Background
Review questions
Methods
Search strategy and selection criteria
SSearch | Query | Records retrieved |
---|---|---|
1. | (“early career” or residency or “junior doctor*” or graduate* or registrar* or intern* or trainee*).tw,kf. OR “Internship and Residency”/ | 1082,351 |
2. | (physician* OR doctor* OR practitioner* OR GP*).tw,kf. OR (medical adj (personnel OR staff OR professional* OR worker*)).tw,kf. OR “allied health”/ OR rural generalist*.tw.kf. OR art therapist*.tw,kf. OR audiologist*.tw,kf. OR chiropractor*.tw,kf. OR (dietician* OR dietitian*).tw,kf. OR genetic counsellor*.tw,kf. OR music therapist*.tw,kf. OR nutritionist*.tw,kf. OR occupational therapist*.tw,kf. OR optometrist*.tw,kf. OR (orthotist* or prosthetist*).tw,kf. OR orthoptist*.tw,kf. OR pharmacist*.tw,kf. OR (physiotherapist* OR physical therapist*).tw,kf. OR podiatrist*.tw,kf. OR psychologist*.tw,kf. OR (radiographer* OR sonographer* OR radiation therapist*).tw,kf. OR rehabilitation counsellor*.tw,kf. OR (speech pathologist* OR language pathologist* OR speech therapist* OR language therapist*).tw,kf. OR ((health OR healthcare OR health care) adj (personnel OR worker* OR staff OR professional* OR workforce OR provider*)).tw,kf. | 963,351 |
3. | ((rural OR remote OR non-metropolitan OR nonmetropolitan OR regional) adj (communit* OR area* OR region* OR province*)).tw,kf. OR ((rural OR remote OR nonmetropolitan OR non-metropolitan OR regional) adj (health service* OR health care OR healthcare OR medical service* OR medical care OR workforce)).tw,kf. OR (rural OR remote OR non-metropolitan OR nonmetropolitan OR regional adj (setting* OR clinic* OR hospital* OR health service*)).tw,kf. OR rural Health/ OR rural hospital*, rural/ OR rural population/ OR rural health service* | 142,677 |
4. | 1 AND 2 AND 3 | 3211 |
5. | (((“semi-structured” OR semistructured OR unstructured OR informal OR “in-depth” OR indepth OR “face-to-face” OR structured OR guide) adj3 (interview* OR discussion* OR questionnaire*)) OR (focus group* OR qualitative OR ethnograph* OR fieldwork OR field work OR key informant)).tw,kf. OR interviews as topic/ OR focus groups/ OR narration/ OR qualitative research/ | 416,304 |
6. | 7. 4 AND 5 | 575 |
Data screening and extraction
Quality appraisal
art therapist audiologist chiropractor dental therapist dietitian exercise physiologist genetic counsellor | music therapist occupational therapist optometrist oral health therapist orthoptist orthotist prosthetist | perfusionist pharmacist physiotherapist osteopath podiatrist psychologist rehabilitation counsellor | radiation therapist radiographer sonographer social worker speech pathologist |
Meta-synthesis
Reflexivity
Results
Study inclusion and characteristics of included studies
Author | Medicine/ Allied Health | Country | Population | Study design | Methods | Phenomena of interest |
---|---|---|---|---|---|---|
Bayley SA, Magin PJ, Sweatman JM, Regan CM [30] | Medicine | Australia | 15 GP registrars enrolled in training | Qualitative Modified grounded theory | Semi-structured interviews, thematic analysis | Perceptions of compulsory rural GP vocational training program |
Bonney A, Mullan J, Hammond A, Burns P, Yeo G, Thomson B, et al. [31] | Medicine | Australia | 7 junior medical officers | Mixed methods Case study methodology | Semi structured interviews, pragmatic template analysis | Experiences of junior medical officers in metropolitan and rural emergency departments |
Brown L, Smith T, Wakely L, Little A, Wolfgang R, Burrows J [32] | Allied Health | Australia | 129 Allied health professionals undertook an undergraduate rural placement | Mixed methods, longitudinal study | Longitudinal survey, content analysis | Impact of rural immersive placement on longer term career outcomes |
Campbell AM, Brown J, Simon DR, Young S, Kinsman L. [33] | Medicine | Australia | 22 registrars and GPs upskilling in obstetrics in the last 5 years | Qualitative | Semi-structured interviews, thematic analysis | Factors influencing rural general practitioners and GP registrars to practise obstetrics |
Cleland J, Johnston PW, Walker L, Needham G [34] | Medicine | Scotland | 20 Trainee doctors | Qualitative | Focus groups and interviews, framework approach | Experiences and perceptions of trainee doctors working in remote and rural areas |
Cosgrave C. 2020 [35] | Allied Health | Australia | 74 managers, early career and experienced allied health | Qualitative constructivist-interpretivist | Semi structured interviews, thematic analysis | Influence of perceived work and personal factors on retention |
