyping, but more women are traditional primary carers. Longer work hours and more on-call commitments go hand-in-hand with rural practice and possibly influence female GPs who are mothers to choose urban centres.
Gender differences were also apparent if a GP’s partner was in the workforce or not. Having a partner in the workforce was not associated with work location for male GPs who, partnered or single, had similar odds of working rurally or not. Female GPs with a partner in the workforce were significantly less likely to work rurally (in areas with less than 15 000 population) than female GPs without a partner in the workforce (OR, 0.89; P = 0.036).
These findings may not be revelatory, but they offer insight into the genuine work–life concerns of GPs. Not only do they help to inform the strategies for ongoing retention of the rural medical workforce, but they also show that a GP’s decision making about living and working in a rural area is never solely about their practice and financial remuneration. Their family needs – education for children and employment for partners – still appear to be paramount for them to want to remain in a place long term.
Venita Munir is a non-practising emergency physician, writer and editor, writing for MABEL (Medicine in Australia: Balancing Employment and Life), at the Melbourne Institute of Applied Economic and Social Research, University of Melbourne.
This article used data from the MABEL longitudinal survey of doctors conducted by the University of Melbourne and Monash University (the MABEL research team). Funding for MABEL comes from the National Health and Medical Research Council (Health Services Research Grant: 2008–2011; and the Centre for Research Excellence in Medical Workforce Dynamics: 2012–2017) with additional support from the Department of Health (in 2008) and Health Workforce Australia (in 2013). The MABEL research team bears no responsibility for how the data have been analysed, used or summarised in this article.
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I am pleased that the data confirms our long-held understanding of the ‘H’ in the HR..
Interestingly, we talk about university placements/bonding (which has been shown NOT to work in terms of rural workforce retention) and JMO compulsory rotations to the country. Comments from Greg, the physician, are also very telling – feeling supported when in training and knowing that our family is employed/socially supported are of utmost import in the earlier years of family life – and hence POST GRADUATE TRAINING.
We need to talk about barriers to rural workforce attraction and retention in the post-graduate sphere as much as medical school. JMOs are forming social networks, learning skills and looking for a path – and if they want to go rural, ‘the powers that be’ should be administratively and bureaucratically making this happen.
People who haven’t grown up in the country may well wish to live/work in rural areas, however cannot readily train in the country toward any Australian specialty, including AGPT training. Almost invariably, moving geographical training location frequently is an ‘accepted’ (facetiously, i mean currently unchangeable) expectation when training with any RTO toward fellowship – or TRYING to get into fellowship training… This does nothing to help attract nor retain rural doctors. ACRRM has made significant inroads in this area in Qld.
Specialty training of any nature is much more feasible when the entire family is based in an urban or rural centre. What are the odds of a newly minted specialist or generalist (and their partner who may or may not also be a health professional or doctor in training) moving to a rural area where they have no network and no investment?
Likely the family also has significant debt associated with housing, etc. Social capital is hardest to account for in this scenario and the richest incentive we have to offer in the country – and probably a huge incentive in workforce retention in rural areas.
Our training programs need to change to accommodate our families if our rural workforce situation is to change… There needs to be reliable training, educational support and early investment in a career path for JMOs who want to work rurally – if we build it, they will come.
These findings are not unexpected, surely. In my own case, I was required by Qld Health to work in small regional and rural hospitals for several months after completing my internship, in order to be offered the opportunity to return to a tertiary hospital subsequently to commence basic physician training. Any thoughts I may have had of non-urban practice as a career option rapidly disappeared when I discovered that there were many medical situations in the country which I was expected to deal with on my own, but had not been trained for. I have no reason to think that the situation has improved.
It is also worth keeping in mind that most medical practitioners are well into their thirties by the time postgraduate training is completed and so are less likely to be interested in working for a few years in the country than in my time, when we were typically in our mid-twenties after the internship.
It is great to have what had been expected actually demonstrated, especially in leading into discussions with the new rural health commissioner.
To think that money and time was spent on such a “study”. For many years these workforce findings have been quite obvious to anyone living in a country town.