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

Michael Tran; Anna Ralston; Elizabeth Holliday; Amanda Tapley; Alison Fielding; Dominica Moad; Jocelyn Ledger; Susan Wearne; Andrew Davey; Mieke van Driel; Jean Ball; Vanessa Moran; Jason Dizon; Parker Magin

doi:10.1071/PY23100

RESEARCH ARTICLE (Open Access)

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.

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