Cuesta-Briand B, Coleman M, Ledingham R, Moore S, Wright H, Oldham D, et al. [36] | Medicine | Australia | 21 junior doctors in postgraduate training | Qualitative descriptive | Semi-structured interviews, thematic analysis | Factors influencing the decision to pursue rural work among junior doctors |
Cuesta-Briand B, Coleman M, Ledingham R, Moore S, Wright H, Oldham D, et al. [37] | Medicine | Australia | 21 junior doctors in postgraduate training | Qualitative descriptive | Semi-structured interviews, thematic analysis | Junior doctors internal decision-making processes in relation to their career path understanding of how junior doctors |
Devine S [38] | Allied Health | Australia | 12 Occupational therapists | Qualitative phenomenological approach | Semi-structured interviews, thematic content analysis | Perceptions of rural occupational therapists regarding essential skills for rural practice graduates |
Devine SG, Williams G, Nielsen I [39] | Allied health | Australia | 17 past or present Allied Health Rural scholarship holders | Mixed methods | In-depth interviews, thematic analysis | Graduate recruitment outcomes and retention within a scholarship program. |
Doyle C, Isles C, Wilson P [40] | Medicine | Scotland | 14 rRural consultants and 23 junior doctors | Qualitative | Questionnaire and structured interviews, thematic analysis | Structure of teams, experience of role, perspectives of potential training pathway |
Edwards SL, Sergio Da Silva AL, Rapport FL, McKimm J, Williams R [41] | Medicine | Wales | 42 Junior doctors from the same medical program | Mixed methods, sequential exploratory | Online questionnaire and in depth interviews, thematic analysis | What influences students’ choices about either staying in, or leaving Wales, post-graduation? |
Elliott T, Bromley T, Chur-Hansen A, Laurence C [42] | Medicine | Australia | 30 Rural GP registrars | Qualitative | Semi structured interviews, thematic analysis | Comparison of pre and post rural rotation expectations and experiences |
Gill SD, Stella J, Blazeska M, Bartley B [43] | Medicine | Australia | 4 remote emergency medical trainees | Multi methods – observational study | Supervision documentation, pre and post semi scripted Interviews, thematic analysis | Experience of receiving remote supervision |
Iedema R, Brownhill S, Haines M, Lancashire B, Shaw T, Street J [44] | Medicine | Australia | 5 junior medical officers, 5 registrars, 2 consultants in one hospital. | Mixed methods. | Diary entries, content analysis | What are the barriers and facilitators of effective clinical supervision? Suggestions for improvement |
Isaacs AN, Raymond A, Jacob A, Hawkings P [45] | Medicine | Australia | 12 rural interns | Qualitative description framework | Semi structured interviews, thematic analysis | Exploring the job satisfaction, autonomy, training, social supports and mental health and wellbeing. |
Keane S, Lincoln M, Smith T [46] | Allied health | Australia | 30 rural allied health professionals | Qualitative study, grounded theory | Focus groups, thematic analysis | factors affecting recruitment and retention of rural allied health |
Lee S, Mackenzie L. [47] | Allied health | Australia | 5 new graduate rural occupational therapists | Qualitative | Semi structured interviews, thematic analysis | Attitudes and experiences of graduates working in rural areas |
Malau-Aduli BS, Smith AM, Young L, Sen Gupta T, Hays R [48] | Medicine | Australia | 20 International graduate registrars and 5 supervisors | Qualitative grounded theory | Semi structured Interviews over 2 phases, researcher notes | What impacts on registrars decisions to go to, to stay or to leave a regional, rural or remote area? |
Martin R, Mandrusiak A, Lu A, Forbes R [49] | Allied health | Australia | 12 Physiotherapists with 2 years or less experience | Qualitative general inductive approach | Semi structured interviews, thematic analysis | Perceptions of rural and remote practice and the influence of university training on preparedness for rural and remote practice |
McKillop A, Webster C, Bennett W, O’Connor B, Bagg W [50] | Medicine | New Zealand | 15 graduates who had studied for 12 months in regional and rural area | Mixed methods, descriptive design | Focus groups and interviews, thematic analysis | Attraction to rural area factors, career intentions and factors influencing these choices |
