involvement in research4. Publication rates for general practitioners in Australia are low, sitting at 2-5% of the rates achieved by their physician and surgical colleagues5. The Australian Government has endeavoured to support primary care research through the Primary Health Care Research, Evaluation Development (PHCRED) strategy established in 20006. This has largely been a top-down approach by funding universities to undertake primary health research and has not been reflected by an increase in rural primary health publication rates6.
An important but limited initiative supported by PHCRED has been the formation of practice-based networks to facilitate research activity at the level of the general practice and other primary care services7. These networks are supported by university research expertise and organisational structures8. After initially taking a top-down approach, a Victoria-based network (VicReN) has recently adopted a more bottom-up approach by undertaking a member-directed research project with community-based general practitioners as members of the research team8,9. This project has resulted in the publication of two peer-reviewed research papers with community-based general practitioners included in the authorship10,11. Elsewhere, international trends in primary care research identify significant success with practice-based research networks12-14.
In Australia, general practices tend to engage in education delivery in response to opportunities offered by universities and/or general practice training providers. Similarly, active research programs in general practice are most likely associated with university-based research initiatives14. Engagement in education and research by general practice tends to be piecemeal with disjointed funding streams and uncoordinated support. Practices are left to create their own solutions for the required structures for managing educational and research activity.
Pressure for increased training capacity by rural general practices
Currently in Australia demand is increasing for medical student, intern and registrar training placements in rural general practices. This demand is being driven by two imperatives. The first is a need for training placements for the growing number of medical students, interns and registrars. Medical student numbers have increased by 81% between 2005 and 201215 with the majority of these students undertaking their placements in rural clinical schools. Following this increase in medical student numbers is a steep increase in the number of medical interns, many of whom are being accommodated in general practice placements. General practice training program entrants doubled, from 600 to 1200 nationally, between 2010 and 201416,17.
The second imperative seeks to address shortages in the rural medical workforce by placing higher numbers of learners in rural settings both to provide an immediate workforce and to build a rural medical workforce. The 'rural pipeline' is considered to be a means of graduating doctors who are likely to practice rurally: preferentially selecting students from rural backgrounds into medical school and providing them with undergraduate, postgraduate, vocational and post-vocational training in the rural context18-21. Education in rural general practices is core to the 'rural pipeline'22. It has been well established that medical students who are exposed to rural settings during their training are more likely to engage in rural practice after graduating20. Also, placing GP registrars in rural practices provides a rural workforce and is a way of attracting more experienced practitioners to rural communities23. The 'rural pipeline' also supports practising rural doctors by enriching their experience, addressing isolation and helping to develop skills18.
While increasing the number of learners in rural general practice may be a way of attracting and retaining rural GPs, the capacity for rural practices to host more learners is limited. Laurence and Black's 2007 survey of urban and rural training practices found that although GPs 