Queensland Rural Medical Support Agency
Discussion Paper
Female medical practitioners in rural and remote Queensland: An analysis of findings, issues and trends
Colin White and Sandra Fergusson
QRMSA
PO Box 167
Kelvin Grove Q. 4067
Acknowledgements
We would like to express our sincere thanks to the many female practitioners in Queensland who completed and returned this survey. We appreciate that the data and survey demands placed on medical practitioners can become quite onerous. However, the information you provide keeps us informed of current workforce issues and trends and allows for the development of strategies and responses to help redress identified problem areas.
This survey has complemented similar research undertaken by the New South Wales Rural Doctors Network (NSWRDN) and the Rural Workforce Agency Victoria (RWAV) and has contributed to a national understanding of issues that impact on female medical practitioners. We would like to thank the Australian Rural and Remote Workforce Agencies Group (ARRWAG) for initiating and supporting the research and the NSWRDN for developing and providing the questionnaire.
Thanks and appreciation is also extended to the QRMSA board for their support for the project and QRMSA staff members for their comments, suggestions and input to the final product.
Col White and Sandra Fergusson
July 2001
Queensland Rural Medical Support Agency 2001
This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission from the Queensland Rural Medical Support Agency. Requests and enquiries concerning reproduction and rights should be directed to the Queensland Rural Medical Support Agency, PO Box 167, Kelvin Grove DC, Qld 4067.
Suggested citation
White, C., & Fergusson, S. (2001). Female medical practitioners in rural and remote Queensland: An analysis of findings, issues and trends. Brisbane: Queensland Rural Medical Support Agency.Contents
Acknowledgements
Contents
1.0Introduction
1.1Differing work practices
1.2The Queensland rural and remote female workforce
1.3Differences in rural/urban practice
1.4Potential decrease in rural and remote workforce pool
1.5Accommodating changing trends in the composition of the medical workforce
1.6Summary of trends
1.7Research Aims
2.0 Methodology
3.0Results
3.1Geographic distribution
3.2Age
3.3Martial status
3.4Partner occupation
3.5Family demographics
3.6Child care responsibilities
3.7Duration of rural practice
3.8Rural Background
3.9Clinical hours worked
3.10Satisfaction with working hours
3.11Choice of rural or remote practice
3.13Intent to leave rural practice
3.13Major issues impacting on female practitioners in rural and remote areas
3.14Important issues pertaining to job satisfaction and retention
3.15Changes recommended to improve recruitment and retention rates
3.16Family support
4.0Discussion
5.0Options
6.0References 20
1.0Introduction
Available data indicates that as at December 1998, female general practitioners comprised 33.2% of the Australian primary care workforce (AMWAC, 2000; AIHW, 2000). Data also indicated that female practitioners comprised 53.5% of the primary care workforce aged between 25 and 34 years and 42.1% of the workforce aged between 35 and 44 years. Current data also indicates that the female proportion of students commencing primary medical degrees exceeded 50% for the first time in 1998 (DHAC, 2000) and now make up 57.8% of GP trainees (AIHW, 2000). Continuation of these patterns will lead to a relatively rapid rise in the proportion of female GPs over the next decade.
1.1Differing work practices
A growing body of research evidence also suggests that female GPs differ in substantial ways from the way that male GPs work. For example, Britt et al. (1993; 1996) reported that women tend to have fewer patient encounters each week, accept longer consultations and deal with more clinical problems in a single encounter compared with male GPs. It has also been found that female GPs appear to find participation in after-hours and on-call arrangements less acceptable (DHAC, 2000) and in comparison to male GPs and other female medical professionals are more likely to have young children. The report, Female Participation in the Australian Medical Workforce (AMWAC & AIHW, 1996) estimated that an average female GP over a lifetime will work 66.0% of the hours of an average male GP and is relatively more likely to practice in metropolitan rather than rural and remote areas. The rising proportion of female doctors in the medical workforce combined with differing work practices and preferences may therefore, over time, be expected to impact on both the supply and distribution of the Australian medical workforce in both urban and non-urban locations.
