Background: The diverse rural medical education initiatives that have been developed in Australia to address the medical workforce maldistribution have been less successful in many smaller and remote communities. This study explored the factors that attract and retain GP registrars and supervisors and the impact that localised training (i.e., rural and remote workplace-based training and support) has on both GP registrars and supervisors, and the GP workforce in rural and remote underserved areas. Methods: A purposive sample of 79 GP registrars, supervisors, practice managers, health services staff and community representatives living and working in areas of low GP workforce in rural and remote Australia were invited to participate in semi-structured interviews and one focus group divided over two phases. Thematic analysis was used to explore themes within the data. Findings: Attractors and barriers to rural and remote practice were identified as the main themes. Attractors include family and community lifestyle factors, individual intrinsic motivators, and remote medicine experiences. In contrast, barriers include work related, location, or family factors. Further, localised GP training was reported to specifically influence GP registrars and supervisors through education, social and financial factors. Conclusion: The current study has provided a contemporary overview of the issues encountered in expanding GP training capacity in rural and remote communities to improve the alignment of training opportunities with community and workforce needs. Strategies including matching scope of practice to registrar interests have been implemented to promote the attractors and lessen the barriers associated with rural and remote practice.

The increasing transient population within rural and remote communities challenges the sustainability of regional Australia. Challenges to sustainability are particularly present for mining communities that have an increasing reliance on transient workforces. Identifying ways to increase length of residency within mining communities could assist in increasing the economic and social stability of these communities. The aim of this qualitative research was to explore residents' intentions to stay and factors that increased their intentions to leave a remote mining community. Twenty residents (three males, 17 females) recruited from a remote mining community in Queensland, Australia, participated in interviews. Interview data was analysed using thematic analysis within an interpretative phenomenological analysis framework. The participants reported their connection to people and place was their predominant motivation for wanting to stay in the community. The main reasons that participants reported wanting to leave the community was a perceived lack of access to family, services and employment, and lifestyle factors. Additionally, some participants reported intentions to leave as they perceived that the community was not their permanent home. These findings provide practical insight into strategies that could be developed to increase length of residency. For example, improving community attachment and satisfaction through promoting awareness of the available services and activities in which residents can participate. Through these strategies for increasing the length of residency within regional communities, the sustainability of these communities may then in turn be enhanced.

Background Substantial government funding has been invested to support the training of General Practitioners (GPs) in Australia to serve rural communities. However, there is little data on the impact of this expanded training on smaller communities, particularly for smaller rural and more remote communities. Improved understanding of the impact of training on underserved communities will assist in addressing this gap and inform ongoing investment by governments and communities. Method A purposive sample of GP supervisors, GP registrars, practice managers and health services staff, and community members ( n = 40) from previously identified areas of workforce need in rural and remote North-West Queensland were recruited for this qualitative study. Participants had lived in their communities for periods ranging from a few months to 63 years (Median = 12 years). Semi-structured interviews and a focus group were conducted to explore how establishing GP training placements impacts underserved communities from a health workforce, health outcomes, economic and social perspective. The data were then analysed using thematic analysis. Results Participants reported they perceived GP training to improve communities’ health services and health status (accessibility, continuity of care, GP workforce, health status, quality of health care and sustainable health care), some social factors (community connectedness and relationships), cultural factors (values and identity), financial factors (economy and employment) and education (rural pathway). Further, benefits to the registrars (breadth of training, community-specific knowledge, quality of training, and relationships with the community) were reported that also contributed to community development. Conclusion GP training and supervision is possible in smaller and more remote underserved communities and is perceived positively. Training GP registrars in smaller, more remote communities, matches their training more closely with the comprehensive primary care services needed by these communities.

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