Mugford BV, Braund W, Worley P, Martin A [51] | Medicine | Australia | 2 interns who had undertaken a rural rotation, 2 supervisors, 1 hospital executive | Qualitative evaluation | Semi structured interviews, thematic analysis | The experience of rural interns undertaking a rural rotation |
Myhre DL, Hohman S [52] | Medicine | Canada | 29 resident doctors who had worked in a rural area for 4–8 weeks | Mixed methods | Survey, thematic analysis | The impact of rural rotations for post graduate medical training positions |
Pandit T, Sabesan S, Ray RA [53] | Medicine | Australia | 11 Junior and 9 senior rural doctors | Qualitative grounded theory | Semi structured interviews, thematic analysis | Perceptions of training needs of rural doctors |
Peel R, Young L, Reeve C, Kanakis K, Malau-Aduli B, Sen Gupta T, et al. [54] | Medicine | Australia | 79 GP registrars, managers, supervisors, consumers and practice staff | Qualitative2 phases | Semi structured interviews and focus group, thematic analysis | Attractors and barriers for GP registrars to train and GP supervisors to work in rural and remote communities |
Smith DM [55] | Medicine | Australia | 19 rural Junior and senior doctors, educators, directors, medical administrators | Qualitative exploratory | Semi structured interviews, thematic analysis | Issues and difficulties faced by junior doctors with bonded scholarships |
Steenbergen K, Mackenzie L. [56] | Allied health | Australia | 9 new graduate rural occupational therapists | Qualitative | Semi structured interviews, thematic analysis | The experience of professional support for occupational therapists |
Thackrah RD, Thompson SC [57] | Allied health | Australia | 3 Occupational therapists and speech pathologists, one health science graduate | Qualitative | Semi structured interviews, thematic analysis | Long term impacts of rural placements, the experience of working rurally |
Walters L, Laurence CO, Dollard J, Elliott T, Eley DS [58] | Medicine | Australia | 18 rural GP registrars | Qualitative grounded theory | Semi structured interviews | Exploring the resilience of rural GP registrars and strategies used to maintain resilience |
Wearne SM [59] | Medicine | Australia | 5 Registrars who had completed a 6 month remote rotation | Qualitative | Structured interviews, content analysis by question | Factors in the interaction between GP registrars and supervisors impact on the quality of registrar learning |
Methodological quality
Yes | No | Unclear | |
---|---|---|---|
1. Is there congruity between the stated philosophical perspective and the research methodology? | 25 | 1 | 4 |
2. Is there congruity between the research methodology and the research question or objectives? | 29 | 1 | |
3. Is there congruity between the research methodology and the methods used to collect data? | 30 | ||
4. Is there congruity between the research methodology and the representation and analysis of data? | 29 | 1 | |
5. Is there congruity between the research methodology and the interpretation of results? | 29 | 1 | |
6. Is there a statement locating the researcher culturally or theoretically? | 4 | 26 | |
7. Is the influence of the researcher on the research, and vice- versa, addressed? | 12 | 18 | |
8. Are participants, and their voices, adequately represented? | 30 | ||
9. Is the research ethical according to current criteria or, for recent studies, and is there evidence of ethical approval by an appropriate body? | 28 | 2 | |
10. Do the conclusions drawn in the research report flow from the analysis, or interpretation, of the data? | 30 |
Meta-synthesis
Synthesised findings | Allied health categories | Medicine categories |
---|---|---|
Making a difference through professional and organisational factors | 1.1.1 Supervision 1.1.2 Manager support 1.1.3 Human resources 1.1.4 Workplace culture | 2.1.1 Supervision 2.1.2 Human resources 2.1.3 Workplace culture |
Working in rural areas can offer unique and rewarding opportunities for allied health professionals | 1.2.1 Broad clinical opportunities 1.2.2 Career opportunities and challenges 1.2.3 Opportunities for Autonomy 1.2.4 Learning opportunities 1.2.5 Professional development opportunities | 2.2.1 Broad clinical opportunities 2.2.2 Career and specialisation opportunities and challenges 2.2.3 Autonomy and professional identity 2.2.4 Hands on learning opportunities 2.2.5 Training opportunities |
