Why do medical graduates choose rural careers?

Abstract

Introduction: This study is based on the metaphor of the &lsquo;rural pipeline&rsquo; into medical practice. The four stages of the ruralpipeline are: (1) contact between rural secondary schools and the medical profession; (2) selection of rural students into medicalprograms; (3) rural exposure during medical training; and (4) measures to address retention of the rural medical workforce.Methods: Using the rural pipeline template we conducted a literature review, analysed the selection methods of Australiangraduate entry medical schools and interviewed 17 interns about their medical career aspirations.Results: Literature review: The literature was reviewed to assess the effectiveness of selection practices to predict successfulgradation and the impact of rural pipeline components on eventual rural practice. Undergraduate academic performance is thestrongest predictor of medical course academic performance. The predictive power of interviews is modest. There are limited dataon the predictive power of other measures of non-cognitive performance or the content of the undergraduate degree. Prior ruralresidence is the strongest predictor of choice of a rural career but extended rural exposure during medical training also has asignificant impact. The most significant influencing factors are: professional support at national, state and local levels; careerpathway opportunities; contentedness of the practitioner&rsquo;s spouse in rural communities; preparedness to adopt a rural lifestyle;educational opportunities for children; and proximity to extended family and social circle. Analysis of selection methods: Staffinvolved in student selection into 9 Australian graduate entry medical schools were interviewed. Four themes were identified:(1) rurality as a factor in student selection; (2) rurality as a factor in student selection interviews; (3) rural representation on studentselection interview panels; (4) rural experience during the medical course. Interns&rsquo; career intentions: Three themes were identified:(1) the efficacy of the rural pipeline; (2) community connectedness through the rural pipeline; (3) impediments to the effect of therural pipeline, the most significant being a partner who was not committed to rural lifeConclusion: Based on the literature review and interviews, 11 strategies are suggested to increase the number of graduateschoosing a career in rural medicine, and one strategy for maintaining practitioners in rural health settings after graduation.</div