Time Spent in Rural Placements and Working Rurally After Graduation: A Retrospective Cohort Study of University of Adelaide Medical Graduates, 2010–2021

ABSTRACT Objectives First, to examine how short rural placements and increasing placement time are related to rural workforce outcomes. Second, to estimate the reliability of Australian Health Practitioner Regulation Agency (AHPRA) data to measure rural workforce outcomes by comparing AHPRA and self‐reported rural practice locations. Methods Design Primary objective—retrospective cohort study. Secondary objective—validation questionnaire. Participants/Setting University of Adelaide medical alumni graduating from 2010 to 2021. Main Outcome Measures The primary outcome of interest was the proportion of alumni practising in rural locations (Modified Monash Model, MMM2‐7). Logistic regression was used to examine associations between time in Adelaide Rural Clinical School rural placements and working rurally after graduation, adjusted for rural background and sociodemographic factors. The secondary outcome measure was agreement between self‐reported and AHPRA rural practice locations for a sample of alumni. Results Practice locations were identified for 1664 alumni (97%). When compared to no rural placements, completing a short placement of 4–8 weeks had no effect, but a full‐year rural placement was associated with a 2‐fold increase in the odds of working rurally (OR 1.97, 95% CI 1.05–3.72). This effect increased to over five times when combined with two additional short rural placements (OR 5.57, 95% CI 2.32–13.37). AHPRA provided a reliable indicator of rural practice location when compared to self‐reported (94.3% agreement, κ = 0.85, p < 0.001). Conclusions Short rural placements are unlikely to have a positive impact on the rural workforce unless combined with an extended placement. The high reliability of AHPRA data to measure primary rural practice location was confirmed.