Rural background, training increases GPs’ chances of staying rural

‘GPs and family physicians with rural backgrounds and rural experience during undergraduate and postgraduate medical education are more likely to enter rural practice.’
 
Such are the findings of a new systematic review and meta-analysis of 27 studies, published in the Medical Journal of Australia in July.
 
The review also concludes that the effects of being from a rural background, and training in these areas, are cumulative in contributing to the likelihood of future practice there.
 
Dr Catherine Engelke is a GP in Kununurra, Western Australia, and has lived in the Kimberley her whole life.
 
These findings make sense to her.
 
‘Having grown up rural, you are familiar with the environment,’ she told newsGP.
 
‘Even though you may not go back to the actual community where you grew up in or your home, you certainly have a real interest in rural life and a need to actually provide something back to a community which has given you so much.’
 
Dr Engelke understands why rural experience in medical training contributes to a greater proportion of trainees wishing to practise rurally upon becoming GPs.
 
But she believes many students and GPs in training are unaware of the benefits of rural practice before training in such areas.
 
‘You don’t know what you don’t know,’ she said. ‘You kind of think general practice is general practice everywhere, and I beg to differ.
 
‘I think it essentially is, but you have to be a little bit more creative and [have] more craftsmanship about how you access services for your patients [in rural areas], particularly those that don’t actually want to go and leave their community but need specialist involvement.’
 
Referring to specialists is a more collaborative effort, Dr Engelke says, and one that often requires a culturally appropriate approach. The breadth of rural medicine is also difficult to comprehend until medical students and trainees see it for themselves.
 
‘I’ve just had a fabulous day with a medical student flying into a remote community,’ she said.
 
That included looking after children, pregnant women, and young women, and engaging in men’s health, while organising transport for two patients to be admitted to hospital for continued care by rural GPs.
 
‘There are very few other areas apart from rural general practice that you can provide that culturally appropriate comprehensive care,’ Dr Engelke said.
 
While the research found exposure to rural practice increases the likelihood of a GP practising outside of the city, it also reported that longer rural placements at the undergraduate and postgraduate levels might further influence that commitment.
 
‘Providing students and doctors with extended rural opportunities throughout training should be components of government strategies for solving rural workforce problems,’ the authors wrote.
 
However, Dr Engelke believes even shorter stints in rural areas offer benefit.
 
‘Any experience, [including] the rural four-week GP placements, allows students the opportunity to experience what it’s like to be a GP in the rural setting and see that it’s not such a fearful experience,’ she said.
 
‘You can see our attachment and involvement with the community and that wonderful relationship that we have with our patients and their families.
 
‘I use the term “holistic”, but I think it’s comprehensive healthcare.’
 
And rural communities are in need of such care, with more than seven million Australians (29% of the population) living in regional and remote areas.
 
According to the researchers, the number of GP services per capita in very remote areas is about half of that in major cities. They therefore say attracting GPs to practise in rural and remote areas is ‘critical’ for effective, coordinated healthcare.
 
The authors say promoting selection of GPs in training from rural backgrounds and encouraging longer rural placements at both the undergraduate and postgraduate medical level can help.
 
Dr Engelke agrees. She sees that firsthand in the medical students who have come from major cities and tell her they plan to return as rural generalists upon graduation.
 
‘One, they enjoy the medicine,’ she said.
 
‘But two, they’ve actually had such a wonderful experience and have seen the work–life balance and the possibilities of actually becoming skilled, and having the variety as well as that lovely relationship that we have with our families within our communities.
 
‘That is very attractive to them and unless they have worked with us, they don’t actually see that possibility.’
 
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