Characteristics of Medical Deserts and Approaches to Mitigate Their Health Workforce Issues: A Scoping Review of Empirical Studies in Western Countries

Document Type : Review Article

Authors

1 Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands

2 Avedis Donabedian Research Institute – UAB, Madrid, Spain

3 Innovation and Entrepreneurship InnoLab, University of Vaasa, Vaasa, Finland

4 Department of Health Policy and Management, Institute of Public Health, Jagiellonian University, Krakow, Poland

5 Department of Health Economics and Social Security, Institute of Public Health, Jagiellonian University, Krakow, Poland

6 School of Medicine, University of Zagreb, Zagreb, Croatia

7 Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands

8 Department of Sociology, Radboud University, Nijmegen, The Netherlands

Abstract

Background 
Medical deserts are considered a problematic issue for many Western countries which try to employ multitude of policies and initiatives to achieve a better distribution of their health workforce (HWF). The aim of this study was to systematically map research and provide an overview of definitions, characteristics, contributing factors and approaches to mitigate medical deserts within the European Union (EU)-funded project “ROUTE-HWF” (a Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies).

Methods 
We performed a scoping review to identify knowledge clusters/research gaps in the field of medical deserts focusing on HWF issues. Six databases were searched till June 2021. Studies reporting primary research from Western countries on definitions, characteristics, contributing factors, and approaches were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies according to the four defined outcomes.

Results 
Two-hundred and forty studies were included (n = 116, 48% Australia/New Zealand; n = 105, 44% North America; n = 20, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n = 171, 71%), characteristics (n = 95, 40%), contributing factors (n = 112, 47%), and approaches to mitigate medical deserts (n = 87, 36%). Most medical deserts were defined by the density of the population in an area. Contributing factors to HWF issues in medical deserts consisted in work-related (n = 55, 23%) and lifestyle-related factors (n = 33, 14%) of the HWF as well as sociodemographic characteristics (n = 79, 33%). Approaches to mitigate them focused on training adapted to the scope of rural practice (n = 67, 28%), HWF distribution (n = 3, 1%), support/infrastructure (n = 8, 3%) and innovative models of care (n = 7, 3%).

Conclusion 
Our study provides the first scoping review that presents and categorizes definitions, characteristics, contributing factors, and approaches to mitigate HWF issues in medical deserts. We identified gaps such as the scarcity of longitudinal studies to investigate the impact of factors contributing to medical deserts, and interventional studies to evaluate the effectiveness of approaches to mitigate HWF issues.

