choosing a career in rural practice in queensland
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Choosing a career in rural practice in Qld
R. B. Hayes, A. Nichols, A. Wise, P. Adkins, M. Craig and M. Mahony
The Australian Journal of Rural Health © Volume 3 Number 4, November 1995
Aust. J. Rural Health (199.5) 3, 171-174
Original Article
CHOOSINGACAREERINRURAL PRACTICEINQUEENSLAND
IGeneral Practice and Rural Health, North Queensland Clinical School, University of
Queensland, Townsuille, “Postgraduate Medical Education Committee2 University of
Queensland, Brisbane; and 3RACGP T raining Program, Brisbane, -Australia
ABSTRACT: As part of a broader investigation into the training needs of rural doctors, the
reasoning behind decisions of graduates to enter rural practice in i\;orth Queensland was explored.
North Queensland is a growing and diverse region that is home to 500 000 people but has had no
local production of medical graduates. FhiIe prior rural exposure xas found to be a powerful
injluence on the decision of some; a small number of those interviezced entered rural practice
almost by chance, liked it and t s aj.ed. Should this finding be conjirmed in more formal
investigation> zcorkforce planners zc;ozrld need to continue initiatives to recruit graduates who have
no prior connection to rural Eij%
KEY WORDS: recruitment, rural doctors: rural practice.
INTRODUCTION
During a recent meeting of medical students held
to discuss their future career options, one student
said quite sincerely that he could not imagine lil--
ing anywhere without a view of the ocean. Such
comments reflect the genuine fear of man!- city-
raised medical students that life axray from the
large coastal cities would be unbearable. It is
quite understandable that most would prefer to
work in an environment the)- understand: close to
family and friends. This is a concern to medical
workforce planners because the majorit!- of med-
ical students are raised and educated in large
cities. Medical school curricula are metropolitan-
Correspondence: R. B. Hays, PO Box 3394hIC, Townsville, Qld 4810, Australia.
Accepted for publication March 1995.
centred, yet the major workforce imbalance in
Australia is a shortage of doctors in rural and
remote communities, coupled with an oversupply
in the larger cities.1
The influence of prior rural experience in
choosing a career in rural medicine is well docu-
mented. Students with a rural background have
been shoxn to be fii\-e times more likely in the
USA’-4 and four times more likely in Australia”
than their urban background colleagues to enter
rural practice. Similarlv. students who have clini-
cal attachments in either their undergraduate or
postgraduate training are more likely to enter
rural practice.6-s It is not surprising, therefore,
that there haT-e been calls in Australia to increase
the recruitment of rural background students into
medical schools9 and to increase the length of
rural clinical attachments during the course.10
These issues are being addressed in Queensland
172 AUSTRALIAN JOURNAL OF RURAL HEALTH
through the establishment of academic general
practice units in Townsvillel” and in Toowoomba.
However, the importance of early rural experi-
ence in the career decisions of rural doctors in
Queensland is not known. The recent finding that
62% of the 4887 rural doctors in Queensland had
no rural connections prior to entering rural prac-
ticelz appears at odds with research elsewhere,
although this could be explained by the Queens-
land Health scholarship scheme. Since 1948, the
Government has recruited rural doctors through
this scheme, w-hich provides financial assistance
during undergraduate training in exchange for at
least 2 years service in rural practice after gradu-
ation. Although scholarship holders do not neces-
sarily have any long term commitment to rural
practice, the scheme has had moderate success in
staffing rural hospitals and some doctors remain
in rural practice for substantial periods of time. A
similar scheme was introduced in New South
Wales in 1990.
This paper reports on an investigation of the
reasoning behind the decisions of graduates cur-
rently practising in rural North Queensland to
enter rural practice, in order to improve initia-
tives to recruit medical graduates to a distant,
predominantly rural region such as North
Queensland.
METHODS
Following on from previous research into the
training needs of rural doctors in Queensland,l”J3
a stratified sample (according to the Rural and
Remote Areas Classification)14 of 23 out of
approximately 140 rural doctors in North Queens-
land was selected for further investigation
through the use of a structured interview. All doc-
tors who were approached for an interview
accepted. Interviews took place in the communi-
ties of the selected doctors. All questions and
probes were designed to explore, in greater depth,
issues emerging from the earlier questionnaire
stage. 13 Interviews were audiotaped and tran-
scribed for analysis.
RESULTS
Most of the 23 rural doctors interviewed nomi-
nated experience of rural life prior to their pre-
sent position as being important to their decision
to practise medicine in a rural location. However,
this was not always in the formative years (up to
the age of 18). Nine of the 23 doctors were raised
and educated in a rural community and regarded
this as the reason why they felt comfortable living
and working in a small community. This was par-
ticularly so for the doctors in smaller, more
remote communities (see Table 1).
These comments support the view that early
exposure to rural life appears to have an influ-
ence on either the choice of, or the satisfaction
with, a rural career. These early impressions are
deep, and an affinity with the bush frequently
comes from a history of family association with a
particular area. This kind of orientation provides
an emotional connection with, an understanding
of, and a firm commitment to, the welfare of the
rural community.
Undergraduate clinical attachments did not
appear to have been as important to those inter-
viewed. This appears at first to conflict with find-
ings elsewhere,6-8 although undergraduate rural
attachments were rare at the time that most inter-
viewees were medical students.
