‘Being in a place where it matters’: GPs who do and do not work in Aboriginal Health Services

Shaun Prentice; Alexandra Barrett; Jill Benson; Taryn Elliott

doi:10.1071/PY23105

RESEARCH ARTICLE (Open Access)

Previous Next Contents Vol 30(1)

‘Being in a place where it matters’: GPs who do and do not work in Aboriginal Health Services

Shaun Prentice

^A ^B ^* , Alexandra Barrett ^C , Jill Benson ^C ^D and Taryn Elliott ^D

+ Author Affiliations

- Author Affiliations

^A School of Psychology, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia.

^B General Practice Training Research Department, The Royal Australian College of General Practitioners, Melbourne, Vic., Australia.

^C School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia.

^D The Royal Australian College of General Practitioners, Melbourne, Vic., Australia.

^* Correspondence to: shaun.prentice@racgp.org.au

Australian Journal of Primary Health 30, PY23105 https://doi.org/10.1071/PY23105

Submitted: 29 May 2023 Accepted: 15 August 2023 Published: 1 September 2023

© 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-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Few general practitioners (GPs) pursue a career in Aboriginal and Torres Strait Islander health. This research examined factors motivating Australian General Practice Training Program (AGPT) graduates to remain in, or leave, Aboriginal Medical Services (AMSs).

Methods

AGPT graduates who remained (n = 11) and left (n = 9) AMSs after placements participated in semi-structured interviews across two studies. Thematic analysis informed by grounded theory was employed.

Results

Both participant groups highlighted similar motivations for requesting an AMS placement, particularly their interest in Aboriginal health or culture. Participants enjoyed organisational structures and relationships, and faced similar barriers to working in AMSs. Those who left placed greater emphasis on the politics and bureaucracy, and unpredictability, and also faced the barrier of ties to their current practice. Those who remained in Aboriginal health more proactively addressed barriers and had a more external view of barriers.

Conclusions

Factors influencing career decisions of GPs in Aboriginal health overlap with those for GPs in rural and other under-served areas. Training providers can better prepare (e.g. more comprehensive orientations) and support registrars during their placements (e.g. greater mentoring). Registrars’ perceptions of, and reactions to, barriers may be pivotal in determining whether they remain in Aboriginal health. This article provides guidance for training providers to better support AMS registrars and encourage more GPs to work in this sector.

Keywords: Aboriginal health, Australia, career motivation, general practice, interviews, medical specialty training, prevocational medical training, qualitative research, under-served populations.

References

Abbott P, Dave D, Gordon E, Reath J (2014) What do GPs need to work more effectively with Aboriginal patients? Views of Aboriginal cultural mentors and health workers. Australian Family Physician 43, 58-63.
| Google Scholar | PubMed |

AIHW (2015) The health and welfare of Australia’s Aboriginal and Torres Strait Islander peoples. Australian Institute of Health and Welfare, Canberra.

Braun V, Clarke V (2006) Using thematic analysis in psychology. Qualitative Research in Psychology 3, 77-101.
| Crossref | Google Scholar |

Eley D, Young L, Przybeck TR (2009) Exploring the temperament and character traits of rural and urban doctors. The Journal of Rural Health 25, 43-49.
| Crossref | Google Scholar | PubMed |

Eley DS, Synnott R, Baker P, Chater AB (2012) A decade of Australian rural clinical school graduates – where are they and why? Rural and Remote Health 12, 1937.
| Crossref | Google Scholar |

Glaser BG, Strauss AL (1967) ‘The discovery of grounded theory: strategies for qualitative research.’ (Aldine: New Brunswick, NJ)

Gwynne K, Lincoln M (2017) Developing the rural health workforce to improve Australian Aboriginal and Torres Strait Islander health outcomes: a systematic review. Australian Health Review 41, 234-238.
| Crossref | Google Scholar | PubMed |

Hall H, Griffiths D, McKenna L (2013) From Darwin to constructivism: the evolution of grounded theory. Nurse Researcher 20, 17-21.
| Crossref | Google Scholar | PubMed |

Kennedy TJT, Lingard LA (2006) Making sense of grounded theory in medical education. Medical Education 40, 101-108.
| Crossref | Google Scholar | PubMed |

Kondalsamy-Chennakesavan S, Eley DS, Ranmuthugala G, Chater AB, Toombs MR, Darshan D, Nicholson GC (2015) Determinants of rural practice: positive interaction between rural background and rural undergraduate training. Medical Journal of Australia 202, 41-45.
| Crossref | Google Scholar | PubMed |

Miles MB, Huberman AM (1994) ‘Qualitative data analysis: an expanded sourcebook.’ (Sage: Thousand Oaks, CA)

Morgan S (2006) Orientation for general practice in remote Aboriginal communities: a program for registrars in the Northern Territory. Australian Journal of Rural Health 14, 202-208.
| Crossref | Google Scholar | PubMed |

Muecke A, Lenthall S, Lindeman MA (2011) Culture shock and healthcare workers in remote Indigenous communities of Australia: what do we know and how can we measure it? Rural & Remote Health 11, 1607.
| Crossref | Google Scholar |

O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA (2014) Standards for reporting qualitative research: a synthesis of recommendations. Academic Medicine 89, 1245-1251.
| Crossref | Google Scholar | PubMed |

Odom Walker K, Ryan G, Ramey R, Nunez FL, Beltran R, Splawn RG, Brown AF (2010) Recruiting and retaining primary care physicians in urban underserved communities: the importance of having a mission to serve. American Journal of Public Health 100, 2168-2175.
| Crossref | Google Scholar | PubMed |

Playford DE, Evans SF, Atkinson DN, Auret KA, Riley GJ (2014) Impact of the Rural Clinical School of Western Australia on work location of medical graduates. Medical Journal of Australia 200, 104-107.
| Crossref | Google Scholar | PubMed |

Skinner EA, Edge K, Altman J, Sherwood H (2003) Searching for the structure of coping: a review and critique of category systems for classifying ways of coping. Psychological Bulletin 129, 216.
| Crossref | Google Scholar | PubMed |

Stevenson AD, Phillips CB, Anderson KJ (2011) Resilience among doctors who work in challenging areas: a qualitative study. British Journal of General Practice 61, e404-e410.
| Crossref | Google Scholar |

Wayne SJ, Kalishman S, Jerabek RN, Timm C, Cosgrove E (2010) Early predictors of physicians’ practice in medically underserved communities: a 12-year follow-up study of University of New Mexico School of Medicine graduates. Academic Medicine 85, S13-S16.
| Crossref | Google Scholar | PubMed |

Worley P, Martin A, Prideaux D, Woodman R, Worley E, Lowe M (2008) Vocational career paths of graduate entry medical students at Flinders University: a comparison of rural, remote and tertiary tracks. Medical Journal of Australia 188, 177-178.
| Crossref | Google Scholar | PubMed |