Keywords


  1. World Health Organization (WHO). Increasing Access to Health Workers in Remote and Rural Areas Thorugh Improved Retention: Global Policy Recommendations. Geneva: WHO; 2010.
  2. Bärnighausen T, Bloom DE. Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions. Hum Resour Health. 2009;7:52. doi:1186/1478-4491-7-52
  3. Lucas-Gabrielli V, Chevillard G. ["Medical deserts" and accessibility to care: what are we talking about?]. Med Sci (Paris). 2018;34(6-7):599-603. doi:1051/medsci/20183406022
  4. Chow AF, Morgan D, Bayly M, Kosteniuk J, Elliot V. Collaborative approaches to team-based primary health care for individuals with dementia in rural/remote settings. Can J Aging. 2019;38(3):367-383. doi:1017/s0714980818000727
  5. Wong C. Indicators in use: challenges to urban and environmental planning in Britain. Town Plan Rev. 2000;71(2):213-239.
  6. Ono T, Schoenstein M, Buchan J. Geographic Imbalances in Doctor Supply and Policy Responses. Paris: OECD; 2014.
  7. WHO Regional Office for Europe. United Action for Better Health in Europe, Draft European Programme of Work, 2020-2025. Copenhagen: WHO Regional Office for Europe; 2020.
  8. Kelly C, Hulme C, Farragher T, Clarke G. Are differences in travel time or distance to healthcare for adults in global north countries associated with an impact on health outcomes? A systematic review. BMJ Open. 2016;6(11):e013059. doi:1136/bmjopen-2016-013059
  9. Kroezen M, Dussault G, Craveiro I, et al. Recruitment and retention of health professionals across Europe: a literature review and multiple case study research. Health Policy. 2015;119(12):1517-1528. doi:1016/j.healthpol.2015.08.003
  10. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:7326/m18-0850
  11. Arksey H, O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 2005;8(1):19-32. doi:1080/1364557032000119616
  12. McGowan J, Sampson M, Salzwedel DM, Cogo E, Foerster V, Lefebvre C. PRESS peer review of electronic search strategies: 2015 guideline statement. J Clin Epidemiol. 2016;75:40-46. doi:1016/j.jclinepi.2016.01.021
  13. Browne RH. On the use of a pilot sample for sample size determination. Stat Med. 1995;14(17):1933-1940. doi:1002/sim.4780141709
  14. Ricketts TC, Tropman SE, Slifkin RT, Konrad TR. Migration of obstetrician-gynecologists into and out of rural areas, 1985-1990. Med Care. 1996;34(5):428-438. doi:1097/00005650-199605000-00005
  15. Theodorakis PN, Mantzavinis GD. Inequalities in the distribution of rural primary care physicians in two remote neighboring prefectures of Greece and Albania. Rural Remote Health. 2005;5(3):457.
  16. Booza JC, Bridge PD, Neale AV, Schenk M. Incorporating Geographic Information Systems (GIS) into program evaluation: lessons from a rural medicine initiative. J Am Board Fam Med. 2010;23(1):59-66. doi:3122/jabfm.2010.01.090167
  17. Crump WJ, Fricker RS, Ziegler CH, Wiegman DL. Increasing the rural physician workforce: a potential role for small rural medical school campuses. J Rural Health. 2016;32(3):254-259. doi:1111/jrh.12156
  18. Daniels ZM, Vanleit BJ, Skipper BJ, Sanders ML, Rhyne RL. Factors in recruiting and retaining health professionals for rural practice. J Rural Health. 2007;23(1):62-71. doi:1111/j.1748-0361.2006.00069.x
  19. Denz-Penhey H, Shannon S, Murdoch CJ, Newbury JW. Do benefits accrue from longer rotations for students in Rural Clinical Schools? Rural Remote Health. 2005;5(2):414.
  20. Eley D, Baker P. Does recruitment lead to retention? Rural Clinical School training experiences and subsequent intern choices. Rural Remote Health. 2006;6(1):511.
  21. Eley D, Young L, Przybeck TR. Exploring temperament and character traits in medical students; a new approach to increase the rural workforce. Med Teach. 2009;31(3):e79-84. doi:1080/01421590802335892
  22. Elliott-Schmidt R, Strong J. Rural occupational therapy practice: a survey of rural practice and clinical supervision in rural Queensland and Northern New South Wales. Aust J Rural Health. 1995;3(3):122-131. doi:1111/j.1440-1584.1995.tb00164.x
  23. Gillham S, Ristevski E. Where do I go from here: we've got enough seniors? Aust J Rural Health. 2007;15(5):313-320. doi:1111/j.1440-1584.2007.00900.x
  24. Goetz K, Musselmann B, Szecsenyi J, Joos S. The influence of workload and health behavior on job satisfaction of general practitioners. Fam Med. 2013;45(2):95-101.
  25. Gray LC, Wright OR, Cutler AJ, Scuffham PA, Wootton R. Geriatric ward rounds by video conference: a solution for rural hospitals. Med J Aust. 2009;191(11-12):605-608. doi:5694/j.1326-5377.2009.tb03345.x
  26. Whitson HE, Steinhauser K, Ammarell N, et al. Categorizing the effect of comorbidity: a qualitative study of individuals' experiences in a low-vision rehabilitation program. J Am Geriatr Soc. 2011;59(10):1802-1809. doi:1111/j.1532-5415.2011.03602.x
  27. Hays R, Wynd S, Veitch C, Crossland L. Getting the balance right? GPs who chose to stay in rural practice. Aust J Rural Health. 2003;11(4):193-198.
  28. Heath B, Salerno R, Hopkins A, Hertzig J, Caputo M. Pediatric critical care telemedicine in rural underserved emergency departments. Pediatr Crit Care Med. 2009;10(5):588-591. doi:1097/PCC.0b013e3181a63eac
  29. Isaac V, Watts L, Forster L, McLachlan CS. The influence of rural clinical school experiences on medical students' levels of interest in rural careers. Hum Resour Health. 2014;12:48. doi:1186/1478-4491-12-48
  30. Jones M, Humphreys J, Prideaux D. Predicting medical students' intentions to take up rural practice after graduation. Med Educ. 2009;43(10):1001-1009. doi:1111/j.1365-2923.2009.03506.x
  31. Kamien M. Staying in or leaving rural practice: 1996 outcomes of rural doctors' 1986 intentions. Med J Aust. 1998;169(6):318-321. doi:5694/j.1326-5377.1998.tb140285.x
  32. Kelley ML, Habjan S, Aegard J. Building capacity to provide palliative care in rural and remote communities: does education make a difference? J Palliat Care. 2004;20(4):308-315.
  33. Landry M, Schofield A, Bordage R, Bélanger M. Improving the recruitment and retention of doctors by training medical students locally. Med Educ. 2011;45(11):1121-1129. doi:1111/j.1365-2923.2011.04055.x
  34. Lasala K. Nursing workforce issues in rural and urban settings: looking at the difference in recruitment, retention and distribution. Online J Rural Nurs Health Care. 2000;1(1):8-24. doi:14574/ojrnhc.v1i1.499
  35. Lavanchy M, Connelly I, Grzybowski S, Michalos AC, Berkowitz J, Thommasen HV. Determinants of rural physicians' life and job satisfaction. Soc Indic Res. 2004;69(1):93-101. doi:1023/B:SOCI.0000032662.79752.e8
  36. Lawrence D, Bryant TK, Nobel TB, Dolansky MA, Singh MK. A comparative evaluation of patient satisfaction outcomes in an interprofessional student-run free clinic. J Interprof Care. 2015;29(5):445-450. doi:3109/13561820.2015.1010718
  37. Steinhaeuser J, Joos S, Szecsenyi J, Miksch A. A comparison of the workload of rural and urban primary care physicians in Germany: analysis of a questionnaire survey. BMC Fam Pract. 2011;12:112. doi:1186/1471-2296-12-112
