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Objective Despite increases in Commonwealth funded general practice (GP) Registrar training positions, workforce trends continue to show geographical maldistribution. This study aimed to identify Registrar attributes which describe a cohort choosing to work in rural practice. Design Cross-sectional self-report questionnaire for socio-demographics, prior training, current training pathway, measures of personality and resilience. Participants and Setting GP Registrars ( N = 452) training in either the general or rural pathways of three Registered Training Providers in three states, or training through the Australian College of Rural and Remote Medicine's independent pathway. Main outcome measure Ordinal logistic regression tested the impact of key variables on the likelihood that Registrars would settle in rural practice. Univariate analysis explored differences between groups and effects of variables. Results A significantly increased interest in rural practice was to found to exist among registrars who were male, identified themselves as being rural, had a partner who identified as being rural, were enrolled in a rural training pathway and had high levels of Cooperativeness. Conclusion We present a discriminating model combining socio-demographics, prior training and personality variables which challenges Australia to rethink Registrar attributes when training for rural general practice. With significant changes about to occur to GP training in Australia, this paper highlights the need for a more holistic approach which considers personal attributes such as Cooperativeness, rural identity and provision of geographically focused rural training pipelines to encourage Registrars to bond to individual rural communities and further develop their personal connectedness to country life and rural medical practice. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The aim of this study was to profile students undertaking placements at University Departments of Rural Health (UDRHs) and investigate factors affecting students' satisfaction and intention to enter rural practice. Design: Cross‐sectional survey comprising 21 core questions used by all UDRHs. Setting: Eleven UDRHs across Australia that support students' placements in regional, rural and remote locations. Participants: Medical, nursing and allied health students who participated in UDRH placements between July 2014 and November 2015 and completed the questionnaire. Main outcome measures: Key dependent variables were placement satisfaction and rural practice intention. Descriptive variables were age, gender, Aboriginal or Torres Strait Islander (ATSI) background, location of placement, healthcare discipline, year of study and type and length of placement. Results: A total of 3328 students responded. The sample was predominantly female (79%), the mean age was 26.0 years and 1.8% identified as ATSI. Most placements (69%) were >2 but ≤12 weeks, 80% were in Modified Monash 3, 4 or 5 geographical locations. Public hospitals and community health made up 63% of placements. Students satisfied with their placement had 2.33 higher odds of rural practice intention. Those satisfied with Indigenous cultural training, workplace supervision, access to education resources and accommodation had higher odds of overall satisfaction and post‐placement rural practice intention. Conclusions: The majority of students were highly satisfied with their placement and the support provided by rural clinicians and the UDRHs. UDRHs are well placed to provide health professional students with highly satisfactory placements that foster rural practice intention. [ABSTRACT FROM AUTHOR]

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 ( Mc Nemar- 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. [ABSTRACT FROM AUTHOR]

Objective To determine if the financial costs of teaching GP registrars differs between rural and urban practices. Design Cost-benefit analysis of teaching activities in private GP for GP vocational training. Data were obtained from a survey of general practitioners in South Australia and Western Australia. Setting and participants General practitioners and practices teaching in association with the Adelaide to Outback General Practice Training Program or the Western Australian General Practice Training. Main outcome measures Net financial effect per week per practice. Results At all the training levels, rural practices experienced a financial loss for teaching GP registrars, while urban practices made a small financial gain. The differences in net benefit between rural and urban teaching practices was significant at the GPT2/ PRRT2 (−$515 per week 95% CI −$1578, −$266) and GPT3/ PRRT3 training levels (−$396 per week, 95% CI (−$2568, −$175). The variables contributing greatest to the difference were the higher infrastructure costs for a rural practice and higher income to the practice from the GP registrars in urban practices. Conclusion There were significant differences in the financial costs and benefits for a teaching rural practice compared with an urban teaching practice. With infrastructure costs which include accommodation, being a key contributor to the difference found, it might be time to review the level of incentives paid to practices in this area. If not addressed, this cost difference might be a disincentive for rural practices to participate in teaching. [ABSTRACT FROM AUTHOR]

