THE health care workforce in rural and remote Australia is “close to the top of the cliff”, according to one of the country’s leading rural health academics.
Professor Jennifer May, Director of the Department of Rural Health at the University of Newcastle, told InSight+ in an exclusive podcast, that it had “taken a long time to get here”, but that it was no surprise.
“We have to be very realistic about what the road is ahead,” said Professor May.
“From my point of view, living and working in rural Australia, we’re not in a very good place at all. It feels a little like [we’re] getting close to the top of the cliff. The ageing of our rural workforce is very obvious.
“The scope of practice of that rural workforce, both in terms of general practice and in terms of specialists and the generalist nature of the work that they have done, is not being replaced.
“In that sense, we’re sitting in a very difficult place. It’s certainly a place that if I project 10 years forward, I don’t see the workforce there to take it on.”
Professor May and Professor Anthony Scott, Professorial Fellow at the Melbourne Institute: Applied Economic and Social Research at the University of Melbourne, have written an editorial for the MJA that accompanies a four-chapter MJA supplement, called Building a sustainable rural physician workforce.
The supplement focuses on physicians who work in rural towns and cities and provide outreach and services to smaller communities.
The first chapter – “Characterising Australia’s rural specialist physician workforce: the professional profile and professional satisfaction of junior doctors and consultants” – by Associate Professor Matthew McGrail, Head of Regional Training Hub Research at the University of Queensland Rural Clinical School, and colleagues, reports that physicians who choose to remain rural have similarly high rates of professional satisfaction to their urban colleagues.
The second chapter – “General physicians and paediatricians in rural Australia: the social construction of professional identity” – by Associate Professor Peter Hill, from the University of Queensland’s School of Public Health, and colleagues, describes the “detrimental effects of rigid accreditation processes and the role of a pervasive culture of undermining” of rural practice and generalism, rather than them being valued within college structures and by health service employers.
The third chapter – “Sustainable rural physician training: leadership in a fragile environment” – by Associate Professor Linda Selvey, from the University of Queensland’s School of Public Health, and colleagues, discusses the importance of the fundamental role of leadership in showcasing and championing positive rural practice.
The fourth chapter – “Principles to guide training and professional support for a sustainable rural specialist physician workforce” – by Dr Remo Ostini, an Adjunct Senior Research Fellow at the University of Queensland Rural Clinical School, and colleagues, outlines eight foundational principles that should be used to guide policy.
Essentially, the sector needs students and junior doctors to have positive experiences in rural settings, and for GPs and generalists to have a career pathway that includes remuneration for experience, support for family, spouses, and children, and leadership that values generalism, the authors wrote.
“There are multiple stakeholders, and that epitomises our current problem,” Professor May told InSight+.
“The federal government obviously has responsibility for community care – for general practice – and also for medical student numbers.
“Our employers, our local health districts have major responsibility in most of Australia for training. And we have professional specialist training colleges, [which] lead the educational attributes and attainment of fellowship.
“It really requires all those three groups to be working on song with communities, if we are going to have a functional model of training in the health system,” she said.
“One of the difficulties over time has been the unintended disinvestment by one or other of those organisations, not realising that there are a whole lot of straws on the camel’s back, and when they fall out, the service will disappear.
“So it is no one’s full responsibility, but all of us have an important part to play.”
One key concept was the privileging and support of generalism, Professor May said.
“We need to buy in to the fact that as a medical workforce in general, we want [generalism] to be one of the hallmarks of how we think about our workforce.
“Now, I have to say, right at the moment, I don’t think as a medical community we are invested in that vision,” she said.
“While ever we’re not, while ever we don’t see the intrinsic value of treating people as locally as possible, to the widest scope of practice that is available, then I think we are going to struggle.
“We are asking for the whole system to pivot.”
The National Medical Workforce Strategy, which is in the final stages of review, “potentially provides a mechanism by which such principles can be used to implement new nationally coordinated policy”, May and Scott wrote in the MJA.
To InSight+, Professor May said:
“Without doubt the themes of that Medical Workforce Strategy must include the geographic distribution of our workforce, and generalism as a concept, and also the support and wellbeing of the medical workforce.
“I’m confident that much of the impact of the Strategy will be around its capacity to influence as opposed to its capacity to mandate.”
Continuing to communicate about the maldistribution of the rural medical workforce was critical, Professor May said.
“The fact that we’re talking about generalism, and its importance to the medical workforce, is incredibly important valuable.
“That discourse is primary to anything changing.
“If we leave the medical workforce as it is at the moment, we are going to get stellar performance from that health service in certain areas, yes.
“But we are going to leave a large amount of our population behind with easily preventable and avoidable harm that will come to them because of the distributional issues that underlie our workforce.”