title: Community assets and capabilities to recruit and retain GPs: the Community Apgar Questionnaire in rural Victoria.
abstract: Rural communities continue to experience significant challenges recruiting and retaining physicians. The Community Apgar Questionnaire (CAQ) was developed in Idaho in the USA to comprehensively assess the characteristics associated with successful recruitment and retention of rural physicians. The CAQ has been utilised and validated across the USA; however, its value in rural Australia has not been examined. The objective of this study was to use the CAQ in rural Australia to examine its utility and develop a greater understanding of the community factors that impact general practitioner (GP) recruitment and retention.
  
  
  
  The project conducted structured face-to-face interviews with hospital chief executive officers (CEOs) and directors of clinical services (DCSs) from 14 of the 21 (76%) health services that agreed to participate in rural north-eastern Victoria, Australia. The interviews were undertaken to complete the CAQ, which contains 50 questions centred on factors that influence physician recruitment and retention. Once completed, CAQs were scored by assigning quantitative values to a community's strengths and challenges including the level of importance placed on each factor. As such, the most important factors in physician recruitment, whether they are advantages or challenges for that community, were then weighed for their relative importance. Scores were then combined to create a CAQ score. To ensure reliability and validity of the results, three additional CAQs were purposefully administered to key general practices within the region.
  
  
  
  The 14 rural communities exhibited cumulative CAQ scores ranging from a high of 387 to a low score of 61. This suggests the tool was sensitive enough to differentiate between communities that were high and low performers in terms of physician recruitment. The groups of factors that had the greatest impact on recruitment and retention were ranked highest to lowest and included medical support, hospital/community support, economic, scope of practice and geographic factors. Overall, the highest individual factors to impact recruitment and retention were perception of quality, hospital leadership, nursing workforce and transfer arrangements. Conversely, the lowest factors and challenges to recruitment and retention were family related, specifically spousal satisfaction and access to schools.
  
  
  
  Hume, in rural Victoria, was the first international site to implement the CAQ to differentially diagnose a community's relative strengths and challenges in recruiting and retaining GPs, while supporting health facilities to prioritise achievable goals to improve long-term retention strategies. It provided each community with a tailored gap analysis, while confidentially sharing best practices of other health facilities. Within Hume, open communication and trust between GPs and health facility leadership and nursing staff ensures that GPs can feel valued and supported. Possible solutions for GP recruitment and retention must consider the social, employment and educational opportunities that are available for spouses and children. Participation in the program was useful as it helped health facilities ascertain how they were performing while highlighting areas for improvement.
authors.affiliation: Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia. d.terry@unimelb.edu.au.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Terry
authors.affiliation: Center for Health Policy at Boise State University, Boise, Idaho, USA. ebaker@boisestate.edu.
authors.forename: Ed
authors.initials: E
authors.lastname: Baker
authors.affiliation: Rural Family Medicine, Family Medicine Residency of Idaho, Boise, Idaho, USA. dave.schmitz@fmridaho.org.
authors.forename: David F
authors.initials: DF
authors.lastname: Schmitz
mesh_terms: D001291:Attitude of Health Personnel; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010558:Personnel Loyalty; D010560:Personnel Selection; D058007:Physicians, Primary Care / Q000600:supply & distribution*; D011320:Primary Health Care; D019035:Rural Health Services; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014739:Victoria; D000078329:Workforce
keywords: Australia/Pacific; General/Family Practice; Medical