title: Rural GPs' ratings of initiatives designed to improve rural medical workforce recruitment and retention.
abstract: BACKGROUND
  Since the early 1990s, Australian governments have recognised the problems of rural medical workforce recruitment and retention and have implemented a range of programs and incentives designed to improve the supply of, and access to, doctors in rural and remote areas. Some incentives involve differential payments according to degree of rurality or remoteness. Since these programs involve considerable costs to governments, some assessment of their impact on recruitment or retention is warranted. The objective of this study is to examine the effectiveness of different recruitment and retention incentives from the perspective of the rural GP. Doctors practising in rural and remote communities were, therefore, asked to rank the relative importance of different interventions in terms of their impact on recruitment to and retention of GPs in their communities.
  
  
  METHODS
  Six possible interventions were selected to cover the major objectives underpinning rural workforce programs most relevant to doctors currently in rural practice. Respondents assigned a rank to indicate the relative importance of each item with respect to each of the two questions: "What would help most to attract more GPs to this community?" and "What would help most to retain GPs in this community?" The data were collected as part of a national study into the viability of rural general practice undertaken jointly by the Rural Doctors Association of Australia and Monash University School of Rural Health Bendigo. The Rural, Remote and Metropolitan Areas (RRMA) classification was used as the rurality indicator. Analysis involved the calculation of mean ranks for each item. Item means were then ranked to indicate most to least important items in total, and within each RRMA category.
  
  
  RESULTS
  Thirty-five percent of all GPs practising in rural and remote Australia responded to the national survey, representing 53% of all practices in those areas. Of these, 1050 doctors who nominated themselves as a principal, partner or associate in their practice were eligible for inclusion in this analysis. The results showed a high degree of agreement in the responses to both questions, with the possible interventions being ranked in the same overall order. 'Better remuneration for Medicare consultations' and 'Improved after-hours and on-call arrangements' were ranked as the most important interventions for both attracting and retaining GPs, whereas 'Better education and professional support activity' and 'Improved availability of allied health professional services' were ranked as least important of the options presented. 'Better locum availability' and 'Capital funding to improve practice infrastructure/enable GPs to set up practice' ranked in between. Results within each RRMA category were very similar to the overall rankings, confirming the significance of the improved remuneration and workload arrangements, regardless of geographical location.
  
  
  CONCLUSIONS
  Ensuring professional support, workforce supply, income and infrastructure support are all relevant to the recruitment and retention of GPs in rural and remote areas. However, from the perspective of GPs practising in such areas, specific initiatives that increase the core income of rural practices, and which address those medical workforce supply issues which impact most on workload, are considered those which are most likely to assist in the recruitment and retention of GPs to Australia's rural and remote communities.
authors.affiliation: Monash University School of Rural Health, Bendigo, Victoria, Australia. judith.jones@med.monash.edu.au
authors.forename: J A
authors.initials: JA
authors.lastname: Jones
authors.forename: J S
authors.initials: JS
authors.lastname: Humphreys
authors.forename: M A
authors.initials: MA
authors.lastname: Adena