“It’s complicated”: qualitative insights into withdrawal from rural generalist training

Introduction: Rural generalist (RG) postgraduate training and workforce models are increasingly being implemented to address rural medical workforce shortages. ‘Pathway’ or ‘pipeline’ approaches aim to support progression from medical school through vocational training to rural practice. However, little is known about why some trainees leave. This study explored why trainees withdrew from Queensland RG training and what might have supported them to remain.

Methods: A qualitative descriptive study was conducted using semi-structured interviews with 12 former Queensland Rural Generalist Pathway trainees who commenced between 2007 and 2017 and withdrew prior to 7 September 2020. Participants varied in age, rural background, relationship status, and training stage at withdrawal. Interviews explored motivations for joining the Pathway, experiences during training, reasons for leaving, reflections on withdrawal, and what might have influenced them to continue. Data were analysed using Braun and Clarke’s reflexive thematic analysis. Participant feedback informed refinement of the findings.

Results: Withdrawal decisions were shaped by factors across four themes: scope of practice, structural and policy impediments, work environment and relationship and family considerations. Some participants considered their personal characteristics or clinical aspirations incompatible with RG practice. Others described structural and policy barriers that created confusion, administrative burden and limited flexibility. Work environments shaped professional identity formation and exposed trainees to competing service-training demands, inadequate support and challenging workplace cultures. Relationship and family considerations included finding a partner, parenthood, and accommodating a partner’s career. Participants often described several overlapping factors rather than a single cause, and none cited rural living itself as a reason for withdrawal. Many reported that earlier, more personalised and flexible support, particularly during periods of transition or personal challenge, might have supported continuation. Many participants retained an interest in rural health and continued or planned to contribute through other specialties and professional roles.

Discussion: Participant accounts illustrate how multiple influences shape withdrawal decisions. Reducing avoidable withdrawal may require more responsive training systems that recognise the developmental needs of early-career doctors, provide clearer and more coordinated support, and accommodate trainees’ personal and professional lives. Increasing RG role modelling and visibility and addressing administrative and structural barriers may improve trainee experiences and support continuation. Appropriate career redirection should also be supported, with consideration given to opportunities for interested individuals to continue contributing to rural health in ways aligned with their skills and circumstances.

Conclusion: Understanding why trainees withdraw can inform strategies to reduce avoidable withdrawal, strengthen rural training programs and support workforce outcomes.

Keywords: generalist training, medical workforce, qualitative interviews, rural generalist, rural health, withdrawal.