FINDING SOLUTIONS TO THE RURAL DOCTOR SHORTAGE - THE ROLES OF SELECTION VERSUS UNDERGRADUATE MEDICAL-EDUCATION AT NEWCASTLE

Background Australia has a rural doctor shortage. Proposed solutions have included both increasing the medical student admissions from rural areas and modifying the curriculum content of rural medicine. Aim: To examine the differences between doctors who chose to practise in rural areas and those who chose urban areas after graduation from the University of Newcastle medical school. Methods: A cross-sectional survey of 331 graduates who had completed at least their intern year was undertaken in 1990, using a mailed self-report questionnaire. Results: A 75% response rate was achieved from those completing their degree before 1987 (N = 217). Twenty-two per cent of respondents were employed in a rural area and the great majority of these doctors were in general practice. Those from earlier graduating years, those from rural backgrounds (relative risk [RR] 2.5, 95% confidence interval [CI]: 1.4-4.4), and those who chose an undergraduate rural general practice attachment in their final year (RR = 3.0, 95% CI: 1.3-7.3) were more likely to become rural doctors. However, there was a tendency for those who chose an undergraduate rural rotation in year 3 not to be more likely to become rural doctors (RR = 0.7, 95% CI: 0.4-1.2). The most frequent reasons given for working in rural areas related to lifestyle, whereas work related reasons were given more often for those who chose urban practices. Conclusion: Our data suggest that the rural doctor shortage would be improved by medical school admission policies favouring students from rural areas, and by encouraging rural placements towards the end of undergraduate training.