‘Rurality’ and community amenity: How they relate to rural primary care supply and workforce retention

Monday 19 October 2015

Poorer access to supply of, and retention of, a primary health care workforce remain key characteristics of rural regions of Australia and the United States of America (US), with consequent unacceptable inequalities in the health and well-being of their populations. In response, more equitable access to health care for all populations and improved workforce retention remain key objectives of both Australian and US governments, especially for rural populations.

Whilst many previous studies have investigated key professional factors relating to recruitment and retention of rural primary health care doctors, less attention has been given to the role of community and place factors on supply, access to and mobility of rural doctors.  Doctor’s location decisions relate both to meeting their professional needs and interests, and to meeting their non-professional satisfaction through, amongst other aspects, various place-related attributes. Thus, observed rural doctor mobility generally results from factors that both push individuals towards rural, and pull individuals away from rural areas. This study (of two related projects) sought to better understand the roles of ‘rurality’ and community amenity aspects in rural primary health care workforce supply and retention.

Beyond this fellowship, I am a Chief Investigator in two large and related programs, the Centre of Research Excellence in Rural and Remote Primary Health Care (CRERRPHC) as well as the Centre for Research Excellence in Medical Workforce Dynamics which conducts the Medicine in Australia: Balancing Employment and Life (MABEL) study. Within the CRERRPHC, I led the development of a new national Index of Access to rural primary health care in Australia. Within MABEL, I led research on measures of the retention and mobility of the rural primary health care workforce in Australia. The two studies completed as part of my fellowship build on my research expertise through these programs by both expanding into the US context and, where appropriate, comparing outcomes between Australia and the US.

This fellowship, which involved a one-month visit to the Robert Graham Center for Policy Studies in Family Medicine, Washington DC, focused on two related projects which both investigate the role of ‘rurality’ and community amenity aspects with, in turn, rural primary care workforce supply and retention. More specifically:

  • Study 1 aimed to describe the geographic mobility patterns of US rural primary care physicians. In particular, it quantifies, over an extended period, where turnover and mobility of rural physicians occurs and investigates the moderating effect of both area-level and individual-level factors on observed rural retention.
  • Study 2 used data from both Australia and the US, including my Australian Index of Access, to investigate the extent to which variations in community amenity aspects explain spatial variations in the supply of rural primary care doctors.

The content of the two studies in this report are both currently under peer-review.

Dr McGrail's reports on the International Visiting Fellowship at available on APHCRI's website, or at research completed.

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