Staying in or leaving rural practice: 1996 outcomes of rural doctors' 1986 intentions

Abstract

Objective: To examine the 1996 outcomes of a sample of Western Australian rural doctors who in 1986 had indicated their intentions to stay in or leave rural practice. Design: Postal questionnaire survey in December 1996, semi‐structured interview and feedback by doctors on a draft of this article. Participants: 91 respondents from the 101 doctors who in 1986 had filled in a questionnaire on their intentions to stay in or leave rural practice. Main outcome measures: Proportion of doctors whose actions by 1996 were at variance with their intentions in 1986, and the reasons for their change of direction. Results: 49% (22/45) of doctors who intended to leave had stayed (“stayers”) and 24% (11/46) who intended to stay had left (“leavers”). Doctors' main concerns in 1986 were overwork, lack of locum relief, professional contact with colleagues, specialist backup in emergencies, downsizing of hospital facilities, continuing medical education, and income. By 1996 stayers had solved most of these professional problems and felt they were doing a special job which made a difference to their community. Conversely, more than half the leavers were unable to solve these problems and felt disempowered and dispirited. Their most potentially solvable problems were overwork, forced deskilling and conflict with other healthcare professionals. Conclusion: Professional satisfaction was the main reason for doctors staying in or leaving rural practice. Professionally dissatisfied rural doctors reach a critical phase which they have to surmount if they are going to stay. An examination of the positive experiences of the stayers points the way to retaining at least half the potential future leavers.

Retention of general practitioners in rural Nepal: A qualitative study

“…7,10,11 This needs to look at each of the three levels described above. Respondents suggested a number of tactics: 1.…”

“…2 These include an adequate income, appropriate workload, locum provision, access to specialists for advice 3 and continuing medical education, spouse career opportunities and children's education. [4][5][6][7] The aim of this qualitative study was to define the factors impacting on Nepali doctors' decisions regarding practice location, and to explore how these factors might be addressed to improve rural retention rates.…”

Systematic review of effective retention incentives for health workers in rural and remote areas: Towards evidence‐based policy

“…[1][2][3] In Australia, the rural medical workforce shortage results from many factors, including inadequate workforce policies guiding the number of doctors in training, changing patterns of employment of doctors as new graduates seek better work-life balance, more female doctors in medical training, rationalisation of rural health services and changes in the nature of rural practice, and increased doctor mobility and decline in hours worked. 4,5 Since the early 1990s, Australian governments have responded to the rural workforce crisis with recruitment strategies and retention incentives designed to attract and keep more doctors in rural and remote regions. Unfortunately, with the exception of the large numbers of International Medical Graduates who are mandated to work in areas of workforce shortage (largely rural and remote areas to date), there is little evidence that these incentives have made any significant difference to the medical workforce supply in underserved areas.…”

Evidence‐based policy versus evidence‐based rural health care reality checks

“…Prominent among these problems was forced deskilling from the downsizing of hospital facilities. 5 Such findings have had no impact on health departments. The most recent manifestation of this problem is the 'sneaky' manner in which the South Australian Health Department, without any consultation with affected doctors, announced the downgrading of 66% of rural hospitals at 17.00 hours on Budget Day.…”