James Cook University ISSN 1445-6354
Introduction: Many strategies have been implemented to address the shortage of medical practitioners in rural areas. One such strategy, the Rural Clinical School (RCS) program supporting 18 RCS, represents a substantial financial investment by the Australian government. This is the first collaborative RCS study summarising the rural work outcomes of multiple RCS. The aim of this study was to combine data from all RCS’ 2011 graduating classes to determine the association between rural location of practice in 2017 and i) extended rural clinical placement during medical school (at least 12 months training in a rural area) and ii) having a rural background.
Methods: All medical schools funded under the RCS program were contacted by email about participation in this study. Deidentified data were supplied for domestic students about their gender, origin (rural background defined as having lived in an ASGC-RA 2-5 area for at least five years since beginning primary school) and participation in extended rural clinical placement (attended a RCS for at least one year of their clinical training). The postcode of their practice location according to the publicly available Australian Health Practitioner Regulation Agency (AHPRA) register was collected (Feb-August 2017) and classified into rural and metropolitan areas using the Australian Standard Geographic Classification (ASGC 2006) and the more recent Modified Monash Model (MMM). The main outcome measure was whether graduates were working in a ‘rural’ area (ASGC categories RA2-RA5 or MMM categories 3-7) or ‘metropolitan’ area. Pearson’s chi-square test was used to detect differences in gender, rural background and extended placement at a RCS between rural and metropolitan practice locations. Binary logistic regression was used to determine odds of rural practice and 95% confidence intervals were calculated.
Results: Although data were received from 14 universities, two universities had not started collecting origin data at this point so were excluded from the analysis. The proportion of students with a rural background ranged from 12.3-76.6% and the proportion who had participated in extended RCS placement ranged from 13.7-74.6%. Almost 17% (16.6%) had a principal practice postcode in a rural area (according to ASGC), ranging from 5.8% to 55.6%, and 8.3% had a principal practice postcode in rural areas (according to MMM 3-7) ranging from 4.5% to 29.9%. After controlling for rural background, students who attended a RCS were 1.54 times more likely to be in rural practice (95%CI 1.15-2.06, p=0.004) using ASGC criteria. Using the MMM 3-7 criteria, students who participated in extended RCS placement were 2.62 times as likely to be practicing in a rural location (95%CI 1.80-3.83, p<0.001) after controlling for rural background. Regardless of geographic classification system (ASGC, MMM) used for location of practice and of student background (metropolitan or rural), those students with an extended RCS had increased odds of working rurally.
Conclusion: Based on the combined data from three quarters (12/16) of the Australian medical schools who had a graduating class in 2011, this suggests that the RCS initiative as a whole is having a significant positive effect on the regional medical workforce at five years post-graduation.