Workforce retention in rural and remote Australia: determining the factors that influence length of practice.

OBJECTIVES To ascertain which factors are most significant in a general practitioner's decision to stay in rural practice and whether these retention factors vary in importance according to the geographical location of the practice and GP characteristics. DESIGN National questionnaire survey. The method of paired comparisons was used to describe the relative importance of the retention items. SETTING Non-metropolitan Australia, September 2001. PARTICIPANTS A stratified sample of all rural GPs practising during April-June 2001. MAIN OUTCOME MEASURES A rank ordering of factors influencing how long GPs stay in rural practice, and an index of their relative perceived importance. RESULTS Professional considerations -- overwhelmingly, on-call arrangements -- are the most important factors determining GP retention in rural and remote areas. Rural doctors consistently ranked on-call arrangements, professional support and variety of rural practice as the top three issues, followed by local availability of services and geographical attractiveness. Proximity to a city or large regional centre was the least important factor. Retention factors varied according to geographical location and GPs' age, sex, family status, length of time in the practice, and hospital duties. CONCLUSIONS A broad, integrated rural retention strategy is required to address on-call arrangements, provide professional support and ensure adequate time off for continuing medical education and recreation.