Survival analysis of Rural Clinical School of Western Australia graduates: the long-term work of building a long-term rural medical workforce

Abstract

Objective –Deficits in the size of the rural medical workforce is an international issue. In Australia, The Rural Clinical School intervention is effective for initial recruitment of rural doctors. However, the extent of retention is not yet established. This paper summarises rural retention over a 10-year period. Methods –Rural Clinical School graduates of STATE NAME were surveyed annually, 2006-2015, and post Graduate Years (PGY) 3-12 included. Survival was described as “tours of service”, where a tour was either a period of ≥1 year, or a period of at ≥2 weeks, working rurally. A tour ended with a rural work gap of ≥52 weeks. Considering each exit from urban as an event, semi-parametric repeated measures survival models were fitted. Results – Of 468 graduates, using the ≥2 weeks definition, 239 PGY3-12 graduates spent at least one tour rurally (average 61.1, CI 52.5 – 69.7 weeks), and a total length of 14,607 weeks. Based on the tour definition of ≥1 year, 120 graduates completed at least one tour (average 1.89, 1.69 – 2.10 years), and a total of 227 years’ rural work. For both definitions, the number of tours increased from one to four by PGY10/11, giving 17,786 total weeks (342 years) across all PGYs for the ≥2 weeks tour definition, and 256 years total for ≥1 year. Significantly more graduates exited from urban work for the 2007-09 middle cohort compared with 2010-11 (HR 1.876, p=0.022), but no significant difference between 2002-06 and 2010-11. Rural origin, age and gender were not statistically significant. Conclusions – PGY3 – 12 RCS graduates contributed substantially to the rural workforce: 51% did so by short rotations, which have not previously been described, while 26% contributed whole years of service. There was an apparent peak in entry and retention for the middle cohort and decline thereafter, likely attributable to lack of rural advanced/specialist vocational training. These data indicate a real commitment to rural practice by RCS graduates, and the need for rural postgraduate vocational training in the rural context as a key element of a successful rural retention strategy.

Income, workload, and any other factors associated with anticipated retention of rural doctors?

“…Some studies have (Win et al, 2017;Boonluksiri et al, 2018) documented a higher retention rate of medical graduates recruited via the Collaborative Project to Increase Production of Rural Doctors due to their rural background. However, an Australian survey (Gupta et al, 2019) claimed that a rural background was not associated with the timing of introduction to rural work. They highlighted the benefits of rural vocational training.…”

“…A concerted effort on the part of national and provincial stakeholders is required to support the rural physician retention strategy. Postgraduate education for rural doctors has been highlighted by many studies (Matsumoto et al, 2005;Gupta et al, 2019). It was treated as a key factor affecting rural retention.…”

“…First, the available data did not include all the variables that could affect retention: some studies had reported that undergraduate exposure (Matsumoto et al, 2005;Boonluksiri et al, 2018) and positive rural learning experiences (Larsen et al, 2017) could effectively increase the recruitment rate. Postgraduate training is a key to increase the rural retention rate (Matsumoto et al, 2005;Gupta et al, 2019). An interview study (Getzin et al, 2016) identified that efforts to enhance health equity and social justice were a major driving force for rural doctors, which brought them to and sustained their work in medicine.…”

Bases para la estructuración de un modelo en salud rural en Arauca

“…En Tasmania, por ejemplo, se garantiza atención en zonas rurales a través de estudiantes de escuelas de medicina (27). Iniciativas similares son expuestas por Gupta et al (30) con las escuelas de medicina ubicadas totalmente en áreas rurales, con prácticas en estos lugares y su posterior seguimiento a fin de verificar su adherencia a ellos como puestos de trabajo, algunos de tiempo completo y otros bajo la modalidad FIFO (first in, first out), es decir, mantienen su tiempo de trabajo entre el campo y la ciudad. En Australia también se brinda apoyo a mujeres para que den a luz cerca de casa con el programa Maternity Connect (31).…”