Original Research

Factors associated with early-career general practitioners’ retention as independent specialists in former training practices


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Michael Tran
1 FRACGP, Lecturer ORCID logo

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Alison Fielding
2,3 PhD, Conjoint Lecturer; Research Manager ORCID logo

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Dominica Moad
2,3 MPH, Conjoint Fellow; Senior Research Officer and Statistician ORCID logo

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Amanda Tapley
2,3 MMedStat, Conjoint Fellow; Senior Research Officer and Statistician ORCID logo

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Elizabeth Holliday
2 PhD, Professor ORCID logo

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Jean Ball
4 GradDipMedStats, Statistician ORCID logo

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Andrew Davey
2,3 FRACGP, Conjoint Lecturer; Senior GP Researcher ORCID logo

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Mieke van Driel
5 FRACGP, Emeritus Professor ORCID logo

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Kristen FitzGerald
6 FRACGP, Senior Lecturer ORCID logo

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Neil Spike
7,8,9 FRACGP, Professor ORCID logo

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Michael Bentley
3 DrPH, Senior Research Assistant ORCID logo

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Catherine Kirby
9 PhD, Research Manager ORCID logo

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Allison Turnock
6,10 FRACMA, Senior Lecturer; Medical Director, GP & Primary Care ORCID logo

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Parker Magin
2,3 FRACGP, Conjoint Professor * ORCID logo


1 Department of General Practice, University of New South Wales, Kensington, NSW 2052, Australia

2 School of Medicine & Public Health, University of Newcastle, Newcastle, NSW 2308, Australia

3 General Practice Training Research Department, Royal Australian College of General Practitioners, Mayfield West, NSW 2304, Australia

4 Clinical Research Design, IT and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute, New Lambton Heights, NSW 2305, Australia

5 General Practice Clinical Unit, Faculty of Medicine, University of Queensland, Royal Brisbane & Women’s Hospital, Brisbane, Qld 4029, Australia

6 Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tas. 7000, Australia

7 School of Rural Health, Monash University, Churchill, Vic. 3842, Australia

8 Department of General Practice and Primary Health Care, University of Melbourne, Carlton, Vic. 3053, Australia

9 Eastern Victoria General Practice Training, Churchill, Vic. 3842, Australia

10 Department of Health, Tasmanian Government, Hobart, Tas. 7000, Australia

ACCEPTED: 4 June 2024

early abstract:

Introduction: Retention of general practice (GP) registrars in their training practices is important for addressing the GP workforce deficit and maldistribution of GPs. Given that rural and remote GP practices are disproportionately affected by low retention, identifying the factors that promote retention may be as important as developing recruitment strategies in these areas. Quantifying the impact of relevant factors on registrar retention will enable a better understanding of how to incentivise retention and attenuate the loss of the rural workforce to other areas. We sought to establish the prevalence, and associations of retention of GP registrars in their training practices.
Methods: This analysis was a component of the New alumni Experience of Training and independent Unsupervised Practice (NEXT-UP) study: a cross-sectional questionnaire-based study of early-career GPs in conjunction with evaluation of data contemporaneously recorded as part of vocational training. Participants were former registrars of three regional training organizations delivering GP training in New South Wales, Tasmania, the Australian Capital Territory and Eastern Victoria, who had attained Fellowship of the Royal Australian College of General Practitioners or the Australian College of Rural and Remote Medicine between January 2016 and July 2018. The outcome measured was whether the registrar had previously worked at their current practice during vocational training. Multivariable logistic regression was used to estimate the association between relevant explanatory variables and the outcome.
Results: 354 alumni responded (response rate 28%), of whom 322 provided data regarding previous training practice retention, with 190 (59%) having previously worked at their current practice as registrars. Among respondents who reported currently working in a regional-rural practice location (n=100), 69% reported having previously worked at their current practice during training. GPs were more likely to be retained by a practice they had trained at if it was of lower socioeconomic status (adjusted odds ratio (aOR) 0.82 [95% confidence interval 0.73, 0.91] p <0.001 for each decile of socioeconomic status) and if the practice provided two or more of home visits, nursing home visits or after-hours services (aOR 4.29 [2.10, 8.75], p < 0.001). They were less likely to be retained by the practice if training was completed in a regional-rural area (aOR 0.35 [0.17, 0.72] p = 0.004).
Conclusion: Regional-rural training location is associated with reduced odds of subsequent retention of GP registrars. This is occurring despite significant government investment in expansion of GP training in regional and rural areas. The practice factor most strongly associated with GP retention were the provision of out-of-practice and after-hours care. There may be altruistic, rather than monetary, reasons that explain this finding. Such training opportunities, if provided to all trainees, especially in regional and rural areas, would be a learning opportunity, a way of promoting holistic community-based care, and an incentive for subsequent retention within the practice and community as an established GP.
Keywords: family practice, general practice, education, medical, rural health services