The combination of a rural background and rural undergraduate training has a multiplier effect on the likelihood of medical graduates practicing outside metropolitan areas, a study has found.

University of Queensland-led research found medical graduates with a rural background and two years of rural training were 10 times more likely to practice in rural areas than those with a metropolitan background and no rural training.

Federal Department of Health funding ensures a quarter of domestic medical students are from rural backgrounds and a quarter of all domestic students attend a rural clinical school for at least a year.

UQ Rural Clinical School Professorial Research Fellow Geoff Nicholson said each year of rural training doubled the likelihood of rural practice for students from both rural and metropolitan background.

“While specialists are less likely than general practitioners to work in rural areas (16 per cent versus 39 per cent), the pattern of effects of rural exposures are similar for both,” Professor Nicholson said.

“The proportion of graduates who had attended a rural clinical school for two years was much smaller among specialists than GPs.

“A possible factor is that the scarcity of specialist training positions in the bush results in students being keen to return to metropolitan clinical units to position themselves for training positions.”

Compared to specialists with a metropolitan background, those with a rural background who had attended rural clinical schools for two years were 16-times more likely to be practicing rurally.

“Strategies to increase specialist training places in rural areas, including recently-announced regional training hubs, are likely to increase the number of rural specialists,” Professor Nicholson said.

“This training happens at a time of life when they might meet their life partner and start putting down roots.

“We found that having a partner from a metropolitan background reduces the likelihood of going into rural practice by two-thirds.”

Professor Nicholson said the number of GPs in rural areas was improving, but specialist rates were half to a third in regional areas compared to metropolitan centres.

“This is likely a contributor to the excess of avoidable deaths outside of major cities,” he said.

Professor Nicholson said rural clinical schools helped build the rural medical workforce and expertise by recruiting experienced clinical academics, both GP and specialist, to teach and provide clinical services.

The study was based on a survey of 729 graduates from UQ’s medicine program between 2002 and 2011, and data from the Australian Health Practitioner Regulation Agency.

UQ’s Rural Clinical School has operated since 2002 – with teaching sites in Toowoomba, Rockhampton, Bundaberg and Hervey Bay –allowing students to complete one or two years of clinical training in a regional setting.

The study is published in PlosOne.