Personal and community influences make a difference | 1.3.1 Family and partner influences 1.3.2 Community influences 1.3.3 Accommodation influences 1.3.4 Professional personal boundaries | 2.3.1 Family and partner influences 2.3.2 Community influences |
Making a difference through professional and organisational factors
1.1.1 and 2.1.1 Supervision
Allied health | Medicine |
1.1.1 Positive supervision and support 2.1.1 Positive supervision and support | |
“More support meant more freedom to ask questions and increased confidence. Opportunities to discuss practice dilemmas as part of professional support decreases anxiety.” pg 163 [56] “having the opportunity to bounce things off my colleagues and discuss difficult circumstances with my seniors [helped me through difficult days]....the senior support and collegial support has been amazing”. pg 4 [57] | “you have to deal with everything that walks in the door. But you are paired with a consultant on the day. You basically run your assessment with them and see if they are happy with your plan, and for any instrumental deliveries or complicated issues you contact them to come in.” pg 668–669 [33] “I was really lucky ‘cause I went to such a supportive practice. I think, potentially, if it’d not been as supportive and I hadn’t had that backup so frequently available, it could have been more stressful.” Pg 83 [30] |
1.1.1 Challenging or absent supervision and support 2.1.1 Challenging or absent supervision and support | |
“None of the study participants (including those working with other occupational therapists) reported being involved in structured supervision with another occupational therapist... Less support caused difficulty developing confidence, especially in a newly created position” pg 162–3 [56] “It’s different talking to someone on the phone than having them there, in the office when you want them. Like you could ring the adviser and she won’t be able to get back to you if you ring her one morning, till the following afternoon. Often you’ve needed to make a decision by then. So you’ve had to make one anyway. “pg 40 [47] | “Yeah, there’s been times that I’ve been very stressed and upset, but not sure who to go to. I think that’s one thing that internship really lacks is someone who is there to look out for us interns.” pg 249 [45] ‘Unable to contact any senior staff regarding sick patient abandoned, overwhelmed’ ‘Registrar did not listen & was very dismissive poor advice given, felt very unsupported’ ‘Mocked by another registrar about previous mistake on patient insulted, unhelpful’ [Field notes] pg 290 [44] |
1.1.2 Manager support
Allied health | |
1.1.2 Positive support provided by manager | |
“Anything I need, anything I have to run by them, they make the time for me and X [name of manager] really gives me a lot of confidence in my abilities. She’s like, ‘Why are you worrying about this? It’s exactly what I would have done.’ ‘Of course, you’re on the right track.’ ‘If you forgot to ask a question [to a patient], you can go back and see them, tomorrow, can’t you?’ or ‘It’s just no fuss.’ I’m stressing about these things that I was made to stress about on placement which I don’t ever stress about here, it’s completely different.” pg 13 [35] “My manager creates the environment and I feel like... she’s the very key reason the staff that I work with are here and a very key reason for why I love to work here.” pg 11 [35] | |
1.1.2 Challenging or absent support from manager | |
“My boss is extremely unorganised, trying to organise time off is a nightmare unless you are [in a] senior [role]. I also feel it is not on a first apply, first granted basis. I also feel my boss is unapproachable.” [32] “The perceived absence of a supportive manager was sharply felt and described as having negative impacts on job satisfaction: ‘[Early career is] not really easy. I personally don’t advise new grads to work in rural anymore. I think they need support and no matter how much promise they get, I got a lot of promises but I didn’t get a lot of support.” pg 13 [35] |
1.1.3 and 2.1.2 Human resources
Allied health | Medicine |
1.1.3 Human resources | 2.1.2 Human resources |
