title: Glass half full: Survival analysis of new rural doctor retention in Western Australia.
abstract: OBJECTIVE
  To measure the time trends in retention of new rural doctors in Western Australia (WA) and identify factors associated with improved retention.
  
  
  METHODS
  Retrospective inception cohort study of the 1154 doctors first commencing rural practice in WA in 2004-2013, who provided 1222 tours of service consisting of up to eight attachments at different rural practice settings.
  
  
  METHODS
  Failure of doctor retention as evidenced by an absence from the rural medical workforce of greater than 1 year and analysed using actuarial survival methods and Cox proportional hazards regression.
  
  
  RESULTS
  Comparing 2009-2013 with 2004-2008, there was an improvement of 10 percentage points in retention of new rural doctors at 2 years (58% versus 48% ) and 7 percentage points at 5 years (38% versus 31%). The retention failure rate ratio was 0.68 (95% CI, 0.58-0.83). The improvement at 5 years was largely attributable to gains in retention of those who began as GP registrars (37% versus 14%). Failure of doctor retention was lower in those who possessed procedural skills (RR 0.61, 95% CI, 0.47-0.78) and lower in international medical graduates than in those trained in Australia (RR 0.75, 95% CI, 0.59-0.95).
  
  
  CONCLUSIONS
  New rural GP retention in WA has improved substantially, an observation at least consistent with government initiatives delivering a positive return. However, it remains the case that the majority of new doctors have left rural practice within 5 years of commencing their tour of service.
authors.affiliation: Rural Health West, Perth, Western Australia, Australia.
authors.forename: Belinda E S
authors.identifier: http://orcid.org/0000-0001-7667-9185
authors.initials: BE
authors.lastname: Bailey
authors.affiliation: Rural Health West, Perth, Western Australia, Australia.
authors.forename: Rosalie G
authors.initials: RG
authors.lastname: Wharton
authors.affiliation: Rural Health West, Perth, Western Australia, Australia.
authors.forename: C D'Arcy J
authors.initials: CD
authors.lastname: Holman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D058005:General Practitioners; D006801:Humans; D008297:Male; D008875:Middle Aged; D010558:Personnel Loyalty; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D019035:Rural Health Services; D016019:Survival Analysis; D014904:Western Australia
keywords: general practice; retention; rural; workforce