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RESEARCH ARTICLE (Open Access)
Contents Vol 30(5)

General practice registrars’ practice in outer metropolitan Australia: a cross-sectional comparison with rural and inner metropolitan areas

Michael Tran A , Anna Ralston B C , Elizabeth Holliday B , Amanda Tapley B C , Alison Fielding B C , Dominica Moad B C , Jocelyn Ledger B C , Susan Wearne D E , Andrew Davey B C , Mieke van Driel F , Jean Ball G , Vanessa Moran C , Jason Dizon G and Parker Magin B C *
+ Author Affiliations
- Author Affiliations

A Discipline of General Practice, University of New South Wales, Wallace Wurth Building (C27), Corner High Street and Botany Street, Kensington, NSW 2052, Australia.

B School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, Newcastle, NSW 2308, Australia.

C NSW and ACT Research and Evaluation Unit, GP Synergy, Regional Training Organisation (RTO), Level 1, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia.

D Academic Unit of General Practice, Australian National University, The Canberra Hospital, Yamba Drive Garran, ACT 2605, Australia.

E Health Workforce Division, Australian Government Department of Health, Sirius Building, Furzer Street, Woden Town Centre, ACT 2606, Australia.

F General Practice Clinical Unit, Faculty of Medicine, University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women’s Hospital, Brisbane, Qld 4029, Australia.

G Clinical Research Design and Statistical Support Unit (CReDITSS), Hunter Medical Research Institute (HMRI), Lot 1 Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.

* Correspondence to: Parker.Magin@newcastle.edu.au

Australian Journal of Primary Health 30, PY23100 https://doi.org/10.1071/PY23100
Submitted: 16 February 2023  Accepted: 27 August 2024  Published: 13 September 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC)

Abstract

Background

General practice training in outer metropolitan (OM) areas contributes to patients’ access to care. Differences in clinical practice and training in rural versus urban areas have been established, but less is known about OM versus inner metropolitan (IM) differences – whether they offer a trainee learning experience of populations with distinct demographics and healthcare characteristics. This study sought to identify the characteristics and associations of general practice training in New South Wales and Australian Capital Territory OM areas, compared to IM and rural areas.

Methods

Cross-sectional analyses of data (2016–2020) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars’ in-consultation clinical and educational experience and behaviours, were performed. Multinomial logistic regression assessed associations of rural/OM/IM practice location with registrar and practice factors, patient factors, consultation content factors and consultation action factors.

Results

Overall, 1308 registrars provided data from 177,026 consultations. For several variables, there was a pattern in the differences of associations across rural/OM/IM areas. Experience of care of older patients and Aboriginal and/or Torres Strait Islander health were more likely in OM than IM areas. Care of patients from non-English speaking background was more likely in OM than in rural areas. Possible markers of healthcare access (specialist referrals, and pathology and imaging requests) were less likely in OM than in both IM and rural areas.

Conclusions

OM areas are distinct (and educationally rich) clinical learning environments, with distinct demographic characteristics and seeming healthcare access limitations. This finding has implications for workforce support and health resource allocation.

Keywords: continuity of patient care, family practice, general practice, graduate medical education, health services accessibility, physicians’ practice, suburban population, urban population.

References

Australian Government Department of Health (2021) National medical workforce strategy 2021–2031. Australian Government Department of Health.

Australian Government Department of Health and Aged Care (2022a) General practice workforce providing primary care services in Australia. Available at https://hwd.health.gov.au/resources/data/gp-primarycare.html [Accessed 30 January 2023]

Australian Government Department of Health and Aged Care (2022b) Health workforce locator. Available at https://www.health.gov.au/resources/apps-and-tools/health-workforce-locator/health-workforce-locator [Accessed 13 October 2022]

Australian Government Department of Health and Aged Care (2022c) Distribution priority area. Available at https://www.health.gov.au/topics/rural-health-workforce/classifications/dpa [Accessed 26 April 2023]

Australian Government Productivity Commission (2022) Report on Government Services 2022. Primary and community health. Available at https://www.pc.gov.au/ongoing/report-on-government-services/2022/health/primary-and-community-health [Accessed 07 April 2023]

Australian Institute of Health and Welfare (2022) Rural and remote health. Available at https://www.aihw.gov.au/reports/rural-remote-australians/rural-and-remote-health [Accessed 31 December 2022]

Bonney A, Morgan S, Tapley A, Henderson K, Holliday E, Davey A, van Driel M, Spike N, Regan C, Ball J, Magin P (2017) Older patients’ consultations in an apprenticeship model-based general practice training program: a cross-sectional study. Australasian Journal on Ageing 36, E1-E7.
| Crossref | Google Scholar | PubMed |

Davey A, Tapley A, van Driel M, Holliday E, Fielding A, Ball J, Mulquiney K, Fisher K, Spike N, Clarke L, Moad D, Ralston A, Patsan I, Mundy B, Turner A, Tait J, Tuccitto L, Roberts S, Magin P (2022) The Registrar Clinical Encounters in Training (ReCEnT) cohort study: updated protocol. BMC Primary Care 23, 328.
| Crossref | Google Scholar | PubMed |

Department of Health and Aged Care (2022) General practice workforce providing primary care services in Australia. Available at https://hwd.health.gov.au/resources/data/gp-primarycare.html [Accessed 30 January 2023]

Dixon J, Welch N (2000) Researching the rural-metropolitan health differential using the ‘social determinants of health’. Australian Journal of Rural Health 8, 254-260.
| Google Scholar | PubMed |

Fielding A, Moad D, Tapley A, Davey A, Holliday E, Ball J, Bentley M, FitzGerald K, Kirby C, Turnock A, Spike N, van Driel ML, Magin P (2022) Prevalence and associations of rural practice location in early-career general practitioners in Australia: a cross-sectional analysis. BMJ Open 12, e058892.
| Crossref | Google Scholar | PubMed |

Gunn LD, Davern M, Higgs C, Both A, Roberts R, Rozek J, Giles-Corti B (2020) Measuring liveability for the 21 largest cities in Australia: liveability report for Sydney. Centre for Urban Research, RMIT University, Melbourne.