  38. Lee YH, Barnard A, Owen C. Initial evaluation of rural programs at the Australian National University: understanding the effects of rural programs on intentions for rural and remote medical practice. Rural Remote Health. 2011;11(2):1602.
  39. Lin IB, Goodale BJ. Improving the supervision of therapy assistants in Western Australia: the Therapy Assistant Project (TAP). Rural Remote Health. 2006;6(1):479.
  40. Lindeke L, Jukkala A, Tanner M. Perceived barriers to nurse practitioner practice in rural settings. J Rural Health. 2005;21(2):178-181. doi:1111/j.1748-0361.2005.tb00079.x
  41. MacIsaac P, Snowdon T, Thompson R, Crossland L, Veitch C. General practitioners leaving rural practice in Western Victoria. Aust J Rural Health. 2000;8(2):68-72. doi:1046/j.1440-1584.2000.00232.x
  42. Magnus JH, Tollan A. Rural doctor recruitment: does medical education in rural districts recruit doctors to rural areas? Med Educ. 1993;27(3):250-253. doi:1111/j.1365-2923.1993.tb00264.x
  43. Matthews C, Bagg W, Yielder J, Mogol V, Poole P. Does Pukawakawa (the regional-rural programme at the University of Auckland) influence workforce choice? N Z Med J. 2015;128(1409):35-43.
  44. Mills A, Millsteed J. Retention: an unresolved workforce issue affecting rural occupational therapy services. Aust Occup Ther J. 2002;49(4):170-81. doi:1046/j.1440-1630.2002.00293.x
  45. Morris CG, Johnson B, Kim S, Chen F. Training family physicians in community health centers: a health workforce solution. Fam Med. 2008;40(4):271-276.
  46. Natanzon I, Szecsenyi J, Ose D, Joos S. Future potential country doctor: the perspectives of German GPs. Rural Remote Health. 2010;10(2):1347.
  47. Newman C, Martin E, McGarry DE, Cashin A. Survey of a videoconference community of professional development for rural and urban nurses. Rural Remote Health. 2009;9(2):1134.
  48. Tsiouli K, Karamesinis K, Antonarakis GS, Christou P. Prediction model of regional orthodontic workforce needs, using Greece as an example. Eur J Paediatr Dent. 2016;17(1):29-33.
  49. Orpin P, Gabriel M. Recruiting undergraduates to rural practice: what the students can tell us. Rural Remote Health. 2005;5(4):412.
  50. O'Toole K, Schoo A, Hernan A. Why did they leave and what can they tell us? Allied health professionals leaving rural settings. Aust Health Rev. 2010;34(1):66-72. doi:1071/ah09711
  51. O'Toole K, Schoo A, Stagnitti K, Cuss K. Rethinking policies for the retention of allied health professionals in rural areas: a social relations approach. Health Policy. 2008;87(3):326-332. doi:1016/j.healthpol.2008.01.012
  52. Pepper CM, Sandefer RH, Gray MJ. Recruiting and retaining physicians in very rural areas. J Rural Health. 2010;26(2):196-200. doi:1111/j.1748-0361.2010.00282.x
  53. Perkins D, Larsen K, Lyle D, Burns P. Securing and retaining a mental health workforce in Far Western New South Wales. Aust J Rural Health. 2007;15(2):94-98. doi:1111/j.1440-1584.2007.00860.x
  54. Playford D, Larson A, Wheatland B. Going country: rural student placement factors associated with future rural employment in nursing and allied health. Aust J Rural Health. 2006;14(1):14-19. doi:1111/j.1440-1584.2006.00745.x
  55. Playford D, Wheatland B, Larson A. Does teaching an entire nursing degree rurally have more workforce impact than rural placements? Contemp Nurse. 2010;35(1):68-76. doi:5172/conu.2010.35.1.068
  56. Playford DE, Cheong E. Rural Undergraduate Support and Coordination, Rural Clinical School, and Rural Australian Medical Undergraduate Scholarship: rural undergraduate initiatives and subsequent rural medical workforce. Aust Health Rev. 2012;36(3):301-307. doi:1071/ah11072
  57. Rabinowitz HK, Diamond JJ, Markham FW, Rabinowitz C. Long-term retention of graduates from a program to increase the supply of rural family physicians. Acad Med. 2005;80(8):728-732. doi:1097/00001888-200508000-00004
  58. Ramos MM, Fullerton L, Sapien R, Greenberg C, Bauer-Creegan J. Rural-urban disparities in school nursing: implications for continuing education and rural school health. J Rural Health. 2014;30(3):265-274. doi:1111/jrh.12058
  59. Ulmer B, Harris M. Australian GPs are satisfied with their job: even more so in rural areas. Fam Pract. 2002;19(3):300-303. doi:1093/fampra/19.3.300
  60. Reymond L, Charles M, Israel F, Read T, Treston P. A strategy to increase the palliative care capacity of rural primary health care providers. Aust J Rural Health. 2005;13(3):156-161. doi:1111/j.1440-1854.2005.00687.x
  61. Rourke JT, Incitti F, Rourke LL, Kennard M. Keeping family physicians in rural practice. Solutions favoured by rural physicians and family medicine residents. Can Fam Physician. 2003;49:1142-1149.
  62. Sabesan S, Larkins S, Evans R, et al. Telemedicine for rural cancer care in North Queensland: bringing cancer care home. Aust J Rural Health. 2012;20(5):259-264. doi:1111/j.1440-1584.2012.01299.x
  63. McDonnel Smedts A, Lowe MP. Efficiency of clinical training at the Northern Territory Clinical School: placement length and rate of return for internship. Med J Aust. 2008;189(3):166-168. doi:5694/j.1326-5377.2008.tb01953.x
  64. Spencer RJ, Cardin AJ, Ranmuthugala G, Somers GT, Solarsh B. Influences on medical students' decisions to study at a rural clinical school. Aust J Rural Health. 2008;16(5):262-268. doi:1111/j.1440-1584.2008.00978.x
  65. Steenbergen K, Mackenzie L. Professional support in rural New South Wales: perceptions of new graduate occupational therapists. Aust J Rural Health. 2004;12(4):160-165. doi:1111/j.1440-1854.2004.00590.x
  66. Stratton TD, Dunkin JW, Szigeti E, Muus KJ. Recruitment barriers in rural community hospitals: a comparison of nursing and nonnursing factors. Appl Nurs Res. 1998;11(4):183-189. doi:1016/s0897-1897(98)80307-8
  67. Thackrah RD, Hall M, Fitzgerald K, Thompson SC. Up close and real: living and learning in a remote community builds students' cultural capabilities and understanding of health disparities. Int J Equity Health. 2017;16(1):119. doi:1186/s12939-017-0615-x
  68. Tolhurst HM, Adams J, Stewart SM. An exploration of when urban background medical students become interested in rural practice. Rural Remote Health. 2006;6(1):452.
  69. Walker JH, Dewitt DE, Pallant JF, Cunningham CE. Rural origin plus a rural clinical school placement is a significant predictor of medical students' intentions to practice rurally: a multi-university study. Rural Remote Health. 2012;12:1908.
  70. Alexander C. Why doctors would stay in rural practice in the New England health area of New South Wales. Aust J Rural Health. 1998;6(3):136-139. doi:1111/j.1440-1584.1998.tb00299.x
  71. Ward AM, Kamien M, Lopez DG. Medical career choice and practice location: early factors predicting course completion, career choice and practice location. Med Educ. 2004;38(3):239-248. doi:1046/j.1365-2923.2004.01762.x
