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Keywords:

  • ASGC – Remoteness Area;
  • equity;
  • geographical classifications;
  • resource allocation;
  • rurality

Abstract

Objective: The objective of this study was to define an improved classification for allocating incentives to support the recruitment and retention of doctors in rural Australia.

Design and setting: Geo-coded data (n = 3636 general practitioners (GPs)) from the national Medicine in Australia: Balancing Employment and Life study were used to examine statistical variation in four professional indicators (total hours worked, public hospital work, on call after-hours and difficulty taking time off) and two non-professional indicators (partner employment and schooling opportunities) which are all known to be related to difficulties with recruitment and retention.

Main outcome measures: The main outcome measure used for the study was an association of six sentinel indicators for GPs with practice location and population size of community.

Results: Four distinct homogeneous population size groups were identified (0–5000, 5001-15 000, 15 001–50 000 and >50 000). Although geographical remoteness (measured using the Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA)) was statistically associated with all six indicators (P < 0.001), population size provided a more sensitive measure in directing where recruitment and retention incentives should be provided. A new six-level rurality classification is proposed, based on a combination of four population size groups and the five ASGC-RA levels. A significant increase in statistical association is measured in four of six indicators (and a slight increase in one indicator) using the new six-level classification versus the existing ASGC-RA classification.

Conclusions: This new six-level geographical classification provides a better basis for equitable resource allocation of recruitment and retention incentives to doctors based on the attractiveness of non-metropolitan communities, both professionally and non-professionally, as places to work and live.