“So the HR process took a long time to come through....Maybe I interviewed in early Feb then, because I remember starting on the [late date in] March.... as that was as soon as HR could onboard me... So I remember like it made me doubt myself..... and I thought how could I have not gotten this job?” pg 12 [35] “I hope to still be working at the hospital in two years’ time but I do want permanency.... I’d love to stay (where I am) but I’ll leave, only because of the permanency issue; this is a contract position.”pg 4 [57] | “Yeah, I think there’re difficulties between DHB expectations, college training expectations, university expectations, RMO [resident medical officer] expectations...” pg 11 [50] “Accommodation could be better. There’s no Internet access at all, so we struggle to do our DOTS modules [compulsory online learning]. We don’t even have a telly (television) that works....these home comforts are actually fairly important.” pg 480 [34] |
1.1.4 and 2.1.3 Workplace culture
Allied health | Medicine |
1.1.4 workforce culture | 2.1.3 workforce culture positives |
“Rural and remote colleagues were seen to be ‘friendly’, ‘laid back’, ‘sociable’ and ‘supportive’.” pg 448 [49] “I felt really welcomed. As soon as I got here, they made sure I was okay, got to know me, had a welcome dinner. Y [staff member’s name] organises all of the social events for X and that was a good opportunity to get to know them outside of work, you talk about different things.” pg 17 [35] “I enjoy working with my colleagues.” “I enjoy it and I like the location and the people.” “I like the way the hospital works, together with all allied health professionals and all hospital staff.” [32] | “It’s different in that it’s usually only you and one other doctor and two or three nursing staff so you really feel very involved in the process and you actually really feel like you’re making a difference.”pg 479 [31] “They lacked resources... but they have a really good work culture which I thought was really, really amazing.” pg 247 [45] |
2.1.3 workforce culture challenges | |
“There was too much. It was quite stressful. The demands of rural practice are probably too high the stress and.... responsibility [and the] considerable personal cost associated with that. I guess a lot of people do it, survive and cope but I can’t see myself doing it at that sort of level.” pg 85 [30] “I’ve had to deal with all sorts of horrendous situations... I’m glad I’ve done it in a way but I think it would have been nice to have got that experience without being sent to the middle of nowhere by myself” pg 3 [55] |
Working in rural areas can offer unique and rewarding opportunities for allied health professionals and doctors
1.2.1 and 2.2.1 Broad clinical opportunities
Allied health | Medicine |
1.2.1 Broad clinical opportunities | 2.2.1 Broad clinical opportunities |
“The diversity of duties that needed to be performed was seen as challenging ....the assorted needs of the client groups ....The importance of having administrative skills and broader management skills was also discussed. Although identified as challenges, these issues were also seen to add to the attractiveness of rural practice.” pg 207 [38] “I think the biggest thing is the diversity of the case load. On placement it was a set discipline or a set ward that you’d be on and even as a new-grad working in those areas....Whereas out here, I can go from an Ortho, to a MSK, to a Paeds, you know....even in one day it’s a very different case load.” pg 448 [49] | “[The rural hospital] was the complete range of patients so I saw lots of patients who didn’t need any treatment at all, right through to patients who had a triage category of one and had either died or were dying at the time. But it’s very unusual for the intern to see a patient who is severely ill at [the metropolitan hospital] because the registrars usually see those patients.” pg 480 [31] “The variety in just one day is incredible I think. I compared it to what my urban GP placement was like in sixth year and there’s no way that we would have been doing the variety of things. Yes, it’s kind of hard to explain but I was really just impressed with how many different things I could see just in one day.” pg 9 [42] |
1.2.2 and 2.2.2 Career and specialisation opportunities and challenges
Allied health | Medicine |
1.2.2 Career opportunities | 2.2.2 Career and specialisation opportunities |
“OK, now I’m here, where’s the next step up?” And the career opportunities are all out here, they’re not back in the city.” pg 8 [46] “I hope to regain employment when my contract finishes as the region has good capacity for growth.” (rural/remote based graduate, physiotherapy) [32] | “..it’s a small little hospital where you had open access for the undifferentiated patients that presents with a problem and it’s got a significant emergency, significant outpatients segment. It’s got obstetrics and a huge Indigenous population. It suited me.” pg 3 [58] “So, I guess at this point I want to be a generalist. I like a bit of everything, it keeps it interesting, it keeps it fresh” pg 6 [37] |
