How can we encourage more doctors to practice in rural and remote locations?

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Supporting clinicians to practice rurally is complex and should be part of a multifaceted strategy to provide more health care in the bush, according to the authors of a supplement and accompanying editorial published by the Medical Journal of Australia.  

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, said that the health care workforce in rural and remote Australia is “close to the top of the cliff”.

“We have to be very realistic about what the road is ahead. 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 getting close to the top of the cliff. The ageing of our rural workforce is very obvious,” Professor May said.

“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.”

The four-chapter supplement, “Building a sustainable rural workforce” focuses on physicians who work in regional towns and cities and provide outreach and services to smaller communities.

  • Chapter 1: "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.
  • Chapter 2: "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".
  • Chapter 3: "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.
  • Chapter 4: "Principles to guide training and professional support for a sustainable rural specialist physician workforce" by Dr. Remo Ostini, an Adjunct Senior Research Fellow at UQ 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.

In an accompanying editorial, “The road less travelled: supporting physicians to practice rurally”, Professor May and Professor Anthony Scott, a Professorial Fellow at the Melbourne Institute, wrote that the realities of professional isolation and poor support networks were common themes throughout the supplement.

Professor May said that one key concept was the privileging and support of generalism. “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.

"Physicians, like GPs, work alongside other health professionals and providers who should together be more integrated into rural models of care," they wrote.

“Right at the moment I don’t think as a medical community we are invested in that vision. 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,” Professor May said.

May and Scott wrote that with the National Medical Workforce Strategy in the final stages of review it potentially provides a mechanism by which such principles can be used to implement new nationally coordinated policy. Clear short-term policy solutions do not exist, and long-term solutions rely on fundamental changes to the way doctors are recruited, trained and supported, which require a high level of coordination between the many stakeholders involved in medical training. Yet doubling of medical graduates in the early 2000s has not solved rural maldistribution of the medical workforce.

In the editorial May and Scott wrote that ensuring that rural patients in need receive an appropriate range of health care will require a number of broad solutions and innovations based on a clear understanding of population need and a more effective distribution of human and other resources. 

 “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”, Professor May said.

“If we leave the medical workforce as it is at the moment 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.”