  72. Wayne SJ, Kalishman S, Jerabek RN, Timm C, Cosgrove E. Early predictors of physicians' practice in medically underserved communities: a 12-year follow-up study of University of New Mexico School of Medicine graduates. Acad Med. 2010;85(10 Suppl):S13-16. doi:1097/ACM.0b013e3181ed1bee
  73. White CH, Meier N, Swint C. The implementation of a stress management program for health care workers through a rural occupational health clinic. Workplace Health Saf. 2021;69(4):161-167. doi:1177/2165079920982406
  74. Williams E, D'Amore W, McMeeken J. Physiotherapy in rural and regional Australia. Aust J Rural Health. 2007;15(6):380-386. doi:1111/j.1440-1584.2007.00931.x
  75. Williamson M, Gormley A, Bills J, Farry P. The new rural health curriculum at Dunedin School of Medicine: how has it influenced the attitudes of medical students to a career in rural general practice? N Z Med J. 2003;116(1179):U537.
  76. Williamson MI, Wilson R, McKechnie R, Ross J. Does the positive influence of an undergraduate rural placement persist into postgraduate years? Rural Remote Health. 2012;12:2011.
  77. Wilson AA. Impact of management development on nurse retention. Nurs Adm Q. 2005;29(2):137-145. doi:1097/00006216-200504000-00008
  78. Worley P, Martin A, Prideaux D, Woodman R, Worley E, Lowe M. Vocational career paths of graduate entry medical students at Flinders University: a comparison of rural, remote and tertiary tracks. Med J Aust. 2008;188(3):177-178. doi:5694/j.1326-5377.2008.tb01567.x
  79. Sullivan Havens D, Warshawsky NE, Vasey J. RN work engagement in generational cohorts: the view from rural US hospitals. J Nurs Manag. 2013;21(7):927-940. doi:1111/jonm.12171
  80. Wilkinson D. Selected demographic, social and work characteristics of the Australian general medical practitioner workforce: comparing capital cities with regional areas. Aust J Rural Health. 2000;8(6):327-334. doi:1046/j.1440-1584.2000.00316.x
  81. Allan J, Crockett J, Ball P, Alston M, Whittenbury K. 'It's all part of the package' in rural allied health work: a pilot study of rewards and barriers in rural pharmacy and social work. Internet J Allied Health Sci Pract. 2007;5(3):1-11. doi:46743/1540-580x/2007.1161
  82. Bennett P, Jones D, Brown J, Barlow V. Supporting rural/remote primary health care placement experiences increases undergraduate nurse confidence. Nurse Educ Today. 2013;33(2):166-172. doi:1016/j.nedt.2012.02.015
  83. Bent A. Allied health in Central Australia: challenges and rewards in remote area practice. Aust J Physiother. 1999;45(3):203-212. doi:1016/s0004-9514(14)60351-2
  84. Abbiati M, Savoldelli GL, Baroffio A, Bajwa NM. Motivational factors influencing student intentions to practise in underserved areas. Med Educ. 2020;54(4):356-363. doi:1111/medu.14063
  85. Berk ML, Bernstein AB, Taylor AK. The use and availability of medical care in health manpower shortage areas. Inquiry. 1983;20(4):369-380.
  86. Bowman RC. Measuring primary care: the standard primary care year. Rural Remote Health. 2008;8(3):1009.
  87. Bradley KJ, Wros P, Bookman N, et al. The Interprofessional Care Access Network (I-CAN): achieving client health outcomes by addressing social determinants in the community. J Interprof Care. 2018:1-8. doi:1080/13561820.2018.1560246
  88. Feng X, Sambamoorthi U, Wiener RC. Dental workforce availability and dental services utilization in Appalachia: a geospatial analysis. Community Dent Oral Epidemiol. 2017;45(2):145-152. doi:1111/cdoe.12270
  89. Fryer GE Jr, Drisko J, Krugman RD, et al. Multi-method assessment of access to primary medical care in rural Colorado. J Rural Health. 1999;15(1):113-121. doi:1111/j.1748-0361.1999.tb00605.x
  90. Kaye HS, Chapman S, Newcomer RJ, Harrington C. The personal assistance workforce: trends in supply and demand. Health Aff (Millwood). 2006;25(4):1113-1120. doi:1377/hlthaff.25.4.1113
  91. Lynge DC, Larson EH, Thompson MJ, Rosenblatt RA, Hart LG. A longitudinal analysis of the general surgery workforce in the United States, 1981-2005. Arch Surg. 2008;143(4):345-350. doi:1001/archsurg.143.4.345
  92. Simou E, Karamagioli E, Roumeliotou A. Reinventing primary health care in the Greece of austerity: the role of health-care workers. Prim Health Care Res Dev. 2015;16(1):5-13. doi:1017/s1463423613000431
  93. Toomey P, Lovato CY, Hanlon N, Poole G, Bates J. Impact of a regional distributed medical education program on an underserved community: perceptions of community leaders. Acad Med. 2013;88(6):811-818. doi:1097/ACM.0b013e318290f9c7
  94. Ariste R. Availability of health workforce in urban and rural areas in relation to Canadian seniors. Int J Health Plann Manage. 2019;34(2):510-520. doi:1002/hpm.2712
  95. Easterbrook M, Godwin M, Wilson R, et al. Rural background and clinical rural rotations during medical training: effect on practice location. CMAJ. 1999;160(8):1159-1163.
  96. Florence JA, Goodrow B, Wachs J, Grover S, Olive KE. Rural health professions education at East Tennessee State University: survey of graduates from the first decade of the community partnership program. J Rural Health. 2007;23(1):77-83. doi:1111/j.1748-0361.2006.00071.x
  97. Frisch L, Kellerman R, Ast T. A cohort study of family practice residency graduates in a predominantly rural state: initial practice site selection and trajectories of practice movement. J Rural Health. 2003;19(1):47-54. doi:1111/j.1748-0361.2003.tb00541.x
  98. Hancock C, Steinbach A, Nesbitt TS, Adler SR, Auerswald CL. Why doctors choose small towns: a developmental model of rural physician recruitment and retention. Soc Sci Med. 2009;69(9):1368-1376. doi:1016/j.socscimed.2009.08.002
  99. Hanson CM, Jenkins S, Ryan R. Factors related to job satisfaction and autonomy as correlates of potential job retention for rural nurses. J Rural Health. 1990;6(3):302-316. doi:1111/j.1748-0361.1990.tb00669.x
  100. Henderson Betkus M, MacLeod ML. Retaining public health nurses in rural British Columbia: the influence of job and community satisfaction. Can J Public Health. 2004;95(1):54-58. doi:1007/bf03403635
  101. Henning-Smith C, Kozhimannil KB. Availability of child care in rural communities: implications for workforce recruitment and retention. J Community Health. 2016;41(3):488-493. doi:1007/s10900-015-0120-3
  102. Hogue A, Huntington MK. Family physician burnout rates in rural versus metropolitan areas: a pilot study. S D Med. 2019;72(7):306-308.
  103. Jones MP, Bushnell JA, Humphreys JS. Are rural placements positively associated with rural intentions in medical graduates? Med Educ. 2014;48(4):405-416. doi:1111/medu.12399
  104. Kent M, Verstappen AC, Wilkinson T, Poole P. Keeping them interested: a national study of factors that change medical student interest in working rurally. Rural Remote Health. 2018;18(4):4872. doi:22605/rrh4872
  105. Bath B, Gabrush J, Fritzler R, et al. Mapping the physiotherapy profession in Saskatchewan: examining rural versus urban practice patterns. Physiother Can. 2015;67(3):221-231. doi:3138/ptc.2014-53
  106. Mathews M, Rourke JT, Park A. The contribution of Memorial University's medical school to rural physician supply. Can J Rural Med. 2008;13(1):15-21.
