Urban washout: how strong is the rural-background effect?

OBJECTIVE: To test predictors of practice location of fully qualified Monash University Bachelor of Medicine, Bachelor of Surgery (MBBS) graduates. DESIGN: Cohort survey, 2011. SETTING: Australia. PARTICIPANTS: Rural (n = 67/129) and urban (n = 86/191) background doctors starting at Monash University 1992-1999. Approximately 60% female, 77% married/partnered, 79% Australian-born, mean age 34 years, 31% general practitioners, 72% fully qualified and 80% training/practising in major cities. MAIN OUTCOME MEASURES: First and current practice location once fully qualified. Intended practice location in 5-10 years. RESULTS: Logistic regression found that rural versus urban background was a significant predictor of rural (outside major city) first practice location (odds ratio (OR) 5.0, 95% confidence interval (CI) 1.3-19.2) and rural current practice location (OR 5.6, 95% CI 1.5-21.2) for fully qualified doctors. General practitioner versus other medical specialists significantly predicted first (OR 7.2, 95% CI 2.1-25.2) or current (OR 3.6, 95% CI 1.1-11.9) rural practice location. Preference for a rural practice location in 5-10 years was predicted by rural background (OR 4.4, 95% CI 1.6-11.8) and positive intention towards rural practice upon completing MBBS (OR 4.6, 95% CI 1.7-12.6). Surveyed in 2011, 28% of those who also responded to the 2006 survey shifted their preferred future practice location from rural to urban communities versus 13% shifting from urban to rural (McNemar-Bowker test, P = 0.02). CONCLUSION: The majority of fully qualified Monash MBBS graduates practicing in rural communities have rural backgrounds. The rural-background effect diminished over time and may need continued support during training and full practice.

Starting rural, staying rural: how can we strengthen the pathway from rural upbringing to rural practice?

OBJECTIVE: To determine if selecting rural background students into the Monash Bachelor of Medicine and Bachelor of Surgery (MBBS) program affects vocational training location and intended practice location after training. DESIGN: Retrospective cohort mail survey. SETTING: Australia. PARTICIPANTS: Rural-background students at Monash 1992-1994 (n=24/40) and 1995-1999 (n=59/120) and urban background students (n=36/93 and 104/300, respectively). Overall study population: 62% female, average age of 28 years; 79% Australian-born; and 60% married/partnered. INTERVENTIONS: Rural or urban background, rural undergraduate exposure. MAIN OUTCOME MEASURES: Intent towards rural medical practice, vocational training location and subsequent practice location. RESULTS: There was a positive and significant (P ≤0.05) association between rural background and rural practice intent when respondents began (10-times higher than urban graduates) and completed (three times higher) their MBBS course. Rural practice intent increased fourfold in urban background graduates. There was a positive and significant association between rural background and preferred place of practice in 5-10 years in a Rural, Remote and Metropolitan Area (RRMA) 3-7 community (three times higher). There was a positive, but non-significant association between rural background and RRMA 3-7 community as their current location and first place of practice once vocationally qualified. CONCLUSIONS: Interest in rural practice is not fully reflected in location during or after vocational training. The beneficial effects of rural undergraduate exposure might be lost if internship and vocational training programs provide insufficient rural clinical experiences and curriculum content. Continuation of the rural pathway might be needed to maintain rural practice intent.