Connection key to retaining rural GPs: Study

A supportive clinic, work-life balance, and community connection have proven key to enticing GPs out of major cities, according to a new study.
 
However, rural experiences can differ greatly depending on whether a GP trained in Australia or overseas, with many international medical graduates (IMGs) left feeling professional isolation.
 
The Australian National University research quizzed two different groups of GPs, those who completed their training in Australia and those trained internationally, all of whom are now working in regional New South Wales.
 
The GPs were asked about their personal, professional, and geographic connectedness, and which aspect was most influential in keeping their working regionally long-term.
 
Ultimately, the study found those who grew up in a rural area, or who lived rurally during medical school, are more likely to return, but depending on their backgrounds, their experiences differed greatly.
 
For Australian-trained doctors, many were seeking specific lifestyle factors when moving regionally, including fulfilling employment for a partner, education opportunities for children, and hobbies.
 
Meanwhile, many IMGs felt required to move regionally to fill gaps in underserviced areas and were much more likely to stay if they felt accepted, appreciated, and part of their community.
 
Locally trained GPs reported work-life balance being key, with many not comfortable with patients approaching them about health-related issues outside of work.
 
In contrast, the IMGs questioned look to build professional relationships with patients and seek to give back to their community, saying the need for a divide between professional and personal life is not as important.
 
But study co-author Suzanne Bain-Donohue said professional connectedness is one area some IMGs said highlighted as having room for improvement.
 
‘They reported having few opportunities to meet other doctors and form professional relationships,’ she said.
 
‘Additionally, they expressed frustration at the lack of training opportunities available to them.
 
‘Focusing on bringing together nationally and internationally trained general practitioners to build a professional network for support and development would be a great place to start.’
 
Despite IMGs accounting for more than half of the total rural medical workforce, one doctor interviewed said they felt ‘isolated’, ‘limited acceptance’, and ‘professionally detached’ by their fellow GPs.
 
‘I haven’t … met a lot of people here. Only I attend one meeting in the [town] hospital when I came here first time,’ one IMG said.
 
RACGP Rural Council Deputy Chair Dr Rodney Omond told newsGP professional isolation is a problem for many doctors working in rural areas, where there are not many colleagues to connect with.
 
‘We do a bit around that with the Fellowship Support Program where I’m a medical educator. We have small group learnings based on geographical areas, and that’s one way they could perhaps start some relationships with colleagues,’ he said.
 
‘It’s really important they have professional contacts, that they feel their families are accepted in the community, and if that doesn’t happen, they’re not going to stay long term.
 
‘There are a lot of cultural barriers many have to overcome when moving from their culture and their country to our culture, and it might not be easy, but a lot of communities try and facilitate that process.’
 
Geographical connectedness was also highlighted by several Australian-trained GPs, who reported seeking a practice which allowed for ‘life beyond medicine’.
 
‘To go out and be a doctor in a small country town, I think you need not only a commitment to medicine but a bit of a sense of adventure and certainly a like of outdoors-type activities,’ one Australian-trained GP said.
 
In contrast, IMGs were more likely to move for the job itself.
 
‘The work’s really interesting, there’s a lot of sick people that live rurally. So, it’s very interesting,’ an IMG said.
 
Encouragingly, IMGs overall reported feeling accepted by their communities, who acknowledged and were thankful for the vital role they play in keeping their populations healthy.
 
‘We are happy here in Australia. People are very good … we haven’t been victimised or harassment or discrimination or anything like that. And people are quite supportive,’ one IMG respondent said.
 
Moving forward, Ms Bain-Donohue said it is crucial that work continues to make all doctors practising rurally feel welcome, accepted, and connected.

‘Retention strategies need to account for the fact that people are coming from distinct backgrounds and there are many factors that need to be addressed to ensure work and life satisfaction,’ she said.
 
Dr Omond said funding is key to ensuring rural doctors are offered adequate support.
 
‘It’s variable across communities, but some communities are really committed to making sure their doctors feel part of the community, and the college itself is very invested in doing this,’ he said.
 
‘We want to make doctors feel at home, we’re just a little bit hamstrung at the moment by funding.
 
‘If we have more support, then we can start doing much more mentoring, we are able to pay rural GPs to be mentors for trainees, and that is what we’re aiming for.’
 
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