Self-Sufficiency in Intern Supply: The Impact of Expanded Medical Schools, Medical Places and Rural Clinical Schools in Queensland

Article excerpt

Abstract

Objective: The doctor shortage in Australia generally, and the rural shortage in particular, has led to an increase in medical schools, medical places and rural training. If effective, these strategies will first impact on the intern workforce. We studied the source of interns in Queensland.

Methods: Analysis of number, source and location of interns by Rural, Remote and Metropolitan Area (RRMA) classification (an index of remoteness) from university and health department records (2003-2008). Odds ratios compared the likelihood of intern supply from Queensland universities and rural clinical schools.

Results: Most interns in Queensland graduated from Queensland universities in 2007 (287 [72%]) and 2008 (344 [84%]). Proportions increased across all three RRMA groups from: 82% to 93% in RRMA1; 56% to 68% in RRMA2 and 67% to 79% in RRMA3. The University of Queensland (UQ) provides most interns in all RRMA locations including RRMA3, and this increased from 2007 (n = 33 [35%]) to 2008 (n = 57 [58%]). Interns from interstate decreased from 61 (15%) in 2007 to 40 (10%) in 2008. Interns from overseas fell from 53 (13%) in 2007 to 27 (7%) in 2008. Rural clinical schools compared with traditional urban-based schools were more likely to supply interns to RRMA3 than RRMA1 hospitals in 2007 (OR, 8.8; 95% CI, 4.6-16.7; P < 0.0001) and 2008 (OR, 6.5; 95% CI, 3.5-12.2; P < 0.0001).

Conclusions: Queensland is close to self-sufficiency in intern supply and will achieve this in the next few years. Rural clinical schools are playing an important role in producing interns for RRMA3 hospitals. Due to its large cohort, UQ remains the major provider across all RRMA groups.

Aust Health Rev 2009: 33(3): 472-477

THE MOST RECENT government policy to address the doctor shortage entails a substantial increase in student numbers across Australian medical schools, and the creation of new schools. Coincident with the call for more doctors is the importance of preparing them for work in a range of geographical areas - in particular, rural areas.1"3 The Commonwealth Government has implemented several initiatives with a rural focus at medical schools,4 such as establishing rural clinical schools (RCS), with the expectation that students will work in rural areas after graduation. If effective, these strategies will first impact on the intern workforce.

Choosing internship location is the first major career decision made by medical graduates and one that is typically contemplated midway through undergraduate training.3 Furthermore, this decision will become more important as numbers of medical graduates and competition for intern places increase in the future. In Queensland, internship preference is afforded to graduates from its own universities, but places are also filled by graduates from interstate and overseas.6

The aim of this study was to determine where Queensland's interns come from, how this is changing over time and the particular contribution to rural internships that the RCS play.7

Methods

A retrospective analysis of data from Queensland Health (QH) and the University of Queensland (UQ) was done in July 2008. The source of interns (Queensland, interstate or overseas), number of graduates and their intern destination was collated and categorised by the Rural, Remote and Metropolitan Area (RRMA)8 classification of each training hospital. The RRMA is an index of remoteness based primarily on population density and an average distance of residents from one another. Seven categories are included in this classification - two metropolitan (RRMA 1 and 2), one regional/rural (RRMA 3), two rural (RRMA 4 and 5) and two remote (RRMA 6 and 7). Only hospitals in RRMAs 1-3 train interns.6 Two separate investigations were undertaken.

The first investigation looked at trends in total intern numbers (all sources) and proportions across each RRMA category of hospital in 2007 and 2008 (we were unable to obtain data from earlier years). …

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