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A strategic approach is needed to address the health workforce challenges for regional Australia to encourage more rural generalists, specialist training, nursing, and allied health professionals.
Improved coordination and integration are needed to help address health workforce challenges in rural and regional Australia.
Historically, the peak bodies and Colleges of the various health professions have operated largely independently, with their own plans for handling the shortage of health workers in regional areas.
Instead, we support an integrated, strategic approach to solving workforce challenges.
What is needed
We argue rural workforce solutions need to be strengths-based, rural-led, adequately resourced and high quality, using an employment model akin to that described in the Ngayubah Gadan consensus statement, which calls for tailored funding and policy that supports sustainable, fit-for-purpose, multidisciplinary health workforce teams in rural areas.
Solutions are required across the pipeline, from student intake, participation and completion of tertiary education health courses, post-graduate training and professional development, to staff recruitment and retention.
The rural health workforce issue is complex and significant, and one we cannot solve in a single editorial article, but we will do our best to give an overview of the current state of affairs and what could be improved.
Current state of play
There are 50% fewer health professionals per capita in rural areas compared with metropolitan areas which contributes to the estimated $6.5 billion underspend on health services in rural areas, despite high health care needs.
Annual staff turnover can be high (for example almost 150% annual turnover of remote areas nurses in the Northern Territory).
Issues including professional isolation, barriers to career progression and psychosocial challenges persist.
The nuanced issue of increasing reliance on locums has far reaching consequences for continuity of care, connection to place, health service overspends, and potential resentment from local health professionals.
These workforce issues cut across medicine, nursing, and allied health. This is particularly the case in rural areas.
Improving rural training pathways
Rural Clinical Schools, funded by the Australian Government’s Rural Health Multidisciplinary Training (RHMT) program have delivered rurally based medical training in various forms for roughly two decades.
Evidence suggests that there is merit in the place-based pipeline approach in medicine, where students (particularly rural origin students) are supported to undertake their medical training in a rural location, with an emphasis on rural generalism.
In 2018, the then National Rural Health Commissioner advised the Australian Government on the development of the National Rural Generalist Pathway in part to be able to better prepare general practitioners in the skills needed for working rurally.
Rural training has advantages, such as more hands-on experience, exposure to broader range of conditions, and better relationships between health care professionals, patients, supervisors and trainees alike.
Extended rural training plus training of rural origin students increases the likelihood of practising rurally.
The success of this pathway model could be adapted for nursing and allied health professions, which we will discuss shortly.
Although we really welcome the pathway approach, gaps in specialist training persist.
Given the background of one of our authors, we’ll use obstetrics and gynaecology as an example. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists has recognised the importance of addressing barriers to specialist training for rural practitioners in order to build the specialist obstetrics and gynaecology workforce in rural areas.
A number of strategies are in place to encourage rural practice, including applying a selection advantage for rural applicants and the requirement to work rural for at least 12 months during the six-year training schedule.
However, the training schedule still demands 46 weeks training in a tertiary hospital.
A full rural specialist pipeline model would help with training and retaining specialists rurally and ensure they are better adapted to the rural requirements.
Adapting the pipeline approach
Although the pipeline approach for rural generalists is still yet to be perfected for the rural medicine workforce, we argue it is worth considering adapting for the provision of nursing and allied health higher education in rural areas.
The Australian Government needs to do more for these disciplines by committing to further developing higher education models that address workforce development in rural areas and investing in whole-of-sector approaches.
Collaborative partnerships between regional universities and peak health professional bodies could lead to the development of discipline-specific curriculum requirements while also retaining a strengths-based rural approach.
Work to deliver higher education to rural people already underway in Regional University Study Hubs offers insight into how collaborations of these kind could function. For example, Regional University Study Hubs complement online learning from universities with provision of practical in-person and infrastructure support.
Place-based education models could be developed with the rural context in mind, by drawing on local resources.
We also call for more research into the higher education models and strategies for nursing and allied health to assist in growing the rural workforce.
Current funding models prioritise metropolitan research, and funding is inequitably distributed, meaning rural health professionals are less likely to secure funding that supports the development of evidence to inform place-based workforce models.
Digital health solutions
Digital health solutions are welcomed, but do not devolve us of our responsibility to address rural health workforce shortages “on the ground”.
Digital health solutions must not further increase the digital divide between metropolitan and rural areas (due to poor access to devices or internet due to black spots, limited digital skills or confidence, or socio-economic disadvantage).
In addition, digital health solutions are unlikely to optimally harness the relational nature of care, or local knowledge of services and supportive networks in rural areas. This issue is not limited to the health sector, as there is also an accelerated push toward online social and government services.
Dr Kristen Glenister is a Senior Research Fellow in Rural Chronic Ill Health at the Department of Rural Health, University of Melbourne, based in Wangaratta.
Dr Claire Quilliam is a Research Fellow in Rural Nursing and Allied Health at the Department of Rural Health, University of Melbourne, based in Shepparton.
Dr Margreet Stegeman is an Obstetrician and Gynaecologist and Deputy Director of Medical Student Education at the Rural Clinical School, University of Melbourne, based in Shepparton.
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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If you would like to submit an article for consideration, send a Word version to mjainsight-editor@ampco.com.au.
As a doctor who works on an Oil Rig and who also works in Rural Emergency rooms, I have to support the comment on renumeration. If the price is right your workers will come.
If the Federal Government provided a financial advantage to rural workers by applying a lower rate of taxation based on remoteness or by allowing taxable deductions for school fee’s / travel expenses / housing, they would see a rush back to the bush. These conditions could be applied to all workers in the bush. This has been done in the past and produced great results, it needs to be revisited.
A simple solution for the cardiologist shortage is to insist that all trainees do 4 months rural placement just a start like GP training. They can act like a locum often 7 years out from graduation. I could support such a cardiologist with a 150 km radius from my practice in rural NSW. It would be a triage rural cardiology solution to a long waiting list
As usual for discussions around rural medicine, there is not a single mention of remuneration. How do they get people to work on oil rigs? Pay them and they will come. No amount of idealistic fluff will work without this factor being addressed.
Pretty obvious solution when all is said and done. When a city GP earns more, it’s not especially attractive. A long term rural generalist that I know recently retired and one issue he faced was that his house and practice were both worth a fraction of what an equivalent city property would be worth.
We can all agree it isn’t just about pay but it is naive to think it does not play a big role. While this continues to be ignored, the shortages will continue.
I have worked in rural settings, first as a locum and then as a visiting specialist. I found my exposure to rural practice rewarding, but there is no shortage of very sick people in rural Australia and there need to be good systems of backup and evacuation to treat those people properly.
One of the major issues causing doctors to leave rural practice is the need to educate their children, which is sometimes difficult to achieve locally. Boarding school is an option, but it is unfashionable and expensive. I have seen several doctors leave rural practice for this reason.