Rural clinicians: essential for research and its translation

Rural and regional clinicians need more recognition of their unique position to help address rural health challenges, write Dr Michael Field, Dr Anne McGuane and Dr Laura Alston.

It is well documented that rural and regional Australians, who make up nearly 30% of the population, experience poorer outcomes in many health issues than their metropolitan counterparts. This includes reduced access to health services, higher rates of ischaemic heart disease and obesity, and lower life expectancy.

It must also be recognised that rural and regional Australia is heterogeneous – diversity between communities in geography, remoteness, demographic characteristics, and industry all need to be considerations in rural and regional health.

Complicating the observed health outcome disparities is a relative lack of rural health research, meaning that there is a relative shortage of knowledge to drive context-specific solutions, and research evidence generated in metropolitan areas may not be entirely applicable in rural and regional settings.

This has been acknowledged by policy makers as playing a role in the persistent inequities we observe in rural health.

More broadly, another concern is the potential for research waste. A well known 2009 viewpoint article by Chalmers and Glasziou found that up to 85% of research is wasted.

Wastage can occur in a variety of ways including incomplete reporting, duplication, failing to report on sample representativeness, or failure to achieve recruitment of the originally specified sample size.

Of particular relevance to rural and regional health research and translation, a significant amount of research waste can occur through avoidable poor design. Chalmers and Glasziou found this includes developing a research question that is not relevant to clinicians or their patients. Another source of avoidable research waste in rural and regional health can occur through lack of translation of results through to patient care.

A way forward

We have written that one way forward on the complex, interrelated health issues that affect the health of rural and regional Australians is to ensure clinicians are prioritised as essential stakeholders in rural and regional research and translation. This includes opportunities for active involvement in topic identification, research design, or acting as key informants.

Research driven by rural and regional clinicians, which truly uses the rich knowledge developed from working at the coalface, can help achieve the principles of The Lancet’s REduce research Waste And Reward Diligence (REWARD) statement:

• setting the right research priorities – rural and regional clinicians are ideally placed to use their deep understanding of the complexities and nuances of the health issues in their communities; and
• robust conduct of research – rural and regional clinicians are often uniquely placed to facilitate achieving appropriate sample recruitment (in terms of sample size and population representativeness) due to their trusted position in the local health care system.

Furthermore, many rural and regional clinicians hold influential roles in health care delivery and/or leadership. This means they can effect change rapidly as “translation champions” in implementing research evidence in their communities. At our rural health service at Colac Area Health in Victoria, recent clinician-led research projects in dysphagia, chemoprophylaxis and postoperative bleeding, and malnutrition have been successfully translated into practice change and/or improved patient outcomes.

Rural and regional clinicians, many of whom operate as contractors without protected time for research, should not be expected to complete these critical research and translation activities unpaid.

As discussed above, the historical underinvestment in rural research compared with metropolitan funding has limited research options for rural and regional clinicians, which has been a lost opportunity for improving health in these areas of high need.

Recent progress

Promisingly, there has been recent progress in providing opportunities to rural expertise.

The Australian Government’s 2023 Medical Research Future Fund (MRFF) “Primary Health Care Research Initiative” has a $6 million to $14 million stream that is available exclusively to rural and regional researchers.

As mandated, it is a requirement for the chief researcher, the organisation undertaking the majority of the research, and greater than 50% of the study’s chief investigators be based in rural or regional areas as per the Modified Monash Model Locator (MM 3 to MM 7).

In addition, funding for Australia’s largest scheme to support clinician researchers, the MRFF’s Clinician Researchers: Applied Research in Health grants, has been increased from $25 million in 2020 to $45 million in 2023.

This could provide further opportunities for the engagement of rural and regional clinicians.

We strongly believe that, for research funding to have the greatest impact on high priority issues in Australia, such as rural health outcome inequalities, context and researcher relative opportunity must be taken into consideration.

Incorporating research

It must also be acknowledged that the rural and regional health workforce is under significant pressure with staff shortages in many areas, and the addition of research and translation activities to an already heavy workload may present additional burden.

However, a recently published study found that career development opportunities were an important factor in Australian medical students’ intention to practise rurally.

In fact, supporting portfolio career opportunities that include both clinical practice and research in rural and regional areas may be an effective strategy to attract and retain talented clinicians in these areas.

A further barrier to rural and regional clinicians conducting research and translation can be confidence in their own skills.

In Australia, the past decade has seen the emergence of academic health science centres (organisations that partner health care and research entities that focus on improving patient care) in rural and regional areas which now offer training opportunities in research and translation and seed funding for projects.

Furthermore, rural health service-based research units are being established and focus on improving clinicians’ access to research infrastructure as well as facilitating networking opportunities that are vital for effective research and translation.

With the current unprecedented commentary around health system reform, rural and regional clinicians must be prioritised as essential stakeholders in research and translation.

We believe there must also be increased recognition of their unique position to assist in addressing rural health challenges to minimise research waste and optimise the delivery of the highest quality health care informed by locally applicable evidence.

Dr Michael Field is the Research Translation Coordinator with Western Alliance Academic Health Science Centre at Colac Area Health, and a Surgical Assistant at St John of God Ballarat.

Dr Anne McGuane is a General Practitioner/Obstetrician at Corangamite Clinic Colac, and Director of Medical Education and Training at Colac Area Health.

Dr Laura Alston is the Director of Research at Colac Area Health, and a Senior Research Fellow at Deakin Rural Health.

The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated. 

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