Australia's rural medical workforce: Supply from its medical schools against career stage, gender and rural-origin

Objective: The aim of this study was to explore the association between career stage and rural medical workforce supply among Australian-trained medical graduates. Design and Setting: Descriptive analysis using the national Medicine in Australia: Balancing Employment and Life (MABEL) longitudinal study. Participants: Australian-trained GPs and other specialists who participated in the MABEL study, 2008-2013. Main outcome measure(s): Proportions of GPs and specialists working in rural locations, according to career stage (establishing, early, mid and late), gender and childhood-origin type (rural versus metropolitan). Results: Logistic regression models revealed that establishing- and early-career GPs had significantly higher likelihood (OR 1.67 and 1.38, respectively) of working rurally, but establishing and early-career doctors were significantly less likely (OR 0.34 and 0.43, respectively) to choose general practice, contributing proportionally fewer rural GPs overall (OR 0.77 and 0.75, respectively) compared to late-career doctors. For specialists, there were no significant associations between career cohorts and rural practice. Overall, there was a significantly lower likelihood (OR 0.83) of establishing-career doctors practising rurally. Women were similarly likely to be rural GPs but less likely to be rural specialists, while rural-origin was consistently associated with higher odds of rural practice. Conclusions: The supply of Australia's rural medical workforce from its medical schools continues to be challenging, with these data highlighting both their source and associations with doctors at different career stages. Despite large investments through rural medical training and rural workforce recruitment and retention policies, these data confirm continued reliance on internationally trained medical graduates for large proportions of rural supply is likely.