Health Workforce Australia (2012) Health workforce 2025. Doctors, nurses and midwives. Volume 1. Health Workforce Australia.

Malau-Aduli BS, Alele FO, Heggarty P, Reeve C, Teague P-A (2021) Key elements of effective postgraduate GP educational environments: a mixed methods study. BMJ Open 11, e041110.
| Crossref | Google Scholar | PubMed |

Martin AA, Laurence CO, Black LE, Mugford BV (2007) General practice placements for pre-registration junior doctors: adding value to intern education and training. Medical Journal of Australia 186, 346-349.
| Crossref | Google Scholar | PubMed |

McGaw AJ, Jayasuriya P, Bulsara C, Thompson SC (2006) Accessing primary health care: a community survey of issues regarding general practice and emergency department services in an outer metropolitan area. Australian Journal of Primary Health 12, 78-84.
| Crossref | Google Scholar |

McGrail MR, Russell DJ, Campbell DG (2016) Vocational training of general practitioners in rural locations is critical for the Australian rural medical workforce. Medical Journal of Australia 205, 216-221.
| Crossref | Google Scholar | PubMed |

Moad D, Tapley A, Fielding A, van Driel ML, Holliday EG, Ball JI, Davey AR, FitzGerald K, Spike NA, Magin P (2022a) Socioeconomic status of practice location and Australian GP registrars’ training: a cross-sectional analysis. BMC Medical Education 22, 285.
| Crossref | Google Scholar | PubMed |

Moad D, Fielding A, Tapley A, van Driel ML, Holliday EG, Ball JI, Davey AR, FitzGerald K, Bentley M, Spike NA, Kirby C, Turnock A, Magin P (2022b) Socioeconomic disadvantage and the practice location of recently Fellowed Australian GPs: a cross-sectional analysis. Australian Journal of Primary Health 28, 104-109.
| Crossref | Google Scholar | PubMed |

Morgan T, Tapley A, Davey A, Holliday E, Fielding A, van Driel M, Ball J, Spike N, FitzGerald K, Morgan S, Magin P (2022) Influence of rurality on general practitioner registrars’ participation in their practice’s after-hours roster: a cross-sectional study. Australian Journal of Rural Health 30, 343-351.
| Crossref | Google Scholar |

Moynihan M (2022) The Australian Population Research Institute, Research Report, October 2022. The Australian Population Research Institute, Victoria, Australia.

Ogden J, Preston S, Partanen RL, Ostini R, Coxeter P (2020) Recruiting and retaining general practitioners in rural practice: systematic review and meta-analysis of rural pipeline effects. Medical Journal of Australia 213, 228-236.
| Crossref | Google Scholar | PubMed |

Pereira Gray DJ, Sidaway-Lee K, White E, Thorne A, Evans PH (2018) Continuity of care with doctors-a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open 8, e021161.
| Crossref | Google Scholar | PubMed |

Roeger LS, Reed RL, Smith BP (2010) Equity of access in the spatial distribution of GPs within an Australian metropolitan city. Australian Journal of Primary Health 16, 284-290.
| Crossref | Google Scholar | PubMed |

Russell DJ, Wilkinson E, Petterson S, Chen C, Bazemore A (2022) Family medicine residencies: how rural training exposure in GME is associated with subsequent rural practice. Journal of Graduate Medical Education 14, 441-450.
| Crossref | Google Scholar | PubMed |

Shadbolt N, Bunker J (2009) Choosing general practice – a review of career choice determinants. Australian Family Physician 38, 53-55.
| Google Scholar | PubMed |

Slavova-Azmanova NS, Newton JC, Johnson CE, Hohnen H, Ives A, McKiernan S, Platt V, Bulsara M, Saunders C (2021) A cross-sectional analysis of out-of-pocket expenses for people living with a cancer in rural and outer metropolitan Western Australia. Australian Health Review 45, 148-156.
| Crossref | Google Scholar | PubMed |

Starfield B, Shi L, Macinko J (2005) Contribution of primary care to health systems and health. The Milbank Quarterly 83, 457-502.
| Crossref | Google Scholar | PubMed |

Tapley A, Davey AR, van Driel ML, Holliday EG, Morgan S, Mulquiney K, Turnock A, Spike NA, Magin PJ (2020) General practice training in regional and rural Australia: a cross-sectional analysis of the registrar clinical encounters in training study. Australian Health Review 28, 32-41.
| Crossref | Google Scholar | PubMed |

Wright M, Mainous AG, 3rd (2018) Can continuity of care in primary care be sustained in the modern health system? Australian Journal of Rural Health 47, 667-669.
| Crossref | Google Scholar | PubMed |