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Rural Health System Resources

BY RURAL PEOPLE FOR RURAL PEOPLE

Interventions for health workforce retention in rural and remote areas: a systematic review

Authors

Deborah Russell, Supriya Mathew, Michelle Fitts, Zania Liddle, Lorna Murakami‐Gold, Narelle Campbell, Mark Ramjan, Yuejen Zhao, Sonia Hines, John S. Humphreys and John Wakerman

Description

Attracting and retaining sufficient health workers to provide adequate services for residents of rural and remote areas has global significance. High income countries (HICs) face challenges in staffing rural areas, which are often perceived by health workers as less attractive workplaces. The objective of this review was to examine the quantifiable associations between interventions to retain health workers in rural and remote areas of HICs, and work‐ force retention. Educational interventions such as preferential selection of rural students and distributed training in rural areas are associated with increased rural retention of health professionals. Strongly coercive interventions are associated with comparatively lower rural retention than interventions that involve less coercion. Policy makers seeking rural retention in the medium and longer term would be prudent to strengthen rural training pathways and limit the use of strongly coercive interventions.

Why is this useful for rural and remote people?

This article provides useful information for rural and remote communities to understand what works and what doesn’t in the recruitment and retention of rural and remote GPs. There are numerous programs in Australia that are intended to grow the rural medical workforce, however the rural medical workforce has continued to contract over the last decade. Understanding what works, and what doesn't, is essential for rural and remote people to advocate for policies that are proven by evidence. The article suggests the following strategies are evidence based and successful:

Recruiting students to medical education from rural and remote communities (as opposed to regional and metropolitan cities) was significantly associated with working rurally, if the students also trained in rural and remote areas (for example, in another study from James Cook University it was found that around 65% of its rural and remote students go into rural and remote practice compared to less than 5% of graduates of metropolitan universities).
In NSW, GPs who were Visiting Medical Officers (and thereby received payments from the NSW Government in addition to income they receive from Medicare in general practice), had a 50% lower risk of leaving rural communities compared to GPs who were not.
Providing GPs with access to a locum for a minimum period of 6 weeks every 12 months to allow GPs to have a holiday was strongly associated with retention.
Providing GPs with access to paid continuing professional development, with provision for back-filling their position for up to a year, was significantly associated with retention in rural areas.
Access to educational opportunities for the children of rural GPs was strongly associated with retention.

The article found the following policies had little evidence or did not achieve stated goals:
There was little evidence that bonding students to work in rural areas in return for fee waivers or scholarships resulted in improved recruitment or retention (e.g. Bonded Medical Places Program).
Australian Government Rural Incentive Program payments were more effective in recruiting new GPs to incentivised rural areas rather than increasing the retention of existing GPs.
Attracting other health workers to live and work in rural and remote towns was associated with an increase in doctors leaving rural towns because these practitioners were viewed to be competing with doctors for patients, reducing the financial viability of rural practice.
There was little evidence to show providing rural doctors with access to a professional support network improved retention.

In summary, the evidence tells us that rural and remote communities may consider the following:

ADVOCACY TO GOVERNMENT
Rural medical education and training program criteria are changed to require that 100% of students recruited to rural medical student places come from a rural and remote location (not inner regional cities or metropolitan cities).
to ensure medical schools are meeting this target, seek a meeting with your University Vice-Chancellor and Dean to ask them to prove that rural places are taking appropriate steps to verify the residential address of students to ensure that places are not being given to metropolitan or regional city students, and ask that all rural medical student places are allocated to students from small rural towns and remote communities.
Rural and remote communities should look up the web site of their local university to find out exactly how much time rural students spend in rural areas for their education and training. If it is less than 100% of the time, rural and remote communities should call a meeting with the University Vice-Chancellor and Dean to ask that all rural medical students are educated and trained in rural and remote locations for 100% of their degree and postgraduate training.
Rural and remote communities should meet with their local members, and write to their Ministers for Health at a State and Federal level, to:
- ask that university funding for rural medical workforce programs are tied to admitting 100% of medical students to rural places from rural and remote communities (that is RA3,4,5 or MMM3, 4, 5,6 or 7).
- ask that funding is allocated to create sufficient training places for rural students to be fully trained in rural and remote locations in general practice, and to require that no rural training places are allocated to regional or metropolitan city origin medical graduates in future.
-demand that a new definition of a rural and remote origin student is established restricting rural medical student places to students who have completed at least 8 years of their schooling in a school located in a rural or remote location.
- ask accountability from providers by funding AHPRA to undertake an annual audit of university medical student admissions to identify instances where students have been admitted despite failing to meet the criteria for entry and establish a minimum penalty for breach including loss of university funding for rural medical student places.
-Meet with your local members at a State and Federal level to ask for the creation of a collaborative pool funding arrangements for local GPs to receive payment as visiting medical officer, with funding to train GPs without relevant emergency qualifications to act as VMOs in rural and remote towns.
-ask for the bonded medical student placement program, and any other program that gives money to metropolitan and regional city medical students to work rurally, to be abolished and for money to be reallocated to support rural and remote people to apply for and succeed in rurally-based medical education and training.
-ask for incentive programs to be focussed on retaining GPs in rural and remote locations by supporting access to quality housing and practice modernisation.
- ask for funding for community primary health clinics to appoint one locum per GP for a minimum period of 8 weeks every 12 months to allow GPs to have a holiday.
-ask for funding for community primary health clinics to pay GPs to engage in the equivalent of 5 months of fully funded continuing professional development every 5 years, with funding to back-fill their position.
-ask for the government to abolish 'professional support network' and related programs and reallocate this to continuing professional development.
-ask for the government to establish a 'Rural Medical Workforce Children's Education Scheme' requiring independent school that receive public funding from government to reserve a minimum of 10-20 student places from years 7-12 for the children of rural GPs for the period that the GP lives and work in a rural or remote town, and to fund the cost of boarding, travel and allowances for those students.

LOCAL ACTION
-Prepare a recruitment and retention plan for rural GPs to provide wrap around support including housing, access to education, welcome functions and other initiatives to make GPs feel welcomed and supported.
-Work with local health services to strengthen collaboration to ensure that each profession understands the impact of their practice on each other and to promote collaboration that strengthen income generation rather than promotes unproductive competition.

Suggested Citation

Deborah Russell, Supriya Mathew, Michelle Fitts, Zania Liddle, Lorna Murakami‐Gold, Narelle Campbell, Mark Ramjan, Yuejen Zhao, Sonia Hines, John S. Humphreys and John Wakerman, Interventions for health workforce retention in rural and remote areas: a systematic review, Hum Resour Health (2021) 19:103 https://doi.org/10.1186/s12960-021-00643-7

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