1.2The Queensland rural and remote female workforce
Based on data provided by the Australian Institute of Health and Welfare, Tolhurst et al (2000) reported that in 1998, only 19% of female general practitioners worked in rural areas.
The number of female medical practitioners working in RRMA 4 to 7 locations in Queensland is somewhat higher. Based on data maintained by the Queensland Rural Medical Support Agency (QRMSA) non-specialist female practitioners currently comprise 30.22% of the 781 rural and remote practitioners in this state. This figure would drop to 22.54% if female medical practitioners employed fully by Queensland Health were excluded. However, due to the differing structure of health service delivery in Queensland compared with other states, they were included in this survey and analyses. In Queensland, the majority of state salaried practitioners in rural and remote locations provide primary care services and in many smaller and remote centres they have the right to private practice.
1.3Differences in rural/urban practice
Traditionally, rural and remote general practice has been male dominated and there are fewer GPs relative to the population distribution. Medical practitioners in rural and remote practice also tend to have a heavier workload, provide a wider range of services, are on call often and are more likely to be called out compared to non-rural practitioners (GPSR, 1998). Female medical practitioners in rural and remote communities are more likely to perceive a number of additional issues as difficulties. These include role conflict occasioned by the pressure to work longer hours to meet rural practice needs, family responsibilities especially child care, employment opportunities for spouses, concerns about personal safety and lack of social support, (GPSR, 1998).
1.4Potential decrease in rural and remote workforce pool
While there is a strong demand for female practitioners in rural and remote areas, the growing participation of female medical practitioners in the Australian medical workforce does present a number of issues for future workforce planning. Current trends indicate that female practitioners are more likely to be working in major urban centres compared with male practitioners and on average work fewer hours and less on-call hours (AMWAC & AIHW, 1996). As a consequence, as the proportion of female practitioners increases, the pool of available practitioners prepared to relocate to rural and remote areas may potentially decrease. In addition, those females who do choose to relocate to rural and remote areas are likely to have differing working practices, work shorter hours and be reluctant to undertake on-call work. This has the potential to create an increased demand for doctors and may increase the number of rural and remote communities medically under serviced (GPSR, 1998).
1.5Accommodating changing trends in the composition of the medical workforce
Wainer et al. (1999) have noted that ‘rural medicine is almost the only branch of the profession with a shortage of applicants’. They also acknowledge the different nature of rural medicine and the continuing necessity to attract as wide a range of young doctors as possible. The fact that now over half of graduating doctors in Australia are women would suggest that it is becoming increasingly important for medical workforce planners to anticipate and accommodate these changing trends and begin to develop structures and services which can adapt to, and incorporate the emerging values, expectations and preferences of this growing cohort.
1.6Summary of trends
Following from the research, reports and workforce modelling undertaken by agencies such as AMWAC, GRSP, AIHW and independent researchers, it is becoming increasingly obvious that:
- It is still difficult to attract and retain medical practitioners in many rural and remote locations.
- Female practitioners appear less prepared to undertake medical practice in rural and remote locations compared with males.
- Female practitioners in rural and remote locations often experience additional pressures including expectations of long work hours, balancing family responsibilities and often lack adequate social support, which can often result in role conflict.
- Female practitioners often practice a different style of medicine which may be more time consuming and less economically viable for the practice/individual.
- The proportion of female practitioners in the Australian medical workforce will continue to increase.
- Extended working and on-call hours are less attractive to female practitioners and they are more likely to work on a part-time basis compared to males.
- The gender balance of the Australian medical workforce will continue to change and rural and remote communities will face greater difficulties in attracting and retaining medical practitioners unless workforce models and practices, which accommodate the differing work expectations and preferences of younger male and female practitioners can be developed and implemented.
