The influence of geographical location on the complexity of rural general practice activities

John S Humphreys, Judith A Jones, Michael P Jones, David Mildenhall, Paul R Mara, Bruce Chater, David R Rosenthal, Nola M Maxfield and Michael A Adena
Med J Aust 2003; 179 (8): 416-420.


Objectives: To examine the complexity of activities undertaken in general practice in relation to degree of rurality of the practice.

Design and setting: National mail questionnaire survey across non-metropolitan Australia in July 2002.

Participants: 1498 respondents out of 4406 GPs providing at least 375  Medicare-rebatable consultations in rural and remote locations during January–March 2002 (response rate, 35%).

Main outcome measures: Responses to five sentinel measures of practice complexity.

Results: In general, the proportion of GPs providing complex services increases with increasing rurality or remoteness. Isolated rural and remote GPs manage myocardial infarctions to a higher level than GPs in larger rural and regional centres, are more likely to administer cytotoxic drugs, perform forensic examinations, stabilise injured patients pending retrieval, and coordinate discharge planning more often.

Conclusions: The more rural or remote the area, the more likely a GP is to be regularly engaged in complex care. These findings have implications for the workload, responsibility, vocational satisfaction, need for professional education and support, and costs and remuneration of practice.

Please login with your free MJA account to view this article in full

  • John S Humphreys1
  • Judith A Jones2
  • Michael P Jones3
  • David Mildenhall4
  • Paul R Mara5
  • Bruce Chater6
  • David R Rosenthal7
  • Nola M Maxfield8
  • Michael A Adena9

  • 1 School of Rural Health, Monash University, North Bendigo, VIC.
  • 2 Jones & Just, Mt Kuringai, NSW.
  • 3 University of Western Australia, Albany, WA.
  • 4 Health Connections, Gundagai, NSW.
  • 5 Theodore, QLD.
  • 6 Parallel Rural Community Curriculum, Renmark, SA.
  • 7 Wonthaggi Medical Group, Wonthaggi, VIC.
  • 8 Covance Pty Ltd, Ainslie, ACT.



This research was funded through the Commonwealth Department of Health and Ageing General Practice Branch, under the auspices of the Rural Doctors Association of Australia in association with Monash University School of Rural Health, Bendigo. Particular thanks go to Gordon Calcino, Naarilla Hirsch, Angela Mikalauskas and Caroline Fredericks for their assistance in expediting access to HIC data; to Fiona Blackshaw and Sybille McKeown from the Statistical Clearing House, Anna Boots from the Rural Doctors Association of Australia, and Vanessa Prince and Marg Bibic from Monash University.

Competing interests:

None identified.

  • 1. National Rural Health Policy Forum. Healthy horizons 1999–2003. Canberra: Department of Health and Aged Care, 1998.
  • 2. General practice in Australia 2000. Canberra: Department of Health and Aged Care, 2000.
  • 3. Wilkinson W, Gibbs D, Aloizos J. The review of the impact of Part IV of the Trade Practices Act 1974 on the recruitment and retention of medical practitioners in rural and regional Australia. Canberra: Department of Health and Ageing, 2002.
  • 4. Strasser R. Rural general practice: is it a distinct discipline? Aust Fam Physician 1995; 24: 870-876.
  • 5. Humphreys JS, Jones M, Jones J, Mara P. Workforce retention in rural and remote Australia: determining the factors that influence length of practice. Med J Aust 2002; 176: 472-476. <MJA full text>
  • 6. Relative value study overview. Canberra: Department of Health and Aged Care, 2001. Available at: (accessed Mar 2002).
  • 7. Humphreys JS, Jones J, Jones M, et al. A critical review of rural medical workforce retention in Australia. Aust Health Rev 2001; 24: 91-102.
  • 8. Britt H, Miles DA, Bridges-Webb C, et al. A comparison of country and metropolitan general practice. Med J Aust 1993; 159 (9 Suppl): S9-S64.
  • 9. Britt H, Miller GC, Valenti L. It’s different in the bush. A comparison of general practice activity in metropolitan and rural areas of Australia 1998–2000. Canberra: Australian Institute of Health and Welfare, 2001. (AIHW Catalogue No. GEP 6.)
  • 10. Department of Primary Industries and Department of Human Services and Health. Rural, remote and metropolitan areas classification. Canberra: AGPS, 1994.
  • 11. Adler M, Ziglio E. Gazing into the oracle: the Delphi method and its application to social policy and public health. London: Jessica Kingsley Publishers, 1996.
  • 12. Schopper D, Ammon C, Ronch A, Rougemont A. When providers and community leaders define health priorities: the results of a Delphi survey in the canton of Geneva. Soc Sci Med 2000; 51: 335-342.
  • 13. Colledge M, Starick R. Australian Commonwealth government statistical clearing house: vehicle for reducing response load and improving survey quality. Int Stat Rev 2000; 48: 221-231.
  • 14. SPSS for Windows [computer program]. Version 11.0. Chicago, Ill: SPSS Inc, 1996.
  • 15. Berry K, Mielke P. Exact confidence limits for population proportions based on the negative hypergeometric probability distribution. Percept Mot Skills 1996; 83: 1216-1218.
  • 16. Altman DG. Practical statistics for medical research. London: Chapman & Hall, 1991.
  • 17. Hungerford P. Rural emergency medicine: the final frontier. Emerg Med (Fremantle) 1998; 10: 208-209.
  • 18. Kellerman SE, Herold J. Physician response to surveys: a review of the literature. Am J Prev Med 2001; 20: 61-67.
  • 19. McDonald P. Response rates in general practice studies [letter]. Br J Gen Pract 1993; 43: 484.
  • 20. McAvoy BR, Kaners EFS. General practice postal surveys: a questionnaire too far? BMJ 1996; 313: 732-733.
  • 21. Cummings SM, Savitz LA, Konrad TR. Reported response rates to mailed physician questionnaires. Health Serv Res 2001; 35: 1347-1355.
  • 22. Humphreys JS, Weinand HW. Health care preferences in a country town. Med J Aust 1991; 154: 733-737.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.