1.2.2 Career challenges | 2.2.2 Career and specialisation challenges |
“Whilst I enjoy the rural lifestyle and experience. As a new graduate, I am limited with opportunities to further my career … .. I am moving somewhere where they have the resources to provide me with better support and opportunities.” pg 9 [32] “Professionally and clinically my particular interests make it a bit difficult to work in regional areas....I loved working in [the country] and that’s why I stayed so long, but the thing that really drew me home last month [to the city] was that I wanted to gain more experience in a very specific area... you don’t get the opportunity to do that in rural areas”. pg 6 [57] | “There aren’t training jobs in the rural hospitals, apart from GP training, which is not what I want to go into straightaway. So it’s actually quite frustrating, because I’ve loved these two years, but there’s nothing to go into afterwards, so that’s why I’m going away.” pg 479 [34] “… unless you specifically want to be that rural GP, there’s firstly no pathway. And two, it’s not only not encouraged, it’s almost frowned upon. I find it amazing because the whole time I was in rural areas people talk about how much they’re trying to bring people rurally. When I look at it I kind of see a lot of closed doors.” pg 7 [36] |
1.2.3 and 2.2.3 Opportunities for autonomy and developing professional identify
Allied health | Medicine |
1.2.3 Opportunity autonomy | 2.2.3 Opportunity for autonomy |
“I like being in a rural area because I have the independence and ability to structure things the way I want to. I love the autonomy, the travel and seeing all these different things.” pg 208 [38] “Less support meant more responsibility to seek out answers to questions, develop skills, become more independent and facilitate creativity.” pg 163 [56] | “Increased sense of autonomy in clinical decision making and in particular felt they had the opportunity to develop and implement patient management plans” pg 2 [51] “You stop and question whether you actually need to speak with a consultant...and now I’m back here [teaching hospital] I ask less for advice …. It forces you to step up to the next level”. pg 449 [43] |
1.2.3 Negatives of autonomy | 2.2.3 Medicine developing professional identify |
“I’m doing two jobs and have been doing for two and a half months. Recruitment is happening and it’s going, and I hit the wall and my manager said, “Keep on going,” and I said, “Can you just acknowledge how much extra – all you need to do is acknowledge it...” pg 5 [46] “I don’t think I’ve necessarily made the wisest decision with what I’ve done (becoming a sole therapist). I’ve made a decision which I certainly benefited from, but professionally and personally it’s been a hard slog ….” ‘pg 42 [47] | “I think it is about fostering supported practice and this is a particular time of vulnerability in terms of support....the movement from hospital-based practice to being a new person in community-based practice.” pg 669 [33] “I call my boss before each shift, my supervisor, and say, I’m on tonight because he gives me telephone back up which I rarely use, but I actually like to know that he knows that I might be calling him.” pg 10 [42] ‘You could finish your internship and it could be your first week in your JHO year and be sent to a rural site and you’re acting as a PHO or SMO, or something, which I think is terrifying and a bit inappropriate.’ Pg 4 [53] |
1.2.4 Learning opportunities and 2.2.4 Hands on learning opportunities
Allied health | Medicine |
1.2.4 Positive learning opportunities | 2.2.4 Positive hands on experiences |
“You’ve really got to embrace it. Think of it, like an opportunity to learn and experience a lot of different...a variety of patients from various demographics and backgrounds.” pg 448 [49] “Overall, participants felt they had gained many skills as a result of their rural practice that would not have been gained outside the rural setting.” pg 208 [38] | “You get to do a lot more clinically, you don’t get this hands on experience in a less remote setting” 3 pg 9 [40] “So you get to look after the patient in general practice and then if they’re sick, you look after them in hospital. That was great.” pg 9 [42] “Great hands on clinical and operative skills rotation” pg 5 [52] |