Objective: Evidence indicates that medical graduates with a rural background are more likely to become rural doctors than those with an urban background (the rural background effect (RBE)). Exactly why this is so has rarely been studied. This study sought to identify the role of social, environmental and economic factors in addition to isolation characterising rural environments that either explain or modify the association between rural background and becoming a rural doctorrural practice intention. Design and setting: Secondary analysis of linked databases from the Medical Schools Outcomes Database (MSOD), Australian Bureau of Statistics and other government sources. Participants: Seven thousand four hundred twenty-two commencing medical students who took part in the MSOD survey and for whom external data could be linked. Results: No social, environmental or economic factor studied or isolation significantly contributed to explaining the RBE, although there is some evidence that areas of more attractive climate strengthen the RBE. However, even when the RBE is at its weakest, it remains a strong, positive predictor of attraction to rural practice. Conclusion: Why the RBE occurs remains unexplained. Evidence was found of a reduced RBE under certain climatic conditions and personal circumstances, but further work is required to better understand why rural background is so strongly related with rural medical intention and practice. [ABSTRACT FROM AUTHOR]

Objective: To compare the all‐cause and specific‐cause death rates of Australian male farmers and farm managers aged 25–74 years, with other Australian men. Methods: Data were extracted from the Australian Bureau of Statistics Death Registration Collection covering the calendar years of 1999–2002. Denominator data for male farmers and farm managers were drawn from the 2001 Australian Population Census. Direct age‐standardized death rates were calculated and compared with the general Australian male population. Results: The 4025 male farmers or farm managers who died in this period represented 3.35% of all male deaths in the 25–74 year age range. The all‐cause death rate for farmers and farm managers (730/100 000) was 33% higher than that of the Australian male population of the same age (549/100 000) (standardized mortality ratio (SMR) = 1.33). Causes of death related to neoplasms (SMR = 1.37), circulatory disease (SMR = 1.40) and all external causes (SMR = 1.37), were all statistically higher than the comparison population. Within these groupings, ischaemic heart disease (SMR = 1.39), other circulatory disease (SMR = 1.42), prostate cancer (SMR = 2.40), lymphohaematopoietic cancer (SMR = 1.80) and transport injuries (SMR = 2.06), were all significantly higher. Conclusion: These data indicate that Australian male farmers and farm managers are a disadvantaged group in terms of health status. The elevated rates of all‐cause and specific‐cause mortality compared with the Australian comparison population, illustrate both the need and scope for further investigation of these issues. [ABSTRACT FROM AUTHOR]

Objective: Identify the most important factors associated with choosing rural medical practice. Design: Cross-sectional design using a web survey to collect quantitative and qualitative data. Participants: One hundred and ninety junior doctors - 91 interns, 99 PGY2. Main outcome measures: Choice of practice location (urban/rural), reason for choosing location, enticement to a rural location. Results: Twenty-seven per cent of junior doctors preferred a rural practice location. Preference to practice in a rural area was associated with medical placement bonding schemes, rural background, rural placement experience and being older. High levels of professional expectations and prestige were associated with a preference for an urban location. The most important reasons for choosing a practice location included consideration of partner, family and friends (35.3%), preference for a location (20.5%), lifestyle goals (19.5%) and career opportunities, specialty requirements and infrastructure (17.9%). Those who preferred an urban compared with a rural location gave more importance to factors concerning partner, family and friends. The factors that would entice a doctor to a rural location included partner and family considerations (27.0%), professional support (20.3%), and career opportunities, specialty requirements and infrastructure (16.3%). Women gave more importance to partner and family factors than men. Conclusions: Our findings support the continuation of policies that are known to encourage choice of rural practice, but highlight the need for additional strategies that consider the personal and professional needs of this generation of doctors. [ABSTRACT FROM AUTHOR]