The costs, barriers and enablers of providing PGY2 placements in general practice in Aotearoa New Zealand: a mixed-methods study

Introduction Few mandatory community-based attachments for postgraduate year two doctors (PGY2s) in Aotearoa New Zealand are hosted in general practices, due to space, time and remuneration barriers.Aim This study aimed to explore the costs, barriers and enablers to general practices of hosting PGY2s.Methods A cost analysis for four general practices beginning to host PGY2s was undertaken, including time spent supervising and supporting PGY2s, revenue impact including subsidies and cost of providing clinical space. Interviews with these practices and seven experienced PGY2 host practices were conducted and analysed thematically.Results The estimated mean cost of hosting PGY2s excluding room cost was NZ$4907 per 13-week placement (range $890-$9183), increasing to $13 727 per placement (range $5750-$24 715) when room rental was included. Four themes were identified: working within a small business model; a new learning environment for PGY2s; providing positive experiences for the PGY2s; the relationship between practices and district hospitals that employed the PGY2s, including job sizing.Discussion Tension exists between the small business model of general practice and providing positive experiences for PGY2s in a new learning environment. Guidance and support structures for PGY2 hosting should be developed nationally, and communication and cooperation between practices and employing hospitals needs improvement. Out-of-hours work should be included in community-based attachments so PGY2s' remuneration is consistent. General practice teams are willing to be part of creating a sustainable workforce. However, the time taken to host and costs of providing training in primary care are barriers. There is urgent need to increase funding to general practices for hosting PGY2s. What is already known: Community-based attachments (CBAs) are mandatory in NZ for junior doctors in their first 2 years of study. Some research indicates that CBAs are a positive experience for the practice and the junior doctors. What this study adds: An estimated average cost for hosting PGY2s in general practice was $NZ4907 (range $890-$9183) per placement before consideration of space costs, over and above current funding provided by Health New Zealand |Te Whatu Ora (TWO) Health Workforce Directorate. The small business model of general practice is in tension with providing a positive experience for the PGY2s in a new learning environment, and better communication and cooperation between practices and TWO employing hospitals are needed.