1.2.4 Challenging learning conditions | 2.2.4 Challenging hands on experiences |
“Study participants often found that it was their responsibility to try to enhance the available resources. As new graduates they had not expected this responsibility and felt unprepared and overwhelmed.” pg 41 [47] | “I’ve had to deal with all sorts of horrendous situations... I’m glad i’ve done it in a way but I think it would have been nice to have got that experience without being sent to the middle of nowhere by myself” pg 3 [55] |
1.2.4 Allied health professional development opportunities and 2.2.4 Medicine training opportunities
Allied health | Medicine |
1.2.4 Positive professional development opportunities | 2.2.3 Positive training opportunities |
“Yeah, good training opportunities, quick training opportunities, you’re able to get training quickly here as in compared to bigger metropolitan cities [where] it takes a while.” pg 15 [35] “… work was supportive of me taking the time off for leave and paid for the course as well, which I really didn’t expect. Which was really nice ….” pg 14 [35] | “..most doctors thought that the resources available at smaller hospitals were adequate to meet their training needs, and some even spoke of the benefit to their clinical reasoning of having limited access to diagnostic technology, where having to ‘make do’ with minimal equipment resulted in their becoming more independent thinkers.” pg 5 [36] “The consultant did weekly teaching; actually twice weekly teaching; So, after work hours, he would do a non-formal tutorial with the registrar and the intern, and I thought that was good...”pg248 [45] |
1.2.4 Challenges with professional development | 2.2.3 Challenges with training |
“Large caseloads and the inability to find locums prevented attendance at professional development events. Travel distances and overall expense were also barriers.” pg 207 [38] “Difficulty accessing useful continuous professional development... travel and time burden to attend educational sessions in metropolitan centres … need for better access to training opportunities available locally..” Pg 163 [56] | “In some practices, tutorials were not given priority on the timetable and so did not occur, or else were held outside of work hours” pg 8 [59] “it is far away from everywhere, so you have got to add a whole day for travel just because of the time of flights and the cost” pg 5 [54] |
Personal and community influences make a difference
1.3.1 and 2.3.1 Family and partner influences
Allied health | Medicine |
1.3.1 Family and partner influences | 2.3.1 Family and partner influences |
“My family is in the city, so that’s been the hardest thing, being so far away. It might be a factor in making a consider moving, but we’ll see how that goes” pg 5 [46] “I will move closer to my partner at some stage as they seek different employment opportunities, but I am hoping to stay working regionally or rurally.” pg 9 [32] “I decided to stay around instead of moving away because my boyfriend is here.” pg 6 [46] “Personal factors such as marrying a person from the area and having friends or family in the area also had an impact” pg 207 [38] | The most important people in my life is just my family, my wife and kids. They are like shock absorbers for you and sometimes you have ups and downs and stress, and sometimes something doesn’t go well you get upset and that is part of work and life. So you need some like you need to unwind your stress, so you need your partner just to sit and talk and de-stress yourself. pg 11–12 [48] “In terms of professional concerns, and the separation from my wife, she was very, very supportive. We worked out that it was good, [my rural placement] was only an hour-and-a-bit from where we lived in Adelaide so weekends where I wasn’t on call in [my rural placement] I’d go down to Adelaide and vice versa … ..” pg 10 [42] |
1.3.2 and 2.3.2 Community influences
Allied health | Medicine |
1.3.2 Community influences positive | 2.3.2 Community influences positive |
