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

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.