1.7Research Aims
Although an activity foreshadowed in the QRMSA business plan, the research reported in this paper was undertaken at the request of the Australian Rural and Remote Workforce Agencies Group (ARRWAG). The purpose was to further explore earlier emerging findings and trends (e.g, AMWAC & AIHW, 1996; Carson & Stringer, 1998; Tolhurst, 2000) and to develop a national understanding of current and potential issues impacting on female participation in the rural and remote medical workforce. It is anticipated that research findings will assist in the development of responses and strategies to improve the recruitment and retention of female practitioners for rural and remote locations. Similar surveys have been undertaken recently by the New South Wales Rural Doctors Network (NSWRDN) in 2000 (McEwin, 2001) and the Rural Workforce Agency Victoria (Wainer, 2001).
2.0 Methodology
A survey of all non-specialist female medical practitioners in RRMA locations 4 to 7 in Queensland was conducted during March/April 2001. The survey form was provided by the NSWRDN and was similar to that used by McEwin (2001). Although the questions were largely unchanged, the format of the questionnaire was modified and a number of additional questions in regard to family support issues were included. A copy of the seven-page questionnaire utilised is included in Appendix 1. There were 236 female practitioners in the QRMSA database at the time of survey and all were sent a questionnaire together with a covering letter explaining the purpose of the survey and a stamped return envelope.
Responses were received from 126 female practitioners giving a response rate of 53.4%. As this was seen as a reasonably representative sample, no attempts were made to elicit further returns. The responses were analysed using SPPS 10.1 (Statistical Package for Social Sciences). Table 1 provides a breakdown of responses by number, percentage and RRMA together with details of the state distribution for comparative purposes.
Table 1 - Queensland distribution of non-specialist female practitioners by RRMA
Total female practitioners / Survey practitionersNumber / Percent / Number / Percent
RRMA4 / 88 / 37.29 / 41 / 32.5
RRMA5 / 94 / 39.83 / 54 / 42.9
RRMA6 / 33 / 13.98 / 17 / 13.5
RRMA7 / 21 / 8.90 / 14 / 11.1
236 / 100.0 / 126 / 100.0
The table indicates that responses received were reasonably representative of the statewide distribution with some slight under representation in RRMA 4 and proportionally a slightly higher representation in RRMA’s 5 and 7. While Victorian and NSW workforce agencies often include RRMA 3 locations in their workforce numbers and surveys, the QRMSA deals exclusively with RRMA 4 to 7 communities. The NSW and Victorian surveys also included female specialists. However, due to the very small number of female specialists based in RRMA 4 to 7 communities in Queensland, they were not included in this survey.
3.0Results
3.1Geographic distribution
Queensland has five divisions of general practice, which consist entirely of RRMA 7 to 4 locations. There are also eight other divisions that have rural locations in the RRMA 4 and 5 categories. An examination of data indicates that responses have been received from female practitioners in all 13 divisions and that the proportion of responses is basically representative of divisional numbers.
3.2Age
The age distribution of the female respondents is presented in 5-year age ranges and is displayed in Figure 1. Data indicates that 56.4% of the respondents were aged 40 years or less. This is comparative to trends in AIHW data (AMWAC, 2000) indicating that in the age group under 35 years, the proportion of female practitioners has increased to 53.4%. An eyeball comparison of age distributions reported by McEwin (2001) and Wainer (2001) would also suggest that female practitioners in rural and remote Queensland tend to be younger than their New South Wales and Victorian cohorts.
Figure 1
3.3Martial status
Reported marital status of survey respondents is displayed in Table 2
Table 2 – Marital Status
Number / PercentSingle / 24 / 19.0%
Separated/Divorced/Widowed / 4 / 3.2%
Married/De Facto / 98 / 77.8%
3.4Partner occupation
Data in regard to partner occupation were incomplete with only 58 of the respondents providing this information. Partner occupational groupings as reported are displayed in Table 3.
Table 3 - Partner Occupation (N58)
Occupational Grouping / NumberMedical/Health Practitioner / 21
Non Medical Professionals / 13
Farmer / 4
Technical/Trade / 12
Office duties/Administration / 1
Home duties / 2
Retired/Unemployed / 3
Student / 2
Despite incomplete data, the pattern in this sample tends to reflect findings by AMWAC (1998), McEwin (2001) and Wainer (2001) that a large majority of female medical practitioners tend to have partners in the medical, health and other professional areas.
