title: Medical family support needs and experiences in rural Queensland.
abstract: BACKGROUND
  Family issues have been recognised as major contributors to both rural GP retention in, and loss to, rural practice. This qualitative interview survey of rural medical spouses sought to identify and understand the support requirements and experiences that could be used to formulate strategies that may positively influence rural medical family retention. A concurrent key informant interview of 14 agencies associated with rural medical practitioner support sought information on those agencies' specific spouse/family support strategies.
  
  
  OBJECTIVE
  The study's specific aims were to: investigate the experiences and needs of families in terms of support to settle and remain in rural and remote areas; and identify the range and type of formal and informal support strategies available to, and used by, rural medical families.
  
  
  METHODS
  This was a qualitative study with two independent, but complementary, components: (1) in-depth, semi-structured interviews with families of 15 purposively selected rural GPs; and (2) information provided by 14 support organisations.
  
  
  CONCLUSIONS
  Medical family support needs and experiences varied with time in a rural setting. The most frequently mentioned early difficulties included integrating into a community (9/15); childcare and schooling (8/15); being seen as the 'doctors spouse' (ie, loss of own identity) (7/15); and housing and housing maintenance (7/15). Support needs changed over time as respondents established their own support networks. Increasingly, support was required for timeout from the community (5/15), and to keep abreast of changing practice management requirements (4/15). Few formal support strategies were reported as known or used by spouses. Informal support strategies included partners of other GPs; hospital functions and informal social gatherings; clubs and organisations; local church groups, and friendships with other itinerants in the community. Spouses indicated important potential sources of support (both when new to community and later on) as a need for a 'head start' with local and regional networks (14/15); ability to talk to other spouses in similar situations (12/15); support for timeout or leave (12/15); access to a GP other than the GP spouse (10/15); information about childcare (9/15); practice and business management (8/15); and dealing with housing issues (6/15). Additionally, an orientation package was seen as a means of assisting new arrivals to get settled (12/15). The survey of agencies/organisations providing direct and indirect support revealed that there is little directly-funded family support in Queensland, although a number of bodies either have support activities in place or planned. The potential number of players presents a risk of duplication of effort unless there is effective inter-agency dialogue.
  
  
  CONCLUSIONS
  Like their medical partners, spouses appreciate and value peer support and understanding. Strategies aimed at rural GP retention should consider the rural medical family as a unit for support purposes. Support organisations and rural communities must recognise and cater for changing support needs over time. The agency interviews provided some hope for the future, although funding for support activities appears to be limited. Perhaps of greater concern is the possibility for duplication of effort and activity, particularly in some areas, and potentially at the risk of ignoring others.
authors.affiliation: School of Medicine, James Cook University, Queensland, Australia. craig.veitch@jcu.edu.au
authors.forename: Craig
authors.initials: C
authors.lastname: Veitch
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Crossland
mesh_terms: D003625:Data Collection; D005190:Family; D005194:Family Practice; D005260:Female; D005544:Forecasting; D006798:Housing; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D011365:Professional Practice Location; D011793:Queensland; D019035:Rural Health Services; D012944:Social Support; D018454:Spouses; D000078329:Workforce