Barriers to prevocational placement programs in rural general practice

Despite explicit support of the federal and state health departments, most prevocational trainees do not experience general practice or rural medicine. We have been running a program of prevocational placements of trainees working as rural general practitioners under supervision. From our experience, we have identified various barriers to implementation of such programs. These barriers include: funding issues (trainees are providing federally funded Medicare-rebatable services, while receiving state-funded hospital salaries); conflicts between the placement of trainees outside the hospital when hospitals are undergoing staffing crises; difficulties in coordinating the many organisations (funding bodies, practices, hospitals) involved in providing the placement; and the isolation experienced by trainees when they arrive in rural practice. Funding from a single administration and coordination by a locally appointed rural Director of Clinical Training are essential to overcome these barriers.