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| Journal of the New Zealand Medical Association,
28-January-2005, Vol 118 No 1208
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New Zealand Rural General Practitioners 1999 Survey
Part 4: analysis of specific sub-groups
Ron Janes, Donna Cormack, Anthony Dowell
Rural general practice in New Zealand (NZ) is facing
increasing difficulties with recruitment and
retention1 and the rural GPs in the current
workforce are stressed.2,3 The NZ Rural GPs
1999 Survey4,5 has confirmed as a key issue the
significant workforce shortage, which in turn leads to heavy workloads, frequent
oncall commitments, and lack of locums to enable time off for professional
development and holidays.
Solutions to these problems have been
suggested.3,5,6 Female rural GPs, while sharing
many of the same concerns as their male counterparts, have additional issues
(e.g. security while oncall, combining family and
work).7 The purpose of this paper is to examine
5 other sub-groups within the rural GP workforce: to compare and contrast their
demographics, working characteristics and computer usage, using data from the
New Zealand Rural GPs 1999 Survey. The 5 characteristics chosen for sub-group
analysis were: age, rurality (Rural Ranking Scale score), vocational training,
country of graduation, and geographic (island) location.
MethodsAnonymous postal questionnaires
were mailed out in November 1999 to 559 GPs identified as rural or semi-rural
from a database compiled by one of the authors (RJ). Non-responders were
initially posted a reminder card in December, a reminder questionnaire in
January 2000, and then had a further reminder (by telephone or facsimile) 1
month later. Inclusion criteria comprised a rural ranking scale (RRS) score of
equal or greater than 35 (maximum score = 100 points) and currently working as a
GP in New Zealand. A detailed description of methods is presented
elsewhere.4
Quantitative data were entered into an Access database.
Epi Info software was used for analysis. Chi-squared tests were carried out to
detect statistically significant differences in demographic and practising
characteristics between the sub-groups of rural GPs. The 5 key characteristics
chosen for sub-group analysis were: age in years (<45; ≥45), rurality
score measured by the RRS (≤50; ≥55), vocationally training, country
of graduation and Island location (North Island or South Island).
ResultsQuestionnaires were sent to a total
of 559 rural and semi-rural GPs, of which 417 were returned completed for an
overall response rate of 75%. Of the 417 completed questionnaires, 74 had RRS
scores of less than 35 points, and 5 had not completed the RRS, which provided
338 appropriately completed questionnaires for analysis.
Table 1 summarises the data for each of the sub-groups
studied.
AgeYounger doctors (<45 years) were
more likely to be vocationally trained, doing accreditation, and using full
electronic medical records than those 45 years or older. Not unexpectedly,
younger doctors were less likely to have been 10 or more years in NZ rural
general practice. They were also less likely to work in a practice by
themselves, work fulltime, own their own practice, or be members of either the
Rural GP Network or New Zealand Medical Association (NZMA).
Rural Ranking ScoreGPs working in less isolated rural
areas (RRS score ≤50) were more likely to be on the North Island and
belong to an IPA. They were less likely to work in a practice by themselves,
have 3 or less GPs in their locality, work as a rural hospital doctor, do
intrapartum obstetrics, or have email at the surgery.
Vocational TrainingRural GPs who have completed a
general practice vocational training programme (either in NZ or abroad) were
more likely to be younger, expect to be in their current practice in 3 years, be
doing either accreditation or reaccreditation, be members of an IPA, and have
email at the surgery. They were less likely to be working in a practice by
themselves.
NZ medical graduateThe only difference between rural
GPs who graduated from NZ medical schools, as compared to overseas graduates,
was that NZ graduates were more likely to have been in NZ rural general practice
for longer than 10 years.
IslandNorth Island rural GPs were less
likely to have a higher RRS score (≥55), work in a locality with 3 or less
GPs, or work as a rural hospital doctor.
DiscussionThis is the first study to compare
and contrast various sub-groups of NZ rural GPs. It highlights a number of
challenges facing rural general practice including the recruitment of young
doctors into an ‘ageing’ workforce and the contrasting rural
environments of the North and South Islands. While the survey results were
collected 4 years ago (December 1999 to March 2000), the stability of rural
healthcare continues to be fragile with workforce shortages still common in many
localities.
Some of the differences observed between younger (<45
years) and older (≥45 years) rural GPs were expected. The NZ general
practice vocational training programme was only established in
1977,8 so was not an option for the older GPs.
Likewise, younger doctors are more likely to be involved
with accreditation and as such, would be less likely to be doing
re-accreditation. While more younger rural GPs are opting to work in group
practices (IE. not solo), it is heartening to see a similar percentage, as
compared to the older rural GPs, working in more isolated localities (RRS
≥55). The greater number of younger doctors working part-time, is partly
explained by the higher percentage of women in this
group.7
It is also self-evident that the more isolated rural GPs
(RRS score ≥55) in smaller centres of population are more likely to have 3
or less GPs in the area, and thus to be more likely to work in solo practice.
Likewise, New Zealand rural hospitals are located at a distance from urban
centres,9 so the more isolated rural GPs are
more likely to work as rural hospital doctors or be required for intra-partum
obstetrics.
While the majority of rural GPs and rural hospitals are
located on the more populated North Island,9 it
is interesting to note that a higher percentage of South Island rural GPs (83%)
worked as rural hospital doctors, as compared to only 63% of North Island rural
GPs. The analysis does raise issues about the differing rural environments in
the South and North Islands.
Of the 199 rural GPs with lower RRS scores of ≤50, the
majority (65%) were located on the North Island. The South Island’s few
main urban centres are mainly located on its east coast, with large rural areas
covering much of the rest of the island.
In contrast, the North Island has more urban centres, which
are more uniformly distributed, thereby reducing the geographic isolation of its
rural localities. While it may be an oversimplification to state that
‘distance to health services is a greater issue for the South Island,
while poor socioeconomic status and Maori health are greater health issues for
the rural North Island’10 there is a need
to recognise both the commonality and differences between rural general practice
experiences in differing areas of NZ.
It is clear that different geography, population
characteristics, health infrastructure and patterns of current and future
regional rural development will have major impacts on the healthcare of rural
people on both the North and South Islands.
Most rural GPs in NZ graduated from an overseas medical
school. While it is unclear to what extent this will affect long-term
sustainability of rural retention, it is heartening to see that overseas
graduates are equally prepared to work in more isolated rural practices.
The observed trend of younger doctors choosing to work
part-time, in group practices, and not owning their practice, has significant
implications for the rural workforce shortage. As the older, predominantly male,
rural GP workforce retires, it will require a greater number of younger,
increasingly part-time (and female), rural GPs to replace them. This may be
especially problematic for the South Island, where rural isolation appears to be
a greater problem.
Author information:
Ron Janes, Associate Professor of Rural Health, Department of General Practice
and Primary Health Care, Auckland University, Auckland and The NZ Institute of
Rural Health, Hamilton; and rural GP, Wairoa Medical Centre, Wairoa,
Hawke’s Bay; Donna Cormack, Junior Research Fellow, Department of General
Practice, Wellington School of Medicine, Otago University, Wellington;
Anthony Dowell, Professor, Department of General Practice, Wellington
School of Medicine, Otago University, Wellington
Acknowledgements: We
gratefully acknowledge research grants from both the RNZCGP Research and
Education Charitable Trust and the Wellington Faculty of the RNZCGP.
Correspondence:
Associate Professor Ron Janes, PO Box 341, Wairoa, Hawke’s Bay, 4192.
Fax: (06) 838 3729; email: ronjanes@xtra.co.nz
References:
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