Abstract：
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.
摘要：
介绍在Aotearoa新西兰的研究生二年级医生（PGY2s）很少有强制性的基于社区的附件，由于空间,时间和报酬的障碍。目的本研究旨在探讨成本，托管PGY2的一般做法的障碍和促成因素。方法对四种开始托管PGY2的一般做法进行成本分析，包括监督和支持PGY2s所花费的时间，收入影响，包括补贴和提供临床空间的成本。对这些实践和七个有经验的PGY2主机实践进行了访谈，并进行了主题分析。结果托管PGY2的估计平均成本（不包括房间成本）为每13周安置4907新西兰元（范围$890-$9183），当包括房间租金时，每个位置增加到$13727（范围$5750-$24715）。确定了四个主题：在小型企业模型中工作；PGY2的新学习环境；为PGY2提供积极的经验；实践与采用PGY2的地区医院之间的关系，包括工作规模。讨论在新的学习环境中，一般实践的小型企业模型与为PGY2提供积极经验之间存在张力。应在全国范围内制定PGY2托管的指导和支持结构，实践与聘用医院之间的沟通与合作需要改进。非工作时间工作应包含在基于社区的附件中，以便PGY2s的薪酬保持一致。一般实践团队愿意成为创建可持续劳动力的一部分。然而,主办初级保健培训所需的时间和提供培训的成本是障碍。迫切需要增加对托管PGY2的一般做法的资金。