3.5Family demographics
Data in relation to children indicated that 62.7% (N=79) of respondents had children and that the total number of children for these respondents was 182. Forty-seven respondents (34.3%) indicated that they did not have children. Table 4 provides a breakdown of family demographics while Figure 2 displays the distribution of children across preschool, primary, secondary and post secondary stages.
Table 4 – Family demographics
Yes / Percent / No / PercentHave children / 79 / 62.7 / 47 / 37.3
Figure 2
Data indicates that the age distribution of children of female practitioners in Queensland tend to be concentrated in the pre and primary school age ranges (59.37%). The more even spread across age categories as reported in the NSW and Victorian surveys (McEwin, 2001; Wainer, 2001) was not apparent in this sample and can possibly be attributed to the younger age of female medical practitioners in Queensland as displayed and commented upon in Figure 1.
3.6Child care responsibilities
Respondents were asked whether they carried the main responsibility for the care and rearing of their children. Again data was less than complete. However, of the 73 responses, 42.47% indicated that they carried the main responsibility, 10.96% indicated that they did not, while 46.58% indicated that it was a responsibility shared with their partner. Table 5 presents these responses in tabular form.
Table 5 – Main responsibility for the care and rearing of the children
Number / PercentYes / 31 / 42.47
No / 8 / 10.96
Shared with partner / 34 / 46.58
Perhaps the more interesting aspect of this response was that less than half of the respondents indicated that they carried the main responsibility for the care and rearing of their children. This differs considerably from the findings of McEwin (2001) where 78% indicated that they carried the main responsibility, Wainer (2001) 65%, and AMWAC (1998), which reported that the majority (95%) of female interviewees (general practitioners and specialists) indicated that, within their household, they carried the main responsibility for the care and rearing of children.
An examination of the relationship between responsibility for care of children and whether the respondent worked on call indicated that 48.4% of respondents who carried the main responsibility for the care of their children also worked on call hours (N31). In comparison, 66.7% of respondents who shared the responsibility, or indicated that they did not carry the main responsibility worked on call (N=42).
3.7Duration of rural practice
Data as displayed in Figure 3 indicates that just under half of the respondents had been in rural practice for five years or less while approximately two thirds had been in rural practice for 10 years or less.
Figure 3
3.8Rural Background
Respondents were asked whether they had been raised in a rural environment. 43.7% indicated that they had, while 55.6% had not, one response was missing. Table 6 provides data in relation to rural background.
Table 6 – Raised in rural environment
Number / PercentYes / 55 / 43.7
No / 70 / 55.6
Missing / 1 / 0.7
Where Raised
Rural Australia / 38 / 69.1
Rural Overseas / 16 / 29.1
Missing / 1 / 1.8
Data indicates that a relatively high percentage of respondents had been raised in a rural environment. In contrast, the NSW survey reports 34% of female practitioners raised in rural environments (McEwin, 2001) while the Victorian figure was 40% (Wainer, 2001). The relatively high number of female practitioners who have rural origins suggests that this may be an important factor in decisions to undertake rural and remote practice. It also suggests that current efforts to increase the intake of students from rural and remote backgrounds into medical schools will be an effective strategy to maintain and/or increase medical services in rural and remote communities.
3.9Clinical hours worked
In line with current findings, data from this survey suggests that female practitioners tend to work less hours compared with their male counterparts. AMWAC (2000) has defined part time work as less than 40 hours per week. Based on clinical hours reported, it would appear that half of the respondents work 40 hours or more. While data were provided in regard to on call hours, the differing interpretations and responses (e.g., one week in four; one week in six etc.) tend to make these data difficult to report and collate. In addition to the 66 respondents who provided an estimate of on call hours, 14 other respondents indicated that they worked on call in a variety of arrangements. Table 7 provides a breakdown of full time/part time clinical hours based on the AMWAC definition of part time hours, together with average number of hours per week reported.