  107. Mathews M, Seguin M, Chowdhury N, Card RT. Generational differences in factors influencing physicians to choose a work location. Rural Remote Health. 2012;12:1864.
  108. McGrail MR, Humphreys JS, Joyce CM. Nature of association between rural background and practice location: a comparison of general practitioners and specialists. BMC Health Serv Res. 2011;11:63. doi:1186/1472-6963-11-63
  109. McGrail MR, Humphreys JS, Joyce CM, Scott A, Kalb G. How do rural GPs' workloads and work activities differ with community size compared with metropolitan practice? Aust J Prim Health. 2012;18(3):228-233. doi:1071/py11063
  110. O'Connor M, Lee-Steere R. General practitioners' attitudes to palliative care: a Western Australian rural perspective. J Palliat Med. 2006;9(6):1271-1281. doi:1089/jpm.2006.9.1271
  111. Orzanco MG, Lovato C, Bates J, Slade S, Grand'Maison P, Vanasse A. Nature and nurture in the family physician's choice of practice location. Rural Remote Health. 2011;11(3):1849.
  112. Pathman DE, Konrad TR, King TS, Taylor DH Jr, Koch GG. Outcomes of states' scholarship, loan repayment, and related programs for physicians. Med Care. 2004;42(6):560-568. doi:1097/01.mlr.0000128003.81622.ef
  113. Puddey IB, Mercer A, Playford DE, Riley GJ. Medical student selection criteria and socio-demographic factors as predictors of ultimately working rurally after graduation. BMC Med Educ. 2015;15:74. doi:1186/s12909-015-0359-5
  114. Roots RK, Brown H, Bainbridge L, Li LC. Rural rehabilitation practice: perspectives of occupational therapists and physical therapists in British Columbia, Canada. Rural Remote Health. 2014;14:2506.
  115. Rourke J, O’Keefe D, Ravalia M, et al. Pathways to rural family practice at Memorial University of Newfoundland. Can Fam Physician. 2018;64(3):e115-e125.
  116. Burnett WH, Mark DH, Midtling JE, Zellner BB. Primary care physicians in underserved areas. Family physicians dominate. West J Med. 1995;163(6):532-536.
  117. Royston P, Parmar MK, Sylvester R. Construction and validation of a prognostic model across several studies, with an application in superficial bladder cancer. Stat Med. 2004;23(6):907-926. doi:1002/sim.1691
  118. Szafran O, Crutcher RA, Chaytors RG. Location of family medicine graduates' practices. What factors influence Albertans' choices? Can Fam Physician. 2001;47:2279-2285.
  119. Thomas CR, Holzer CE 3rd. The continuing shortage of child and adolescent psychiatrists. J Am Acad Child Adolesc Psychiatry. 2006;45(9):1023-1031. doi:1097/01.chi.0000225353.16831.5d
  120. van Hassel D, Verheij R, Batenburg R. Assessing the variation in workload among general practitioners in urban and rural areas: an analysis based on SMS time sampling data. Int J Health Plann Manage. 2019;34(1):e474-e486. doi:1002/hpm.2663
  121. Woloschuk W, Tarrant M. Does a rural educational experience influence students' likelihood of rural practice? Impact of student background and gender. Med Educ. 2002;36(3):241-247. doi:1046/j.1365-2923.2002.01143.x
  122. Wood D. Effects of educational focus on a graduate nurse's initial choice of practice area. J Prof Nurs. 1998;14(4):214-219. doi:1016/s8755-7223(98)80061-6
  123. Wood BR, Bell C, Carr J, et al. Washington state satellite HIV clinic program: a model for delivering highly effective decentralized care in under-resourced communities. AIDS Care. 2018;30(9):1120-1127. doi:1080/09540121.2018.1481194
  124. Bushy A, Leipert BD. Factors that influence students in choosing rural nursing practice: a pilot study. Rural Remote Health. 2005;5(2):387.
  125. Butler C, Sheppard L. The impact of undergraduate rural education on recently graduated physiotherapists. Aust J Physiother. 1999;45(1):23-31. doi:1016/s0004-9514(14)60339-1
  126. Carter RG. The relation between personal characteristics of physicians and practice location in Manitoba. CMAJ. 1987;136(4):366-368.
  127. Chan BT, Degani N, Crichton T, et al. Factors influencing family physicians to enter rural practice: does rural or urban background make a difference? Can Fam Physician. 2005;51(9):1246-1247.
  128. Chen C, Petterson S, Phillips RL, Mullan F, Bazemore A, O'Donnell SD. Toward graduate medical education (GME) accountability: measuring the outcomes of GME institutions. Acad Med. 2013;88(9):1267-1280. doi:1097/ACM.0b013e31829a3ce9
  129. Cramer M, Nienaber J, Helget P, Agrawal S. Comparative analysis of urban and rural nursing workforce shortages in Nebraska hospitals. Policy Polit Nurs Pract. 2006;7(4):248-260. doi:1177/1527154406296481
  130. Bamford EJ, Dunne L, Taylor DS, Symon BG, Hugo GJ, Wilkinson D. Accessibility to general practitioners in rural South Australia. A case study using geographic information system technology. Med J Aust. 1999;171(11-12):614-616.
  131. Doogan NJ, Roberts ME, Wewers ME, Tanenbaum ER, Mumford EA, Stillman FA. Validation of a new continuous geographic isolation scale: a tool for rural health disparities research. Soc Sci Med. 2018;215:123-132. doi:1016/j.socscimed.2018.09.005
  132. Gilliland JA, Shah TI, Clark A, Sibbald S, Seabrook JA. A geospatial approach to understanding inequalities in accessibility to primary care among vulnerable populations. PLoS One. 2019;14(1):e0210113. doi:1371/journal.pone.0210113
  133. Jo O, Kruger E, Tennant M. Geospatial analysis of the urban and rural/remote distribution of dental services in Scotland, Wales and Northern Ireland. Int Dent J. 2020;70(6):444-454. doi:1111/idj.12590
  134. Lavergne MR. Identifying distinct geographic health service environments in British Columbia, Canada: cluster analysis of population-based administrative data. Healthc Policy. 2016;12(1):43-51.
  135. Pearce J, Witten K, Bartie P. Neighbourhoods and health: a GIS approach to measuring community resource accessibility. J Epidemiol Community Health. 2006;60(5):389-395. doi:1136/jech.2005.043281
  136. Playford DE, Mercer A, Carr SE, Puddey IB. Likelihood of rural practice in medical school entrants with prior tertiary experience. Med Teach. 2019;41(7):765-772. doi:1080/0142159x.2019.1570099
  137. Iversen L, Farmer JC, Hannaford PC. Workload pressures in rural general practice: a qualitative investigation. Scand J Prim Health Care. 2002;20(3):139-144. doi:1080/028134302760234573
  138. Ceronsky L, Shearer J, Weng K, Hopkins M, McKinley D. Minnesota Rural Palliative Care Initiative: building palliative care capacity in rural Minnesota. J Palliat Med. 2013;16(3):310-313. doi:1089/jpm.2012.0324
  139. Griffin B, Porfeli E, Hu W. Who do you think you are? Medical student socioeconomic status and intention to work in underserved areas. Adv Health Sci Educ Theory Pract. 2017;22(2):491-504. doi:1007/s10459-016-9726-1
  140. Abid Y, Connell CJW, Sijnja B, Verstappen AC, Poole P. National study of the impact of rural immersion programs on intended location of medical practice in New Zealand. Rural Remote Health. 2020;20(4):5785. doi:22605/rrh5785
