Building the allure of a country practice

Volume 10 Number 12 December 8 2014 - January 11 2015

 

Stav Psonis speaks with health economist Anthony Scott about research designed to inform decision-making about attracting GPs to rural practice.

Having access to basic medical care provided by GPs is a service that Australians living in metropolitan areas take for granted. In rural and remote areas, it has been difficult to attract and retain doctors. What can be done to address the shortage of doctors in country practice?

Published this month in Social Science & Medicine, a study led by University researchers is the first in Australia to identify the types of incentive programs likely to influence the majority of GPs to remain longer in rural areas.

Lead researcher Professor Anthony Scott from the Melbourne Institute of Applied Economic and Social Research, says the study has found a locum relief scheme together with an increase in GP retention payments and the rural skills loading, are the most important factors to improve the retention of rural doctors. 

“We know doctors are likely to leave rural practice after the first two years, even though incentives to attract and encourage doctors to stay in rural areas have been in place for decades,” Professor Scott says. 

Existing retention grants are based on an ‘average GP and rural area’ model which aims to compensate rural GPs based on where they are located.

“There has been no empirical research to date that evaluates the effectiveness of the existing ‘one size fits all’ retention policies,” Professor Scott says. 

“Our study examines the role of new incentive packages in retaining rural GPs, by exploring their preferences for the different types of incentives that may be available. When we understand what motivates doctors, we can use those findings to guide the design of retention policies,” he says.

The survey of 1604 rural GPs was conducted in 2009 as part of Australia’s national longitudinal survey of doctors, the MABEL study – Medicine in Australia: Balancing Employment and Life. This study was conducted through the Centre of Research Excellence in Medical Workforce Dynamics, which is funded by the National Health and Medical Research Council. The MABEL study aims to improve our understanding of doctors’ work preferences and how this may impact Australians’ access to health care.

Participants in the survey were presented with a series of incentive packages and asked to identify those incentives most likely to influence their decision to stay in rural areas. 

The survey found nearly two-thirds of rural GPs were likely to stay in rural practice longer if the new incentive packages were available, compared with the existing policies. A locum relief scheme would have the largest impact on improving the retention of rural doctors, followed by an increase in retention payments and a 10 to 20 per cent rural skills loading, especially for GPs working in rural hospitals. 

Importantly, one quarter of rural GPs were not influenced to remain in rural practice by any of the incentive packages presented to them in the survey. Those GPs are likely to be older, have no dependent children and are practising in a larger rural area with less frequent on-call needs. 

Professor Scott says this finding suggests a ‘one size fits all’ policy for rural incentives may not be optimal, as it has no impact on the decision of some GPs to remain in rural practice.

“Designing schemes to encourage doctors to locate and stay in rural areas requires an understanding of the various factors that motivate doctors’ decisions. Our study has shown the types of incentives that are likely to keep GPs longer in rural areas, so looking at what motivates doctors can help policy-makers design more effective future retention schemes,” he says.

 

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