FINDING SOLUTIONS TO THE RURAL DOCTOR SHORTAGE - THE ROLES OF SELECTION VERSUS UNDERGRADUATE MEDICAL-EDUCATION AT NEWCASTLE

Background Australia has a rural doctor shortage. Proposed solutions h ave included both increasing the medical student admissions from rural areas and modifying the curriculum content of rural medicine. Aim: To examine the differences between doctors who chose to practise in rura l areas and those who chose urban areas after graduation from the Univ ersity of Newcastle medical school. Methods: A cross-sectional survey of 331 graduates who had completed at least their intern year was unde rtaken in 1990, using a mailed self-report questionnaire. Results: A 7 5% response rate was achieved from those completing their degree befor e 1987 (N = 217). Twenty-two per cent of respondents were employed in a rural area and the great majority of these doctors were in general p ractice. Those from earlier graduating years, those from rural backgro unds (relative risk [RR] 2.5, 95% confidence interval [CI]: 1.4-4.4), and those who chose an undergraduate rural general practice attachment in their final year (RR = 3.0, 95% CI: 1.3-7.3) were more likely to b ecome rural doctors. However, there was a tendency for those who chose an undergraduate rural rotation in year 3 not to be more likely to be come rural doctors (RR = 0.7, 95% CI: 0.4-1.2). The most frequent reas ons given for working in rural areas related to lifestyle, whereas wor k related reasons were given more often for those who chose urban prac tices.Conclusion: Our data suggest that the rural doctor shortage woul d be improved by medical school admission policies favouring students from rural areas, and by encouraging rural placements towards the end of undergraduate training.