  141. Pathman DE, Konrad TR, Ricketts TC 3rd. The comparative retention of National Health Service Corps and other rural physicians. Results of a 9-year follow-up study. JAMA. 1992;268(12):1552-1558.
  142. Pathman DE, Steiner BD, Jones BD, Konrad TR. Preparing and retaining rural physicians through medical education. Acad Med. 1999;74(7):810-820. doi:1097/00001888-199907000-00016
  143. Pegram RW, Humphreys JS, Calcino G. Primary medical care workforce enumeration in rural and remote areas of Australia: time for a new approach? Aust J Rural Health. 2006;14(1):24-28. doi:1111/j.1440-1584.2006.00751.x
  144. Rohova M. Regional imbalances in distribution of Bulgarian health professionals. J IMAB. 2017;23(1):1427-1431. doi:5272/jimab.2017231.1427
  145. Smith JL. Examination of the relative importance of hospital employment in non-metropolitan counties using location quotients. Rural Remote Health. 2013;13(3):2497.
  146. Zhu X, Mueller KJ, Vaughn T, Ullrich F. A rural taxonomy of population and health-resource characteristics. Rural Policy Brief. 2015;(2015 4):1-6.
  147. Boscardin CK, Grbic D, Grumbach K, O'Sullivan P. Educational and individual factors associated with positive change in and reaffirmation of medical students' intention to practice in underserved areas. Acad Med. 2014;89(11):1490-1496. doi:1097/acm.0000000000000474
  148. Duma O, Anton D, Tarţău L, Mocanu V. [Medical-social aspects of medical staff migration]. Rev Med Chir Soc Med Nat Iasi. 2011;115(2):507-511. [Romanian].
  149. Garcia AN, Kuo T, Arangua L, Pérez-Stable EJ. Factors associated with medical school graduates' intention to work with underserved populations: policy implications for advancing workforce diversity. Acad Med. 2018;93(1):82-89. doi:1097/acm.0000000000001917
  150. O'Connell TF, Ham SA, Hart TG, Curlin FA, Yoon JD. A national longitudinal survey of medical students' intentions to practice among the underserved. Acad Med. 2018;93(1):90-97. doi:1097/acm.0000000000001816
  151. Bigbee J, Mixon D. Recruitment and retention of rural nursing students: a retrospective study. Rural Remote Health. 2013;13(4):2486.
  152. Butler DC, Petterson S, Bazemore A, Douglas KA. Use of measures of socioeconomic deprivation in planning primary health care workforce and defining health care need in Australia. Aust J Rural Health. 2010;18(5):199-204. doi:1111/j.1440-1584.2010.01154.x
  153. Horner RD, Samsa GP, Ricketts TC 3rd. Preliminary evidence on retention rates of primary care physicians in rural and urban areas. Med Care. 1993;31(7):640-648. doi:1097/00005650-199307000-00006
  154. Humphreys JS. Delimiting 'rural': implications of an agreed 'rurality' index for healthcare planning and resource allocation. Aust J Rural Health. 1998;6(4):212-216. doi:1111/j.1440-1584.1998.tb00315.x
  155. Kulig JC, Andrews ME, Stewart NJ, et al. How do registered nurses define rurality? Aust J Rural Health. 2008;16(1):28-32. doi:1111/j.1440-1584.2007.00947.x
  156. McGirr J, Seal A, Barnard A, et al. The Australian Rural Clinical School (RCS) program supports rural medical workforce: evidence from a cross-sectional study of 12 RCSs. Rural Remote Health. 2019;19(1):4971. doi:22605/rrh4971
  157. McGrail MR, Wingrove PM, Petterson SM, Humphreys JS, Russell DJ, Bazemore AW. Measuring the attractiveness of rural communities in accounting for differences of rural primary care workforce supply. Rural Remote Health. 2017;17(2):3925. doi:22605/rrh3925
  158. McGrail MR, Russell DJ, O'Sullivan BG, Reeve C, Gasser L, Campbell D. Demonstrating a new approach to planning and monitoring rural medical training distribution to meet population need in North West Queensland. BMC Health Serv Res. 2018;18(1):993. doi:1186/s12913-018-3788-0
  159. Steinhaeuser J, Otto P, Goetz K, Szecsenyi J, Joos S. Rural area in a European country from a health care point of view: an adoption of the Rural Ranking Scale. BMC Health Serv Res. 2014;14:147. doi:1186/1472-6963-14-147
  160. Hills D, Joyce C, Humphreys J. Validation of a job satisfaction scale in the Australian clinical medical workforce. Eval Health Prof. 2012;35(1):47-76. doi:1177/0163278710397339
  161. Rolfe IE, Pearson SA, O'Connell DL, Dickinson JA. Finding solutions to the rural doctor shortage: the roles of selection versus undergraduate medical education at Newcastle. Aust N Z J Med. 1995;25(5):512-517. doi:1111/j.1445-5994.1995.tb01497.x
  162. Hays RB, Veitch PC, Cheers B, Crossland L. Why doctors leave rural practice. Aust J Rural Health. 1997;5(4):198-203. doi:1111/j.1440-1584.1997.tb00267.x
  163. Humphreys JS, Jones MP, Jones JA, Mara PR. Workforce retention in rural and remote Australia: determining the factors that influence length of practice. Med J Aust. 2002;176(10):472-476. doi:5694/j.1326-5377.2002.tb04518.x
  164. Laurence CO, Williamson V, Sumner KE, Fleming J. "Latte rural": the tangible and intangible factors important in the choice of a rural practice by recent GP graduates. Rural Remote Health. 2010;10(2):1316.
  165. Hoffmann K, Wojczewski S, George A, Schäfer WL, Maier M. Stressed and overworked? A cross-sectional study of the working situation of urban and rural general practitioners in Austria in the framework of the QUALICOPC project. Croat Med J. 2015;56(4):366-374. doi:3325/cmj.2015.56.366
  166. Janes R, Elley R, Dowell A. New Zealand Rural General Practitioners 1999 Survey--Part 2: gender issues. N Z Med J. 2004;117(1191):U814.
  167. Chisholm M, Russell D, Humphreys J. Measuring rural allied health workforce turnover and retention: what are the patterns, determinants and costs? Aust J Rural Health. 2011;19(2):81-88. doi:1111/j.1440-1584.2011.01188.x
  168. Lee S, Mackenzie L. Starting out in rural New South Wales: the experiences of new graduate occupational therapists. Aust J Rural Health. 2003;11(1):36-43. doi:1046/j.1440-1584.2003.00476.x
  169. Wainer J. Work of female rural doctors. Aust J Rural Health. 2004;12(2):49-53. doi:1111/j.1038-5282.2004.00557.x
  170. Smith T, Cross M, Waller S, et al. Ruralization of students' horizons: insights into Australian health professional students' rural and remote placements. J Multidiscip Healthc. 2018;11:85-97. doi:2147/jmdh.s150623
  171. Humphreys JS, Jones JA, Jones MP, et al. The influence of geographical location on the complexity of rural general practice activities. Med J Aust. 2003;179(8):416-420. doi:5694/j.1326-5377.2003.tb05619.x
  172. Cameron PJ, Este DC, Worthington CA. Physician retention in rural Alberta: key community factors. Can J Public Health. 2010;101(1):79-82. doi:1007/bf03405568
  173. Rabinowitz HK, Diamond JJ, Hojat M, Hazelwood CE. Demographic, educational and economic factors related to recruitment and retention of physicians in rural Pennsylvania. J Rural Health. 1999;15(2):212-218. doi:1111/j.1748-0361.1999.tb00742.x
  174. Keane S, Smith T, Lincoln M, Fisher K. Survey of the rural allied health workforce in New South Wales to inform recruitment and retention. Aust J Rural Health. 2011;19(1):38-44. doi:1111/j.1440-1584.2010.01175.x
