title: Urban washout: how strong is the rural-background effect?
abstract: OBJECTIVE
  To test predictors of practice location of fully qualified Monash University Bachelor of Medicine, Bachelor of Surgery (MBBS) graduates.
  
  
  METHODS
  Cohort survey, 2011.
  
  
  METHODS
  Australia.
  
  
  METHODS
  Rural (n = 67/129) and urban (n = 86/191) background doctors starting at Monash University 1992-1999. Approximately 60% female, 77% married/partnered, 79% Australian-born, mean age 34 years, 31% general practitioners, 72% fully qualified and 80% training/practising in major cities.
  
  
  METHODS
  First and current practice location once fully qualified. Intended practice location in 5-10 years.
  
  
  RESULTS
  Logistic regression found that rural versus urban background was a significant predictor of rural (outside major city) first practice location (odds ratio (OR) 5.0, 95% confidence interval (CI) 1.3-19.2) and rural current practice location (OR 5.6, 95% CI 1.5-21.2) for fully qualified doctors. General practitioner versus other medical specialists significantly predicted first (OR 7.2, 95% CI 2.1-25.2) or current (OR 3.6, 95% CI 1.1-11.9) rural practice location. Preference for a rural practice location in 5-10 years was predicted by rural background (OR 4.4, 95% CI 1.6-11.8) and positive intention towards rural practice upon completing MBBS (OR 4.6, 95% CI 1.7-12.6). Surveyed in 2011, 28% of those who also responded to the 2006 survey shifted their preferred future practice location from rural to urban communities versus 13% shifting from urban to rural (McNemar-Bowker test, P = 0.02).
  
  
  CONCLUSIONS
  The majority of fully qualified Monash MBBS graduates practicing in rural communities have rural backgrounds. The rural-background effect diminished over time and may need continued support during training and full practice.
authors.affiliation: Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada.
authors.forename: John C
authors.initials: JC
authors.lastname: Hogenbirk
authors.affiliation: School of Rural Health, Monash University, Churchill, Victoria, Australia.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: McGrail
authors.affiliation: Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada.|Dean's Office, Northern Ontario School of Medicine, Sudbury, Ontario, Canada.
authors.forename: Roger
authors.initials: R
authors.lastname: Strasser
authors.affiliation: Centre for Rural and Northern Health Research, Laurentian University, Sudbury, Ontario, Canada.
authors.forename: Sara A
authors.initials: SA
authors.lastname: Lacarte
authors.affiliation: Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia.
authors.forename: Ajay
authors.initials: A
authors.lastname: Kevat
authors.affiliation: School of Rural Health, Monash University, Churchill, Victoria, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Lewenberg
mesh_terms: D000328:Adult; D001315:Australia; D002321:Career Choice; D015331:Cohort Studies; D005260:Female; D058005:General Practitioners / Q000523:psychology; D006801:Humans; D033182:Intention; D016015:Logistic Models; D008297:Male; D011365:Professional Practice Location; D019035:Rural Health Services; D011795:Surveys and Questionnaires
keywords: doctor; logistic regression; practice intention; practice location