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AUSTRALIA can and should achieve a distributed specialist workforce to provide health care close to where it is needed. While acknowledging that there is a national need to develop more generalists and bolster general practice, it also makes sense to attract into regional areas the growing number of medical graduates who are specialising.
Regional areas continue to get only a 15% share of all Australian medical specialists, which places rural people at risk and creates huge reliance on patient transport systems. The need for a baseline range and number of specialists based in regional centres and surrounds is paramount to meet rural community demand, support rural GPs and optimise regional-level outreach services. Regional specialists, critically, also underpin the capability to provide regional specialist training and train the next generation.
But how do we do this? According to recent research, a good place to start is understanding the professional and personal factors that drive regional specialists and their practices.
Drawing on data from the Medicine in Australia: Balancing Employment and Life (MABEL) survey, Dr Belinda O’Sullivan from Monash University examined the location, job conditions and satisfaction of over 3000 specialists from metropolitan, regional and rural areas. In a complementary study, Professor Jennifer May, from the University of Newcastle, surveyed specialists about the factors that had influenced their decisions to move to or stay in regional centres. Both these articles provide some timely evidence about specialists in regional practice – what attracts them to these areas, what keeps them there, and what challenges they face.
Dr O’Sullivan’s research, published in the Australian Journal of Rural Health, suggested that rural specialists were most likely to be in general medicine or general surgery. They probably work 1.6 more hours per week than their metropolitan counterparts, were more likely to be on call, and may feel that they have less access to professional development opportunities. But overall, they were just as highly satisfied with their hours, pay, work variety and responsibility as their metropolitan counterparts.
This tallies with Professor May’s research, recently published in Australian Health Review, finding that professional satisfaction was high among the regional specialists that she interviewed. Many ranked work variety highest as their reason for moving to a regional area, and this also strongly influenced whether or not they stayed. Workplace culture and connections with colleagues were also important to specialists who remained in regional practice. Non work-related factors included a sense of community, climate, spouse employment and children’s educational opportunities. It is interesting that climate and environment outranked all professional factors among specialists who worked in coastal areas. “Perhaps things like good surf help this group to stay longer rurally?”
So, what do these findings mean for health workforce planning?
“The finding that regional specialist work is highly rewarding is really important,” Dr O’Sullivan said. “Often rural specialist work is perceived as limiting and a poor career choice, but this research breaks down that notion.”
Professor May agreed.
“Despite working more hours and providing more on-call services, regional specialists’ professional satisfaction is high. They love the regional work-family lifestyle.”
But, Dr O’Sullivan said, “getting the right range of specialists will take deliberate planning”.
“A range of other specialists, considered relevant to have in regional service hubs, such as endocrinologists, psychiatrists and paediatricians, were lagging in large regional centres. Not all specialists we need in regional centres are hospital-based. So, there is a need to foster training and recruitment across both public and private sectors as well as giving regional training options to build a broad specialist skill base.”
Professor May said: “State governments, regional hospitals and large practices may need to invest in cross-regional support and referral options to attract specialists. Other things specialists need include strong and clear management structures, essential infrastructure, positive workplace culture and sustained funding for professional development”.
Effective planning involves regional health service CEOs working with local clinicians and workforce planners to develop a clear vision for regional specialist services. Specialist colleges can also play an important role in promoting and enabling regional specialist careers, for example, by accrediting regional training posts and facilitating regional training.
“The recent allocation of Commonwealth government funding to 26 regional training hubs across Australia is an opportunity for the states, Commonwealth, regional communities, colleges and rural workforce agencies to work together,” Professor May said.
“For small regional centres, access to larger, well developed service hubs is essential,” said Dr O’Sullivan. “Small regional centres are largely supported by general specialists, with most of the workforce being international medical graduates. Their public hospitals still need specialists, but can’t afford to employ the full suite. Having a range of specialists in larger regional centres is likely to foster their outreach to smaller centres, supporting each other with rosters, after hours or emergency workloads and the supervision of trainees.”
Regional communities can get involved by providing orientation and workforce support. “This can be as practical as arranging bachelor and spinster balls to foster rural connections,” said Professor May.
While we may not be seeing Rural specialist wants a spouse on television in the near future, it is clear that regional specialist practice is viable and satisfying, and with the right policies in place, a well suited and sustainable regional specialist workforce can be achieved.
Sarah Fraser is a freelance medical writer who was commissioned by the Centre of Research Excellence in Medical Workforce Dynamics (including MABEL) to write this article.
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