  175. Eley DS, Synnott R, Baker PG, Chater AB. A decade of Australian Rural Clinical School graduates--where are they and why? Rural Remote Health. 2012;12:1937.
  176. Stagg P, Greenhill J, Worley PS. A new model to understand the career choice and practice location decisions of medical graduates. Rural Remote Health. 2009;9(4):1245.
  177. King KR, Purcell RA, Quinn SJ, Schoo AM, Walters LK. Supports for medical students during rural clinical placements: factors associated with intention to practise in rural locations. Rural Remote Health. 2016;16(2):3791.
  178. Brockwell D, Wielandt T, Clark M. Four years after graduation: occupational therapists' work destinations and perceptions of preparedness for practice. Aust J Rural Health. 2009;17(2):71-76. doi:1111/j.1440-1584.2008.01020.x
  179. Puddey IB, Mercer A, Playford DE, Riley GJ. Medical student selection criteria and socio-demographic factors as predictors of ultimately working rurally after graduation. BMC Med Educ. 2015;15:74. doi:1186/s12909-015-0359-5
  180. McGrail MR, Humphreys JS. Spatial access disparities to primary health care in rural and remote Australia. Geospat Health. 2015;10(2):358. doi:4081/gh.2015.358
  181. Puddey IB, Mercer A, Playford DE, Pougnault S, Riley GJ. Medical student selection criteria as predictors of intended rural practice following graduation. BMC Med Educ. 2014;14:218. doi:1186/1472-6920-14-218
  182. Australian Medical Workforce Advisory Committee (AMWAC). Doctors in vocational training: rural background and rural practice intentions. Aust J Rural Health. 2005;13(1):14-20. doi:1111/j.1440-1854.2004.00640.x
  183. Beauchamp J, Bélanger M, Schofield A, Bordage R, Donovan D, Landry M. Recruiting doctors from and for underserved groups: does New Brunswick's initiative to recruit doctors for its linguistic minority help rural communities? Can J Public Health. 2013;104(6 Suppl 1):S44-48. doi:17269/cjph.104.3478
  184. Kondalsamy-Chennakesavan S, Eley DS, Ranmuthugala G, et al. Determinants of rural practice: positive interaction between rural background and rural undergraduate training. Med J Aust. 2015;202(1):41-45. doi:5694/mja14.00236
  185. Herd MS, Bulsara MK, Jones MP, Mak DB. Preferred practice location at medical school commencement strongly determines graduates' rural preferences and work locations. Aust J Rural Health. 2017;25(1):15-21. doi:1111/ajr.12301
  186. Hogenbirk JC, McGrail MR, Strasser R, Lacarte SA, Kevat A, Lewenberg M. Urban washout: how strong is the rural-background effect? Aust J Rural Health. 2015;23(3):161-168. doi:1111/ajr.12183
  187. Kwan MMS, Kondalsamy-Chennakesavan S, Ranmuthugala G, Toombs MR, Nicholson GC. The rural pipeline to longer-term rural practice: general practitioners and specialists. PLoS One. 2017;12(7):e0180394. doi:1371/journal.pone.0180394
  188. Playford D, Ngo H, Gupta S, Puddey IB. Opting for rural practice: the influence of medical student origin, intention and immersion experience. Med J Aust. 2017;207(4):154-158. doi:5694/mja16.01322
  189. Rabinowitz HK, Diamond JJ, Markham FW, Santana AJ. The relationship between entering medical students' backgrounds and career plans and their rural practice outcomes three decades later. Acad Med. 2012;87(4):493-497. doi:1097/ACM.0b013e3182488c06
  190. Rabinowitz HK, Diamond JJ, Markham FW, Paynter NP. Critical factors for designing programs to increase the supply and retention of rural primary care physicians. JAMA. 2001;286(9):1041-1048. doi:1001/jama.286.9.1041
  191. Rabinowitz HK, Diamond JJ, Veloski JJ, Gayle JA. The impact of multiple predictors on generalist physicians' care of underserved populations. Am J Public Health. 2000;90(8):1225-1228. doi:2105/ajph.90.8.1225
  192. Runge CE, MacKenzie A, Loos C, et al. Characteristics of Queensland physicians and the influence of rural exposure on practice location. Intern Med J. 2016;46(8):981-985. doi:1111/imj.13156
  193. Sen Gupta T, Woolley T, Murray R, Hays R, McCloskey T. Positive impacts on rural and regional workforce from the first seven cohorts of James Cook University medical graduates. Rural Remote Health. 2014;14:2657.
  194. Smith T, Sutton K, Beauchamp A, et al. Profile and rural exposure for nursing and allied health students at two Australian universities: a retrospective cohort study. Aust J Rural Health. 2021;29(1):21-33. doi:1111/ajr.12689
  195. Strasser R, Hogenbirk JC, Lewenberg M, Story M, Kevat A. Starting rural, staying rural: how can we strengthen the pathway from rural upbringing to rural practice? Aust J Rural Health. 2010;18(6):242-248. doi:1111/j.1440-1584.2010.01167.x
  196. Woolley T, Sen Gupta T, Murray R, Hays R. Predictors of rural practice location for James Cook University MBBS graduates at postgraduate year 5. Aust J Rural Health. 2014;22(4):165-171. doi:1111/ajr.12106
  197. Drovandi A, Woolley T. Workforce supply of pharmacists in Queensland communities from James Cook University Pharmacy Graduates. Aust J Rural Health. 2020;28(5):462-468. doi:1111/ajr.12662
  198. O'Sullivan B, McGrail M, Major L, Woodfield M, Holmes C. Rural work outcomes of medical students participating in a contracted Extended Rural Cohort (ERC) program by course-entry preference. Med Teach. 2019;41(6):703-710. doi:1080/0142159x.2019.1569755
  199. Playford DE, Ng WQ, Burkitt T. Creation of a mobile rural workforce following undergraduate longitudinal rural immersion. Med Teach. 2016;38(5):498-503. doi:3109/0142159x.2015.1060304
  200. Rosenblatt RA, Whitcomb ME, Cullen TJ, Lishner DM, Hart LG. Which medical schools produce rural physicians? JAMA. 1992;268(12):1559-1565.
  201. Sen Gupta T, Murray R, Hays R, Woolley T. James Cook University MBBS graduate intentions and intern destinations: a comparative study with other Queensland and Australian medical schools. Rural Remote Health. 2013;13(2):2313.
  202. Somers GT, Spencer RJ. Nature or nurture: the effect of undergraduate rural clinical rotations on pre-existent rural career choice likelihood as measured by the SOMERS Index. Aust J Rural Health. 2012;20(2):80-87. doi:1111/j.1440-1584.2012.01258.x
  203. Bailey BE, Wharton RG, Holman CD. Glass half full: survival analysis of new rural doctor retention in Western Australia. Aust J Rural Health. 2016;24(4):258-264. doi:1111/ajr.12260
  204. Shires L, Allen P, Cheek C, Deb W. Regional universities and rural clinical schools contribute to rural medical workforce, a cohort study of 2002 to 2013 graduates. Rural Remote Health. 2015;15(3):3219.
  205. Gupta S, Ngo H, Burkitt T, Puddey I, Playford D. Survival analysis of Rural Clinical School of Western Australia graduates: the long-term work of building a long-term rural medical workforce. BMC Health Serv Res. 2019;19(1):998. doi:1186/s12913-019-4816-4
  206. Clark TR, Freedman SB, Croft AJ, et al. Medical graduates becoming rural doctors: rural background versus extended rural placement. Med J Aust. 2013;199(11):779-782. doi:5694/mja13.10036
