Building general practice training capacity in rural and remote Australia with underserved primary care services: a qualitative investigation

Abstract

Background Australians living in rural and remote areas have access to considerably fewer doctors compared with populations in major cities. Despite plentiful, descriptive data about what attracts and retains doctors to rural practice, more evidence is needed which informs actions to address these issues, particularly in remote areas. This study aimed to explore the factors influencing General Practitioners (GPs), primary care doctors, and those training to become GPs (registrars) to work and train in remote underserved towns to inform the building of primary care training capacity in areas needing more primary care services (and GP training opportunities) to support their population’s health needs. Methods A qualitative approach was adopted involving a series of 39 semi-structured interviews of a purposeful sample of 14 registrars, 12 supervisors, and 13 practice managers. Fifteen Australian Medical Graduates (AMG) and eleven International Medical Graduates (IMG), who did their basic medical training in another country, were among the interviewees. Data underwent thematic analysis. Results Four main themes were identified including 1) supervised learning in underserved communities, 2) impact of working in small, remote contexts, 3) work-life balance, and 4) fostering sustainable remote practice. Overall, the findings suggested that remote GP training provides extensive and safe registrar learning opportunities and supervision is generally of high quality. Supervisors also expressed a desire for more upskilling and professional development to support their retention in the community as they reach mid-career. Registrars enjoyed the challenge of remote medical practice with opportunities to work at the top of their scope of practice with excellent clinical role models, and in a setting where they can make a difference. Remote underserved communities contribute to attracting and retaining their GP workforce by integrating registrars and supervisors into the local community and ensuring sustainable work-life practice models for their doctors. Conclusions This study provides important new evidence to support development of high-quality GP training and supervision in remote contexts where there is a need for more GPs to provide primary care services for the population.

An exploration of the experiences of GP registrar supervisors in small rural communities: a qualitative study

“…Of the scant literature on this topic, one study [13] interviewed rural GP supervisors in NSW and Victoria, not restricted to rural settings, finding that GPs are motivated to supervise by personal and professional factors, including professional development reasons, and because it was rewarding. A further study to inform growth of GP training in remote Queensland identified that supervising GP registrars in remote communities could be a way to enable unique high quality and team-based learning but practice busy-ness was a concern [14].…”

General practice training in regional and rural Australia: A cross‐sectional analysis of the Registrar Clinical Encounters in Training study

“…5,6 As well as serving workforce imperatives, rural GP training offers particular training experiences 7 including increased exposure to complex medical and surgical care, 8 as well as unique learning experiences for registrars, including increased scope of practice. 9 Rural practice might also entail considerable challenges and stress for registrars, including perceived greater workload and responsibility, 7 burnout 9 and perceived higher risk of occupational violence. 10 Understanding the epidemiology of registrars' training experience in rural and regional areas, compared to urban areas, is important for Australian GP training and for rural communities.…”

An exploration of the experiences of GP registrar supervisors in small rural communities: a qualitative study

“…Many (14) participants undertook supervision in the hope of securing a doctor to support their succession planning, but there were few instances where this directly occurred. One participant, considering the seemingly insurmountable di culties of recruiting doctors to remote Tasmania, re ected "you can't conscript … I'd like to, but [we're] not allowed to" (#6, <5 FTE, remote).…”

“…Of the scant literature on this topic, one study (13) interviewed rural GP supervisors in NSW and Victoria, not restricted to rural settings, nding that GPs are motivated to supervise by personal and professional factors, including professional development reasons, and because it was rewarding. A further study to inform growth of GP training in remote Queensland identi ed that supervising GP registrars in remote communities could be a way to enable unique high quality and team-based learning but practice busy-ness was a concern (14).…”