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PhD Doctorate The peer reviewed publications contained in this thesis provide clear evidence that the broad characteristic 'rural background' is an important independent predictor of rural practice. Rural background was explored in several ways: primary and secondary home and schooling; location of undergraduate and postgraduate training and finally partner's primary and secondary home and schooling. What influences a doctor to practice in a rural location is complex but for the 2414 GPs who are represented in this thesis we now know that rural background, special entry programs, 'place of education' and partners background were associated with rural practice. The publications are representative of the stages of the thesis. The systematic review identified factors relating to practice location explored in previous studies. The State study informed the development of the questionnaire used in the national study and the feasibility of carrying out a national study. The final stage was conducted as an observational retrospective case-control study in each state and territory (excluding the ACT) in Australia. In the publications presented in this thesis, the strength of the association between rural background and rural practice location was consistent across the factors explored and they were 2-3 times more likely to have attended a rural primary or secondary school. They were 2-3 times more likely to have a spouse/partner who had attended a rural primary or secondary school. Rural GPs were 1.6 times more likely to have experienced rural placements while at medical school and approximately 3 times more likely to have had rural postgraduate training. However, the strength of the association with postgraduate training was found to increase proportionally and when more than half of their postgraduate training was in a rural location the GP was 10 times more likely to be practising in a rural location.These findings can be applied to the broad group of Australian private practice GPs who make up the majority of the medical workforce in the primary care setting. While overseas trained medical practitioners importantly make up approximately 25% of the GP workforce in Australia, this study aimed to provide evidence to inform medical education policy in Australia. Over the last 5-10 years Australian medical schools have increased the number of rural background students studying medicine with the objective of increasing the number of graduates practising in rural locations. During this same time the opportunities for medical education to be undertaken in rural locations have also increased. This thesis supports these initiatives The future direction for workforce research now rests with prospective longitudinal research such as the Committee of Deans of Australian and New Zealand Medical Schools, Medical Schools Outcomes Database project. Following our medical students through their medical training and into their postgraduate years will allow evaluation of rural selection policies, rural programs and medical education and in time assist with medical workforce planning to increase the size of the rural medical workforce in Australia.

Objective To determine the association between rural undergraduate training, rural postgraduate training and medical school entry criteria favouring rural students, on likelihood of working in rural Australian general practice. Methods National case - control study of 2414 rural and urban general practitioners (GPs) sampled from the Health Insurance Commission database. Participants completed a questionnaire providing information on demographics, current practice location and rural undergraduate and postgraduate experience. Results Rural GPs were more likely to report having had any rural undergraduate training [ odds ratio ( OR) 1.61, 95% confidence interval (CI) 1.32 - 1.95] than were urban GPs. Rural GPs were much more likely to report having had rural postgraduate training ( OR 3.14, 95% CI 2.57 - 3.83). As the duration of rural postgraduate training increased so did the likelihood of working as a rural GP: those reporting that more than half their postgraduate training was rural were most likely to be rural GPs ( OR 10.52, 95% CI 5.39 - 20.51). South Australians whose final high school year was rural were more likely to be rural GPs ( OR 3.18, 95% CI 0.99 - 10.22). Conclusions Undergraduate rural training, postgraduate training and medical school entry criteria favouring rural students, all are associated with an increased likelihood of being a rural GP. Longer rural postgraduate training is more strongly associated with rural practice. These findings argue for continuation of rural undergraduate training opportunities and rural entry schemes, and an expansion in postgraduate training opportunities for GPs.