General practice registrars' practice in outer metropolitan Australia: a cross-sectional comparison with rural and inner metropolitan areas

Background General practice training in outer metropolitan (OM) areas contributes to patients' access to care. Differences in clinical practice and training in rural versus urban areas have been established, but less is known about OM versus inner metropolitan (IM) differences - whether they offer a trainee learning experience of populations with distinct demographics and healthcare characteristics. This study sought to identify the characteristics and associations of general practice training in New South Wales and Australian Capital Territory OM areas, compared to IM and rural areas.Methods Cross-sectional analyses of data (2016-2020) from the Registrar Clinical Encounters in Training (ReCEnT) study, an ongoing cohort study of Australian GP registrars' in-consultation clinical and educational experience and behaviours, were performed. Multinomial logistic regression assessed associations of rural/OM/IM practice location with registrar and practice factors, patient factors, consultation content factors and consultation action factors.Results Overall, 1308 registrars provided data from 177,026 consultations. For several variables, there was a pattern in the differences of associations across rural/OM/IM areas. Experience of care of older patients and Aboriginal and/or Torres Strait Islander health were more likely in OM than IM areas. Care of patients from non-English speaking background was more likely in OM than in rural areas. Possible markers of healthcare access (specialist referrals, and pathology and imaging requests) were less likely in OM than in both IM and rural areas.Conclusions OM areas are distinct (and educationally rich) clinical learning environments, with distinct demographic characteristics and seeming healthcare access limitations. This finding has implications for workforce support and health resource allocation. General practice in outer metropolitan regions is unique. In GP registrars' practice in these regions, fewer specialist, pathology and imaging referrals were generated, and care of older patients and Aboriginal and Torres Strait Islander patients was more likely than in inner metropolitan areas. Care of patients from non-English speaking backgrounds was more likely than in rural areas. A gradient (from inner metropolitan to outer metropolitan to rural regions) existed for many characteristics of registrars, practices, patients and clinical care.