  207. Zink T, Center B, Finstad D, et al. Efforts to graduate more primary care physicians and physicians who will practice in rural areas: examining outcomes from the University of Minnesota-Duluth and the rural physician associate program. Acad Med. 2010;85(4):599-604. doi:1097/ACM.0b013e3181d2b537
  208. Young L, Kent L, Walters L. The John Flynn Placement Program: evidence for repeated rural exposure for medical students. Aust J Rural Health. 2011;19(3):147-153. doi:1111/j.1440-1584.2011.01201.x
  209. Eley D, Baker P, Chater B. The Rural Clinical School Tracking Project: more IS better--confirming factors that influence early career entry into the rural medical workforce. Med Teach. 2009;31(10):e454-459. doi:3109/01421590902850857
  210. May J, Brown L, Burrows J. In-place training: optimizing rural health workforce outcomes through rural-based education in Australia. Educ Sci. 2018;8(1):20. doi:3390/educsci8010020
  211. Playford DE, Evans SF, Atkinson DN, Auret KA, Riley GJ. Impact of the Rural Clinical School of Western Australia on work location of medical graduates. Med J Aust. 2014;200(2):104-107. doi:5694/mja13.11082
  212. Wendling AL, Phillips J, Short W, Fahey C, Mavis B. Thirty years training rural physicians: outcomes from the Michigan State University College of Human Medicine rural physician program. Acad Med. 2016;91(1):113-119. doi:1097/acm.0000000000000885
  213. Kane KY, Quinn KJ, Stevermer JJ, et al. Summer in the country: changes in medical students' perceptions following an innovative rural community experience. Acad Med. 2013;88(8):1157-1163. doi:1097/ACM.0b013e318299fb5d
  214. Wilkinson D, Laven G, Pratt N, Beilby J. Impact of undergraduate and postgraduate rural training, and medical school entry criteria on rural practice among Australian general practitioners: national study of 2414 doctors. Med Educ. 2003;37(9):809-814. doi:1046/j.1365-2923.2003.01596.x
  215. Brockwell D, Wielandt T, Clark M. Four years after graduation: occupational therapists' work destinations and perceptions of preparedness for practice. Aust J Rural Health. 2009;17(2):71-76. doi:1111/j.1440-1584.2008.01020.x
  216. Emery A, Hurley S, Williams J, Pougnault S, Mercer A, Tennant M. A seven-year retrospective analysis of students entering medicine via a rural student recruitment program in Western Australia. Aust J Rural Health. 2009;17(6):316-320. doi:1111/j.1440-1584.2009.01105.x
  217. Jamar E, Newbury J, Mills D. Early career location of University of Adelaide rural cohort medical students. Rural Remote Health. 2014;14:2592.
  218. Rabinowitz HK. Evaluation of a selective medical school admissions policy to increase the number of family physicians in rural and underserved areas. N Engl J Med. 1988;319(8):480-486. doi:1056/nejm198808253190805
  219. Rabinowitz HK. Recruitment, retention, and follow-up of graduates of a program to increase the number of family physicians in rural and underserved areas. N Engl J Med. 1993;328(13):934-939. doi:1056/nejm199304013281307
  220. Rabinowitz HK, Diamond JJ, Markham FW, Santana AJ. Retention of rural family physicians after 20-25 years: outcomes of a comprehensive medical school rural program. J Am Board Fam Med. 2013;26(1):24-27. doi:3122/jabfm.2013.01.120122
  221. Rabinowitz HK, Diamond JJ, Markham FW, Hazelwood CE. A program to increase the number of family physicians in rural and underserved areas: impact after 22 years. JAMA. 1999;281(3):255-260. doi:1001/jama.281.3.255
  222. Longenecker RL, Andrilla CHA, Jopson AD, et al. Pipelines to pathways: medical school commitment to producing a rural workforce. J Rural Health. 2021;37(4):723-733. doi:1111/jrh.12542
  223. McGrail MR, Russell DJ, Campbell DG. Vocational training of general practitioners in rural locations is critical for the Australian rural medical workforce. Med J Aust. 2016;205(5):216-221. doi:5694/mja16.00063
  224. Hajat A, Stewart K, Hayes KL. The local public health workforce in rural communities. J Public Health Manag Pract. 2003;9(6):481-488. doi:1097/00124784-200311000-00007
  225. Jones JA, Humphreys JS, Adena MA. Rural GPs' ratings of initiatives designed to improve rural medical workforce recruitment and retention. Rural Remote Health. 2004;4(3):314.
  226. Russell DJ, Humphreys JS, McGrail MR, Cameron WI, Williams PJ. The value of survival analyses for evidence-based rural medical workforce planning. Hum Resour Health. 2013;11:65. doi:1186/1478-4491-11-65
  227. Ray RA, Fried O, Lindsay D. Palliative care professional education via video conference builds confidence to deliver palliative care in rural and remote locations. BMC Health Serv Res. 2014;14:272. doi:1186/1472-6963-14-272
  228. Humphreys JS, McGrail MR, Joyce CM, Scott A, Kalb G. Who should receive recruitment and retention incentives? Improved targeting of rural doctors using medical workforce data. Aust J Rural Health. 2012;20(1):3-10. doi:1111/j.1440-1584.2011.01252.x
  229. Kuhn B, Kleij KS, Liersch S, Steinhäuser J, Amelung V. Which strategies might improve local primary healthcare in Germany? An explorative study from a local government point of view. BMC Fam Pract. 2017;18(1):105. doi:1186/s12875-017-0696-z
  230. Irby MB, Boles KA, Jordan C, Skelton JA. TeleFIT: adapting a multidisciplinary, tertiary-care pediatric obesity clinic to rural populations. Telemed J E Health. 2012;18(3):247-249. doi:1089/tmj.2011.0117
  231. Asghari S, Kirkland MC, Blackmore J, et al. A systematic review of reviews: recruitment and retention of rural family physicians. Can J Rural Med. 2020;25(1):20-30. doi:4103/cjrm.cjrm_4_19
  232. Dolea C, Stormont L, Braichet JM. Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bull World Health Organ. 2010;88(5):379-385. doi:2471/blt.09.070607
  233. Verma P, Ford JA, Stuart A, Howe A, Everington S, Steel N. A systematic review of strategies to recruit and retain primary care doctors. BMC Health Serv Res. 2016;16:126. doi:1186/s12913-016-1370-1
  234. Royston PJ, Mathieson K, Leafman J, Ojan-Sheehan O. Medical student characteristics predictive of intent for rural practice. Rural Remote Health. 2012;12:2107.
  235. Godwin DM, Hoang H, Crocombe LA, Bell E. Dental practitioner rural work movements: a systematic review. Rural Remote Health. 2014;14(3):2825.
  236. Noya F, Carr S, Freeman K, Thompson S, Clifford R, Playford D. Strategies to facilitate improved recruitment, development, and retention of the rural and remote medical workforce: a scoping review. Int J Health Policy Manag. 2021;11(10):2022-2037. doi:34172/ijhpm.2021.160
  237. Buykx P, Humphreys J, Wakerman J, Pashen D. Systematic review of effective retention incentives for health workers in rural and remote areas: towards evidence-based policy. Aust J Rural Health. 2010;18(3):102-109. doi:1111/j.1440-1584.2010.01139.x
  238. Benzies KM, Premji S, Hayden KA, Serrett K. State-of-the-evidence reviews: advantages and challenges of including grey literature. Worldviews Evid Based Nurs. 2006;3(2):55-61. doi:1111/j.1741-6787.2006.00051.x