Urban washout: How strong is the rural-background effect?

• Published in: The Australian journal of rural health Vol. 23; no. 3; pp. 161 - 168
• Main Authors: Hogenbirk, John C., McGrail, Matthew R., Strasser, Roger, Lacarte, Sara A., Kevat, Ajay, Lewenberg, Michael
• Format: Journal Article
• Language: English
• Published: Australia Blackwell Publishing Ltd 01-06-2015; Wiley Subscription Services, Inc
• Subjects: Adult; Australia; Career Choice; Cohort Studies; Confidence intervals; doctor; Female; General Practitioners - psychology; Humans; Intention; Logistic Models; logistic regression; Male; Nursing; practice intention; practice location; Professional Practice Location; Rural areas; Rural Health Services; Surveys and Questionnaires; doctor; practice location; practice intention; logistic regression
• ISSN: 1038-5282; 1440-1584
• DOI: 10.1111/ajr.12183

Objective
To test predictors of practice location of fully qualified Monash University Bachelor of Medicine, Bachelor of Surgery (MBBS) graduates.
Design
Cohort survey, 2011.
Setting
Australia.
Participants
Rural (n = 67/129) and urban (n = 86/191) background doctors starting at Monash University 1992–1999. Approximately 60% female, 77% married/partnered, 79% Australian‐born, mean age 34 years, 31% general practitioners, 72% fully qualified and 80% training/practising in major cities.
Main outcome measures
First and current practice location once fully qualified. Intended practice location in 5–10 years.
Results
Logistic regression found that rural versus urban background was a significant predictor of rural (outside major city) first practice location (odds ratio (OR) 5.0, 95% confidence interval (CI) 1.3–19.2) and rural current practice location (OR 5.6, 95% CI 1.5–21.2) for fully qualified doctors. General practitioner versus other medical specialists significantly predicted first (OR 7.2, 95% CI 2.1–25.2) or current (OR 3.6, 95% CI 1.1–11.9) rural practice location. Preference for a rural practice location in 5–10 years was predicted by rural background (OR 4.4, 95% CI 1.6–11.8) and positive intention towards rural practice upon completing MBBS (OR 4.6, 95% CI 1.7–12.6). Surveyed in 2011, 28% of those who also responded to the 2006 survey shifted their preferred future practice location from rural to urban communities versus 13% shifting from urban to rural (McNemar–Bowker test, P = 0.02).
Conclusion
The majority of fully qualified Monash MBBS graduates practicing in rural communities have rural backgrounds. The rural‐background effect diminished over time and may need continued support during training and full practice.