For those who had no rural life experience
before entering medical school, non-metropolitan
clinical attachments after graduation appear to
have been an important influence (see Table 2).
Early postgraduate work in a non-
metropolitan area was also rated as important. For
some the important non-metropolitan clinical
experience was not rural, but in the provincial
cities which serve a rural hinterland. In most
cases, the rural doctors entered rural practice in
the hinterland of the provincial city where they
had completed their intern and/or RMO years.
This finding reinforces the value of encouraging
provincial city hospitals to be primary employers
of junior medical staff and to actively recruit
recent graduates, as an important step in increas-
ing the number of doctors in their service area.
CAREERS IN QLD RL’R;\L PRACTICE: R. B. H;\l-5 ET .-IL. 173
TABLE 1: Doctors’ comments regarding their decisions to practise in a rural area (with rural 1zjk e.yerierzce)
Doctor 9 I’ve been in and out of the back countrx- el-er since I was nine years old. MJ~ father xas on the land and
his before him, I’m steeped in it, and even though I grew LIP in the city and was trained there. I went
back as often as I could and lived with these people, mustered with them I haI-e no difficulty
feeling very comfortable here, I know the tough times. I know the boom times. I knox the drought
times.
Doctor 4 . . my parents come from Indonesia. I like the tropics.. . I wanted to be a resort doctor in an isolated
area rather than a city area.
Doctor 10 I like the country lifestyle (because of earl? influences).
Doctor 16 . . I was born in Innisfail, went Lo school here in m! primary school !-ears and hadn’t really made up
my mind to end LIP here but it was alwal~s in the back of my mind.
Doctor 14, Probably because I leas born and bred in Innisfail. Before I went to medical school this xas the place
I wanted to practise.
Doctor 20 My grandfather practised in a rural commnnit!-.
Doctor 19 I xas born in the countq and it seemed the xay to go.
Doctor 17 MI!- rvife did come from the counts>-. She \\-a~ born in the Darling Dor+-ns area. but I haT-e also spent a
bit of time in the counts?- during uni\~eraity holidays, working in various fields of the countlT - cotton
picker, kangaroo shooter and x arious other things. I enjoy the bush and rras happl~ to go out there.
Doctor 22 (The most important thing T\-as) being bwm in the bush and Ii\ ing in the bush. (I jt~as raised in) North
Queensland and did all my schooling here and left to go to uni.
Doctor 21 I am very parochial, I’m from North Queensland.
TABLE 2: Doctors’ comments regarding their decisions to mrk in u rural awn (zriihout rural life experience)
Doctor 13 I did three or four locums in A!-r . three different loc~uns in Innisfail __ I uanted a quiet life.
Doctor 7 . . .the opportunit>j came LIP to be the rural reliever at the one doctor hospital in Cape 1-ork. four days a
month . , that \vas quite an interesting job and I was happy with that.
Doctor 6 I went to SIackal- as a resident. liked Mackay, liked Queensland. and sta!-ed.
Doctor 1 Probabl!- the single most important factor in what’s determined m!- career was the fact that I did my
intern J-ear in a base hospital xhich is smaller than the usual size hospital. a non-teaching hospital
and that happened in Darwin that proyoked interest ._. and I think that fact more than anything
else has led me to sta!- in or come back to rural practice.
Doctor 2 . I went to Cairns because I Lnex I would be going to the country _. halming m!- internship in a
provincial centre . x$-as a good prepardtion.
The interviews also shed some light on other
circumstances that led doctors to enter rural
practice. One doctor with no prior iural experi-
ence was a State Scholarship holder and had
stayed in a remote practice for 7 !~ears. He stated:
‘I was told to come, I was bonded and therefore I
came for twelve months . . . and 1.1-e liked the
lifestyle, I’ve liked the work I do and decided to
stay’ (Doctor 15).
Others were in frustrating city positions and
harboured a desire to do something different, for
example: -I’d been worI;ing overseas and came
back and xas doing some administration at (a
Brisbane hospital) which I found particularly
depressing and I decided to go back to general
practice _. . I’T-e alrral-s had horses . . . so I’ve got
an interest in the country’ (Doctor 11); and ‘I
worked in Glasgow and spent my time writing
prescriptions and referral letters.. .’ (Doctor 18).
174 AUSTRALIANJOURNALOFRURALHEALTH
CONCLUSION 4
These findings, although based on statements by
a small sample of rural doctors, indicate that a
larger and more formal study should be con-
ducted to investigate pathways to a rural career.
The role of the State Scholarship scheme as both
a confounding variable and a strategy for address-
ing the problem requires further exploration. Pos-
itive experiences in a rural community during
postgraduate training (or even later) may still be
influential in subsequent career choice. More
postgraduate training positions should be offered
in provincial cities and rural centres. Initiatives
to attract graduates without a rural background
should continue.
5
Stratton TD, Geller JM, Ludtke RL, Fickenscher
KM. Effects of an expanded medical curriculum
on the number of graduates practising in a rural
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6 Ebbesson SOE. The Alaska WAMI program: A
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choice and practice location. Alaska Medicine
1988; 30: 55-60.
7
8
ACKNOWLEDGEMENTS
The authors gratefully acknowledge the funding
provided by the Research and Development
Grants Advisory Committee.
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