Rural and urban? an exploration of medical workforce issues in regional centres of Australia
thesisposted on 01.03.2017, 01:36 by May, Jennifer Ann
Recent patterns of population change across rural Australia combined with the concomitant centralisation and rationalisation of many key public and private services have seen an expanding role for regional centres, particularly in the provision of primary and specialist medical care. Any undersupply of GPs and/or specialists in regional centres is likely to have serious impacts on services provision and resultant health outcomes for residents both of regional centres and of the large rural hinterlands they serve. To date there is little research evidence of the factors that influence recruitment and retention of the medical workforce specifically in regional centres. This study aims to address this gap by investigating factors associated with medical workforce supply in regional centres of Australia, focusing on key considerations related to recruitment and retention of GPs and specialists in these areas. The need for a critical mass in regional centres is part of the larger national picture of medical workforce supply. The study highlights the methodological challenges of defining regional centres for health policy purposes and measuring the adequacy of workforce supply. A comprehensive review of the literature informed the development of an initial framework of factors instrumental in decision-making for regional centre practitioners. The responses of 66 GPs and 62 specialists in four regional centres were explored; in particular, their attitudes towards regional centre practice (work) and life in a regional centre (liveability). Their responses were reviewed with calculation of mean rankings supported by thematic analysis with reflection on both recruitment and retention decisions. The study found the most highly ranked factors in recruitment and retention were work related, including work variety, after-hours, workplace culture and workload considerations, which are all potentially modifiable in nature. Remuneration was not considered highly important either by GPs or specialists. Support to families and the role of the community with considerations such as spousal employment were pivotal. Environment attributes and favourable climate were highly important for coastal dwellers. Location trumped other factors for coastal residents and was not rated highly by those living inland. This key finding of the focused career planning of doctors to move to coastal locations, but the lack of consideration by them of job opportunities in inland areas, is cause for reflection. This study represents one of the most comprehensive pieces of research on GP and specialist recruitment and retention to regional centres of Australia. The new evidence provides the foundation on which to consider targeted policy responses and contributions by government, the profession and the community. Multi-faceted policy options to best target gaps in medical workforce in regional centres are required. The model of the rural pipeline with affirmative selection for regional and rural residents, supportive training and exposure and articulated training pathways supporting resident clinicians may well address current gaps. Policy should ensure competitive levels of remuneration, reflect the importance of employment opportunities for practitioners and their partners and the highlight the need for transparent workforce planning. A key outcome from this study is a new framework, which provides a scaffold on which to consider the policy input of the Commonwealth and state governments, speciality colleges and community leadership. Regional centres will remain a key feature of the Australian landscape. This study shines the spotlight on medical care in these centres and their rural hinterlands with the intention that a systematic evidence-informed approach can be developed to generate a critical mass of GPs and specialists in regional centres in Australia.