“I really like the community support and spirit. Even outside of work the community is really good and it’s easy to meet people. The community focus rather than the medical model focus is great.” pg 208 [38] “Within one or two weeks he was offering if I wanted to play on a social touch team....Everyone only had positive experiences about going out there (rural town), they all kind of tell you the things that you can do on the weekends!” pg 448 [49] | “very nice lifestyle. It’s not as busy, not as fast, not as crowded, everything is just nice. You know, you’ve got short ways everywhere. You don’t have to drive so far. You get parking spots everywhere. You don’t have to pay for everything. The nature is easily accessible. The people are usually relaxed and nice. Hospitals are small, you know, more working in a family than like in the big [urban] Hospital.”pg 13 [48] “I just made the most of it. I really enjoyed going from a big city to being in the outdoors, learned how to sail, went hiking lots, and just made the most of it.” pg 480 [34] |
1.3.2 Community influences negatives | 2.3.2 Community influences negatives |
“‘getting out into that wider community has been difficult’ pg 41 [47] “I think in the country towns is if you’re not sort of in the football, netball, then it’s harder I suppose to make those connections outside of work and get to know the people.” pg 19 [35] | “...it can be quite isolating as well.... if you’re not from there, you’ll tend to make friends who are related to the medical side of things, and there’s not so much going on in the city as perhaps in bigger cities, so it’s kind of hard to get away from it....But medically, I’d say it’s –it’s good in that, I thought it was ....quite captivating.” pg 6 [41] “Adjusting to living in small communities... those accustomed to living in big cities found it quite peculiar in towns where everybody knew everybody, and everyone knew everyone else’s business” pg 5 [55] |
1.3.3 Accommodation and commuting influences
Allied health | |
1.3.3 Accommodation | |
“Access to appropriate and affordable accommodation was important and assistance in finding accommodation was recommended as well as having access to financial support for accommodation and relocation costs.” pg 7 [39] “I just couldn’t find anything. I just thought, ‘I can’t find anything that fits the bill’ … ..My working hours are anywhere between 7 and 5, so it’s just, it was impossible to even to get to a real estate office to say, ‘I’m looking for a property, I want some support’ ... I’d have friends going to inspections for me.” pg 17 [35] | |
1.3.3 Clinicians commuting to work | |
“I would love to be closer and I have close bonds with people [here] but there is still the [distance] barrier that separates you from developing... things further. And a lot of other people are not from here, so they’re most likely to go back home [straight after work] anyway …” [35] “There was a couple of people there who just weren’t interested in any of the regional stuff, unless it was open after hours on a Monday to Thursday because ‘we’ll only be here for one year and we’ll be going to Melbourne every Friday night and coming back on Monday morning’.” [35] |
1.3.4 Professional personal boundaries
Allied Health | |
1.3.4 Professional and personal boundaries | |
“I’d have to sort of, deal with, like, people interacting outside of a professional environment? I saw another one of my patients at the pub. We were drinking, and I was like ‘this is kind of weird’ so I don’t know, I found that actually quite hard, like how much, how do I even, interact with them?” [49] “I’d walk around and people would recognise me as the new physio and essentially. I was filling up my car at the petrol station and a guy came over and said ‘Are you the new physio?“pg 447–448 [49] |
Discussion
Implications
-
A structured career path for early career doctors in areas other than general practice and anaesthetics similar to opportunities available in metropolitan areas might encourage more doctors to train and work in rural areas.
-
Giving allied health professionals career advancement opportunities in rural areas through specialist or generalist training that result in recognition of expertise, and a pathway of rural career progression might enable clinicians to plan a rural career.
-
Local supervision and prioritised access to post graduate training for junior doctors will provide a more positive experience.
-
Allied health professionals need access to discipline specific supervision in order for them to develop confidence and competence.
-
Acknowledging and addressing personal factors including the location and needs of a partner or family, integration into the community and consideration of personal and professional boundaries may result in a more positive experience for all health professionals.