Predictors of rural practice location for James Cook University MBBS graduates at postgraduate year 5

OBJECTIVE: To describe factors predicting James Cook University (JCU) medical graduates having a rural practice location at postgraduate year (PGY) 5.

PARTICIPANTS: JCU MBBS graduates who had completed their PGY 5 in Australia (n = 260).

DESIGN: Multiple logistic regression analysis involving graduates' application data (age, gender, location of hometown, School Leaving Score, interview score, ethnicity), undergraduate data (scholarship awarded, honours program), and postgraduation data (internship location, specialty training undertaken).

MAIN OUTCOME MEASURE: Predictors of practice in a 'rural' town (Australian Standard Geographic Classification Remoteness Area (ASGC-RA)) 3-5 at PGY 5.

RESULTS: Practice in a 'rural' town in PGY 5 was predicted by 'internship in an ASGC-RA 3-5 location' (prevalence odds ratios (POR) = 3.9, P < 0.001), 'undertaken postgraduate training as a general practitioner or rural generalist' (POR = 3.4, P < 0.001), 'hometown at application located in ASGC-RA 3-5 area' (POR = 2.9, P = 0.023), 'Aboriginal & Torres Strait Islander ancestry' (POR = 5.6, P = 0.031), and NOT undertaken postgraduate training in surgery (POR = 5.4, P = 0.055).

CONCLUSIONS: This study provides evidence that likelihood of early career rural medical practice in Australia is enhanced by education strategies, such as providing rurally located internship places, supporting rural general practice, and selecting applicants with rural origins, Aboriginal or Torres Strait Islander ancestry, and/or a genuine interest in rural, remote, Indigenous, and tropical medicine. This early evidence supports the proposition that investing in rural medical education will produce an appropriately trained medical workforce to meet the needs of rural Australia. Findings also suggest rural workforce may be further enhanced with additional specialty training opportunities in rural tertiary hospitals, in particular, surgery.