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

Carol Atmore; Trudy Sullivan; Jessica Millar; Aisha Paulose; Andy Shute; Dot Brown; Tim Stokes

doi:10.1071/HC23116

RESEARCH ARTICLE (Open Access)

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

Carol Atmore

¹ ² ^* , Trudy Sullivan ⁴ , Jessica Millar ¹ , Aisha Paulose ¹ , Andy Shute ¹ , Dot Brown ³ , Tim Stokes

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.

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