title: Widening access to medicine may improve general practitioner recruitment in deprived and rural communities: survey of GP origins and current place of work.
abstract: BACKGROUND
  Widening access to medicine in the UK is a recalcitrant problem of increasing political importance, with associated strong social justice arguments but without clear evidence of impact on service delivery. Evidence from the United States suggests that widening access may enhance care to underserved communities. Additionally, rural origin has been demonstrated to be the factor most strongly associated with rural practice. However the evidence regarding socio-economic and rural background and subsequent practice locations in the UK has not been explored. The aim of this study was to investigate the association between general practitioners' (GPs) socio-economic and rural background at application to medical school and demographic characteristics of their current practice.
  
  
  METHODS
  The study design was a cross-sectional email survey of general practitioners practising in Scotland. Socio-economic status of GPs at application to medical school was assessed using the self-coded National Statistics Socio-Economic Classification. UK postcode at application was used to define urban-rural location. Current practice deprivation and remoteness was measured using NHS Scotland defined measures based on registered patients' postcodes.
  
  
  RESULTS
  A survey was sent to 2050 Scottish GPs with a valid accessible email address, with 801 (41.5 %) responding. GPs whose parents had semi-routine or routine occupations had 4.3 times the odds of working in a deprived practice compared to those with parents from managerial and professional occupations (95 % CI 1.8-10.2, p = 0.001). GPs from remote and rural Scottish backgrounds were more likely to work in remote Scottish practices, as were GPs originating from other UK countries.
  
  
  CONCLUSIONS
  This study showed that childhood background is associated with the population GPs subsequently serve, implying that widening access may positively affect service delivery in addition to any social justice rationale. Longitudinal research is needed to explore this association and the impact of widening access on service delivery more broadly.
authors.affiliation: School of Medicine, University of Dundee, Scotland, UK. j.s.dowell@dundee.ac.uk.|Head of Division of Undergraduate Medical Education, School of Medicine Deanery, Ninewells Hospital and Medical School, Level 8, Room LB8 001, Mail box 16, DD1 9SY, Dundee, UK. j.s.dowell@dundee.ac.uk.
authors.forename: J
authors.initials: J
authors.lastname: Dowell
authors.affiliation: Raven Song Community Health Centre, Vancouver, BC, Canada. Michaelnorbury1@aol.com.
authors.forename: M
authors.initials: M
authors.lastname: Norbury
authors.affiliation: School of Medicine, University of Dundee, Scotland, UK. kathrynb@doctors.org.uk.
authors.forename: K
authors.initials: K
authors.lastname: Steven
authors.affiliation: School of Medicine, University of Dundee, Scotland, UK. b.guthrie@dundee.ac.uk.
authors.forename: B
authors.initials: B
authors.lastname: Guthrie
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002321:Career Choice; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D058006:General Practice / Q000193:education; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008507:Medically Underserved Area; D008875:Middle Aged; D010560:Personnel Selection / Q000379:methods*; D011365:Professional Practice Location / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012307:Risk Factors; D012424:Rural Population; D012577:Schools, Medical; D012606:Scotland; D012959:Socioeconomic Factors; D000078329:Workforce