Register      Login
Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

The costs, barriers and enablers of providing PGY2 placements in general practice in Aotearoa New Zealand: a mixed-methods study

Carol Atmore https://orcid.org/0000-0002-4031-7016 1 2 * , Trudy Sullivan 4 , Jessica Millar 1 , Aisha Paulose 1 , Andy Shute 1 , Dot Brown 3 , Tim Stokes https://orcid.org/0000-0002-1127-1952 2
+ Author Affiliations
- Author Affiliations

1 WellSouth Primary Health Network, Level 2, 333 Princes Street, Dunedin 9016, New Zealand.

2 Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.

3 University of Otago, Christchurch, New Zealand.

4 Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.

* Correspondence to: Carol.Atmore@wellsouth.org.nz

Handling Editor: Felicity Goodyear-Smith

Journal of Primary Health Care 16(2) 151-159 https://doi.org/10.1071/HC23116
Submitted: 17 September 2023  Accepted: 8 January 2024  Published: 8 February 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Introduction

Few mandatory community-based attachments for postgraduate year two doctors (PGY2s) in Aotearoa New Zealand are hosted in general practices, due to space, time and remuneration barriers.

Aim

This study aimed to explore the costs, barriers and enablers to general practices of hosting PGY2s.

Methods

A cost analysis for four general practices beginning to host PGY2s was undertaken, including time spent supervising and supporting PGY2s, revenue impact including subsidies and cost of providing clinical space. Interviews with these practices and seven experienced PGY2 host practices were conducted and analysed thematically.

Results

The estimated mean cost of hosting PGY2s excluding room cost was NZ$4907 per 13-week placement (range $890–$9183), increasing to $13 727 per placement (range $5750–$24 715) when room rental was included. Four themes were identified: working within a small business model; a new learning environment for PGY2s; providing positive experiences for the PGY2s; the relationship between practices and district hospitals that employed the PGY2s, including job sizing.

Discussion

Tension exists between the small business model of general practice and providing positive experiences for PGY2s in a new learning environment. Guidance and support structures for PGY2 hosting should be developed nationally, and communication and cooperation between practices and employing hospitals needs improvement. Out-of-hours work should be included in community-based attachments so PGY2s’ remuneration is consistent. General practice teams are willing to be part of creating a sustainable workforce. However, the time taken to host and costs of providing training in primary care are barriers. There is urgent need to increase funding to general practices for hosting PGY2s.

Keywords: community-based attachment, cost analysis, general practice, mixed-methods, postgraduate year 2, primary care, qualitative, quantitative.

References

Royal New Zealand College of General Practitioners. Te Rangahau Ohu Mahi The Workforce Survey 2022 Time Series Report. Wellington, NZ: Royal New Zealand College of General Practitioners; 2023.

Seleq S, Jo E, Poole P, et al. The employment gap: the relationship between medical student career choices and the future needs of the New Zealand medical workforce. N Z Med J 2019; 132(1506): 52-9.
| Google Scholar | PubMed |

Poole P, Wilkinson TJ, Bagg W, et al. Developing New Zealand’s medical workforce: realising the potential of longitudinal career tracking. N Z Med J. 2019; 132(1495): 65-73.
| Google Scholar | PubMed |

Illing J, Van Zwanenberg T, Cunningham WF, et al. Preregistration house officers in general practice: review of evidence. BMJ 2003; 326(7397): 1019-22.
| Crossref | Google Scholar | PubMed |

Martin AA, Laurence CO, Black LE, et al. General practice placements for pre‐registration junior doctors: adding value to intern education and training. Med J Aust 2007; 186(7): 346-9.
| Crossref | Google Scholar | PubMed |

Spooner S, Pearson E, Gibson J, et al. How do workplaces, working practices and colleagues affect UK doctors’ career decisions? A qualitative study of junior doctors’ career decision making in the UK. BMJ Open 2017; 7(10): e018462.
| Crossref | Google Scholar | PubMed |

de Beer W, Clark H. Four years of prevocational Community Based Attachments in New Zealand: a review. N Z Med J 2021; 134(1539): 56-62.
| Google Scholar | PubMed |

Sheehan D, Thwaites J, Weenink V, et al. PGY2 attachments in general practice - a New Zealand experience. N Z Med J 2017; 130(1451): 72-4.
| Google Scholar | PubMed |

Scott-Jones J, Lucas S. Rural general practice training: experience of a rural general practice team and a postgraduate year two registrar. J Prim Health Care 2013; 5(3): 243-8.
| Google Scholar | PubMed |

10  GPNZ. Welcome to General Practice New Zealand (GPNZ). New Zealand: General Practice NZ; 2023. Available at gpnz.org.nz

11  Robinson OC. Sampling in interview-based qualitative research: a theoretical and practical guide. Qual Res Psychol 2014; 11(1): 25-41.
| Crossref | Google Scholar |

12  Whitehead J, Davie G, de Graaf B, et al. The Geographic Classification for Health, Methodology and classification report. New Zealand: University of Otago; 2021.

13  Medical Assurance Society. GP Locum/Associate Remuneration Report 2021. New Zealand: Medical Assurance Society; 2021.

14  New Zealand Nurses Organisation. Primary Health Care Multi-Employer Collective Agreement (MECA) 2021. New Zealand Nurses Organisation; 2021.

15  MedTech Global. Our fees are changing from 1 January 2022. Auckland: MedTech Global; 2021.

16  Little A. Plan for big boost in GP training numbers [press release]. Wellington, NZ: New Zealand Government; 2022.

17  Gale NK, Heath G, Cameron E, et al. Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 2013; 13(1): 117.
| Crossref | Google Scholar | PubMed |

18  Parekh R, Jones MM, Singh S, et al. Medical students’ experience of the hidden curriculum around primary care careers: a qualitative exploration of reflective diaries. BMJ Open 2021; 11(7): e049825.
| Crossref | Google Scholar | PubMed |