Russell Deborah J, McGrail Matthew R, Humphreys John S, Wakerman John
Office of Research, School of Rural Health, Monash University, PO Box 666, Bendigo, Vic. 3552, Australia.
Aust J Prim Health. 2012;18(4):289-94. doi: 10.1071/PY11049.
The objectives of this study were to measure the relative strength, significance and contribution of factors associated with rural and remote medical workforce retention. Length of stay data from two Australian GP workforce datasets, the 2008 National Minimum Data Set (4223 GPs) and a subset of the 2008 Medicine in Australia: Balancing Employment and Life dataset (1189 GPs), were separately analysed using multiple linear regression models and the results compared. Length of employment in their current practice location was the outcome measure. Consistent results were obtained across both datasets. The most important factors associated with the retention of rural and remote GPs, after adjusting for GP age, were primary income source, registrar status, hospital work and restrictions on practice location (which are linked to geographic location). Practice ownership was associated with -70% higher retention than average, whilst undertaking hospital work in addition to routine general practice was associated with at least 18% higher retention compared with if no hospital work was undertaken. Less important factors included geographic location, procedural skills, annual leave, workload and practice size. Our findings quantify a range of financial and economic, professional and organisational, and geographic factors contributing to the retention of rural GPs. These findings have important implications for future medical workforce policy, providing an empirical evidence base to support the targeting and 'bundling' of retention initiatives in order to optimise the retention of rural GPs.
本研究的目的是衡量与农村和偏远地区医疗劳动力留存相关因素的相对强度、重要性和贡献。利用多元线性回归模型分别分析了来自两个澳大利亚全科医生劳动力数据集（2008年国家最低数据集，共4223名全科医生；以及2008年澳大利亚医学：平衡就业与生活数据集的一个子集，共1189名全科医生）的留存时长数据，并对结果进行了比较。以在其当前执业地点的工作时长作为结果指标。两个数据集均得到了一致的结果。在对全科医生年龄进行调整后，与农村和偏远地区全科医生留存相关的最重要因素是主要收入来源、注册医生身份、医院工作以及执业地点限制（这与地理位置相关）。诊所所有权与留存率比平均水平高70%相关，而除了常规全科医疗工作外还从事医院工作，与不从事医院工作相比，留存率至少高18%。不太重要的因素包括地理位置、操作技能、年假、工作量和诊所规模。我们的研究结果量化了一系列有助于农村全科医生留存的财务经济、专业组织和地理因素。这些发现对未来的医疗劳动力政策具有重要意义，为支持留存举措的针对性和“捆绑式”实施以优化农村全科医生的留存提供了实证依据。
