Choosing regional, rural, and remote practice: what attracts or deters early-career doctors?

Enhancing the retention of medical professionals in regional, rural and remote (RRR) areas requires a multi-faceted strategy that acknowledges and addresses the contextual barriers doctors face when deciding whether to continue practising in RRR hospitals. Gaining a deeper understanding of these factors can inform evidence-based workforce planning and policy development to mitigate the rural physician shortage across Australia. This study aimed to explore motivators and perceived barriers among junior medical doctors when choosing their training location- whether in RRR hospitals or metropolitan settings- during the early years of postgraduate training. A qualitative study was conducted using virtual one-on-one interviews. The setting included four Hospital and Health Services (HHSs) in Northern Queensland, Australia (Townsville, Cairns, Mackay and North West). Participants were doctors in training from intern level to postgraduate year 5 (including prevocational and early vocational doctors). Twenty-five interviews were transcribed verbatim. Data were thematically analysed, through an inductive approach. Most participants were female (n = 19) and aged under 29 years (n = 21). The motivations for choosing RRR hospitals among most Australian-trained doctors included proximity to family, a desire for adventure, rural upbringing, peer recommendations, and the availability of benefits through incentivisation schemes. For many recently graduated doctors, regional hospitals were considered the "right size", offering a broad range of specialties without feeling lost in the crowd often associated with larger metropolitan hospitals. Barriers included limited job opportunities in rural settings, challenges in securing preferred rotations, social isolation, lack of camaraderie in the workplace, and the cost of living. This study provides valuable insights into the key pull and push factors influencing doctors' decisions to train/ work in RRR areas. At both the HHS and national levels, these findings can help guide decision-makers and employers on where to invest to positively influence doctors' choices regarding training and practice locations. A multifaceted approach is needed, with interventions tailored to doctors' specific needs, particularly those that support family life, increase rural exposure, and offer competitive remuneration.