Supervision--growing and building a sustainable general practice supervisor system.

This article explores various models and ideas for future sustainable general practice vocational training supervision in Australia. The general practitioner supervisor in the clinical practice setting is currently central to training the future general practice workforce. Finding ways to recruit, retain and motivate both new and experienced GP teachers is discussed, as is the creation of career paths for such teachers. Some of the newer methods of practice-based teaching are considered for further development, including vertically integrated teaching, e-learning, wave consulting and teaching on the run, teaching teams and remote teaching. Approaches to supporting and resourcing teaching and the required infrastructure are also considered. Further research into sustaining the practice-based general practice supervision model will be required.

Workforce retention in rural and remote Australia: determining the factors that influence length of practice.

OBJECTIVES: To ascertain which factors are most significant in a general practitioner's decision to stay in rural practice and whether these retention factors vary in importance according to the geographical location of the practice and GP characteristics. DESIGN: National questionnaire survey. The method of paired comparisons was used to describe the relative importance of the retention items. SETTING: Non-metropolitan Australia, September 2001. PARTICIPANTS: A stratified sample of all rural GPs practising during April-June 2001. MAIN OUTCOME MEASURES: A rank ordering of factors influencing how long GPs stay in rural practice, and an index of their relative perceived importance. RESULTS: Professional considerations -- overwhelmingly, on-call arrangements -- are the most important factors determining GP retention in rural and remote areas. Rural doctors consistently ranked on-call arrangements, professional support and variety of rural practice as the top three issues, followed by local availability of services and geographical attractiveness. Proximity to a city or large regional centre was the least important factor. Retention factors varied according to geographical location and GPs' age, sex, family status, length of time in the practice, and hospital duties. CONCLUSIONS: A broad, integrated rural retention strategy is required to address on-call arrangements, provide professional support and ensure adequate time off for continuing medical education and recreation.

The influence of geographical location on the complexity of rural general practice activities.

OBJECTIVES: To examine the complexity of activities undertaken in general practice in relation to degree of rurality of the practice. DESIGN AND SETTING: National mail questionnaire survey across non-metropolitan Australia in July 2002. PARTICIPANTS: 1498 respondents out of 4406 GPs providing at least 375 Medicare-rebatable consultations in rural and remote locations during January-March 2002 (response rate, 35%). MAIN OUTCOME MEASURES: Responses to five sentinel measures of practice complexity. RESULTS: In general, the proportion of GPs providing complex services increases with increasing rurality or remoteness. Isolated rural and remote GPs manage myocardial infarctions to a higher level than GPs in larger rural and regional centres, are more likely to administer cytotoxic drugs, perform forensic examinations, stabilise injured patients pending retrieval, and coordinate discharge planning more often. CONCLUSIONS: The more rural or remote the area, the more likely a GP is to be regularly engaged in complex care. These findings have implications for the workload, responsibility, vocational satisfaction, need for professional education and support, and costs and remuneration of practice.