Burgis-Kasthala Sarath, Bain-Donohue Suzanne, Tailby Ellen, Stonestreet Kathryn, Moore Malcolm
ANU Rural Clinical School, Acton, Australia Capital Territory, Australia.
University of St Andrews, North Haugh, St Andrews, Scotland.
PLOS Glob Public Health. 2024 Mar 18;4(3):e0002860. doi: 10.1371/journal.pgph.0002860. eCollection 2024.
Australia, in common with many countries globally, has a shortage of doctors working rurally. Whilst strategies and current research focus on recruitment, attrition from rural practice is a significant determinant of such shortages. Understanding doctors' decisions to stay or leave, once recruited, may provide further insights on how to address this rural differential. This study comprises a qualitative study of 21 recently recruited nationally-trained doctors and international medical graduates to a rural area of New South Wales, Australia. Interviews focused on their experiences prior to and within rural practice, and how these influenced their future career intentions. We used reflexive thematic analysis with each interview coded by two researchers to build an explanatory framework. Our findings comprise five themes which applied differentially to nationally-trained doctors and international medical graduates: connectedness across professional, personal and geographic domains, how multi-faceted connectedness was, and dissonance between participants' expectations and experiences. Amongst nationally-trained doctors, connectedness stemmed from prior rural experiences which engendered expectations founded upon their ability to develop community-level relationships. Experiences were mixed; some described difficulties maintaining a boundary between their personal and professional lives, which encroached upon their ability to embed within the community. International medical graduates' expectations were cultivated by their pre-conceptions of Australian postgraduate training but they lamented a lack of professional opportunities once in practice. Moreover, they described a lack of professional relationships with local, nationally-trained, doctors that could help them embed into rural practice. This study highlighted that when connectedness occurs across professional, geographic and personal domains doctors are more likely to continue rural practice, whilst illustrating how the importance of each domain may differ amongst different cadres of doctor. Supporting such cadres develop supportive interrelationships may be a low hanging fruit to maximise retention.
与全球许多国家一样，澳大利亚农村地区的医生短缺。虽然目前的策略和研究重点是招聘，但农村医疗岗位的人员流失是造成这种短缺的一个重要因素。了解医生入职后留下或离开的决定，可能会为如何解决农村地区的差异提供进一步的见解。本研究对21名最近招聘到澳大利亚新南威尔士州农村地区的国内培训医生和国际医学毕业生进行了定性研究。访谈重点关注他们在农村医疗工作之前和期间的经历，以及这些经历如何影响他们未来的职业意向。我们采用反思性主题分析，由两名研究人员对每次访谈进行编码，以构建一个解释框架。我们的研究结果包括五个主题，这些主题对国内培训医生和国际医学毕业生的适用情况有所不同：专业、个人和地理领域之间的联系、这种多方面联系的程度，以及参与者的期望与经历之间的不一致。在国内培训医生中，联系源于之前的农村经历，这些经历产生了基于他们建立社区层面关系能力的期望。经历好坏参半；一些人描述了在个人生活和职业生活之间保持界限的困难，这影响了他们融入社区的能力。国际医学毕业生的期望是由他们对澳大利亚研究生培训的先入之见所形成的，但他们感叹入职后缺乏职业机会。此外，他们表示缺乏与当地国内培训医生的专业关系，而这些关系本可以帮助他们融入农村医疗工作。这项研究强调，当在专业、地理和个人领域之间建立联系时，医生更有可能继续在农村执业，同时说明了每个领域的重要性在不同医生群体中可能存在差异。支持这些群体发展支持性的相互关系可能是提高留用率的一个容易实现的目标。
