It’s more than money: policy options to secure medical specialist workforce for regional centresJennifer May A E , Judi Walker B , Mathew McGrail C and Fran Rolley D
A University of Newcastle, Department of Rural Health, Tamworth, NSW 2340, Australia.
B School of Rural Health, Monash University, Wellington Road, Clayton, Vic. 3168, Australia. Email: email@example.com
C School of Rural Health, Churchill Campus, Monash University, Northways Road, Vic. 3842, Australia. Email: firstname.lastname@example.org
D Department of Geography and Planning, University of New England, Armidale, NSW 2351, Australia. Email: email@example.com
E Corresponding author. Email: Jennifer.firstname.lastname@example.org
Australian Health Review - http://dx.doi.org/10.1071/AH16159
Submitted: 18 July 2016 Accepted: 24 October 2016 Published online: 16 December 2016
Objectives Regional centres and their rural hinterlands support significant populations of non-metropolitan Australians. Despite their importance in the settlement hierarchy and the key medical services provided from these centres, little research has focused on their issues of workforce supply and long-term service requirements. In addition, they are a critical component of the recent growth of ‘regional’ hub-and-spoke specialist models of service delivery.
Methods The present study interviewed 62 resident specialists in four regional centres, seeking to explore recruitment and retention factors important to their location decision making. The findings were used to develop a framework of possible evidence-informed policies.
Results This article identifies key professional, social and locational factors, several of which are modifiable and amenable to policy redesign, including work variety, workplace culture, sense of community and spousal employment; these factors that can be targeted through initiatives in selection, training and incentives.
Conclusions Commonwealth, state and local governments in collaboration with communities and specialist colleges can work synergistically, with a multiplicity of interdigitating strategies, to ensure a positive approach to the maintenance of a critical mass of long-term rural specialists.
What is known about the topic? Rural origin increases likelihood of long-term retention to rural locations, with rural clinical school training associated with increased rural intent. Recruitment and retention policy has been directed at general practitioners in rural communities, with little focus on regional centres or medical specialists.
What does this study add? Rural origin is associated with regional centre recruitment. Professional, social and locational factors are all moderately important in both recruitment and retention. Specialist medical training for regional centres ideally requires both generalist and subspecialist skills sets. Workforce policy needs to address modifiable factors with four groups, namely commonwealth and state governments, specialist medical colleges and local communities, all needing to align their activities for achievement of long-term medical workforce outcomes.
What are the implications for practitioners? Modifiable factors affecting recruitment and retention must be addressed to support specialist models of care in regional centres. Modifiable factors relate to maintenance of a critical mass of practitioners, training a fit-for-purpose workforce and coordinated effort between stakeholders. Although remuneration is important, the decision to stay relates primarily to non-financial factors.
References Australian Institute of Health and Welfare (AIHW). Medical workforce 2012. 2014. Available at: https://www.aihw.gov.au/publication-detail/?id=60129546100 [verified 4 February 2014].
 Australian Institute of Health and Welfare (AIHW). Trends in coronary artery disease mortality: age groups and populations. 2014. Available at: http://www.aihw.gov.au/publication-detail/?id=60129547046 [verified 16 March 2016].
 National Rural Health Alliance Inc., Australian Council of Social Service. A snapshot of poverty in rural and regional Australia. 2013. Available at: http://ruralhealth.org.au/documents/publicseminars/2013_Sep/Joint-report.pdf [verified 3 October 2014].
 Stewart GD, Long G, Tulloh BR. Surgical service centralisation in Australia versus choice and quality of life for rural patients. Med J Aust 2006; 185 162–3.
 Brooks PM, Lapsley HM, Butt DB. Medical workforce issues in Australia: ‘tomorrow’s doctors – too few, too far’. Med J Aust 2003; 179 206–8.
 Murray RB, Wronski I. When the tide goes out: health workforce in rural, remote and Indigenous communities. Med J Aust 2006; 185 37–8.
 Pesce A. Rural maternity units: how will they have a future? Med J Aust 2008; 188 70
 Clinical Oncological Association of Australia. Mapping rural and regional cancer services (2000). Available at: https://www.cosa.org.au/media/1067/cosa_paper_mapping-regional-oncology-services_2006.pdf [10 November 2016].
 Australian Government Department of Health. Reform of the ASGC – RA classification system 2016. Available at: http://www.health.gov.au/internet/publications/publishing.nsf/Content/work-review-australian-government-health-workforce-programs-toc~chapter-4-addressing-health-workforce-shortages-regional-rural-remote-australia~chapter-4-reform-asgc-ra-rural-classification- [verified 11 November 2016].
 World Health Organization (WHO). Global policy recommendations. Increasing access to health workers in remote and rural areas through improved retention. Executive summary. 2010. Available at: http://www.who.int/hrh/retention/Executive_Summary_Recommendations_EN.pdf?ua=1 [verified 22 October 2014].
 Australian Government Department of Human Services. General practice rural incentives programme. 2015. Available at: https://www.humanservices.gov.au/health-professionals/services/medicare/general-practice-rural-incentives-programme#a1 [verified 13 October 2016].
 Russell DJ, Humphreys JS, McGrail M, Cameron WI, Williams PJ. The value of survival analyses for evidence-based rural medical workforce planning. Hum Resour Health 2013; 11 65
| The value of survival analyses for evidence-based rural medical workforce planning.CrossRef |
 Cutchin M. Community and self; concepts for rural physician integration and retention. Soc Sci Med 1997; 44 1661–74.
| Community and self; concepts for rural physician integration and retention.CrossRef | 1:STN:280:DyaK2szitFOjsA%3D%3D&md5=60fa56b749f3dfb7e54b86b174414306CAS |
 Bowling A. Research methods in health, investigating health and health services, 2nd edn. Maidenhead: Open University Press; 2002.
 Jones JA, Humphreys JS, Adena MA. Rural GPs’ ratings of initiatives designed to improve rural medical workforce recruitment and retention. Rural Remote Health 2004; 4 10
 Waring T, Wainwright D. Innovative developments in the use of template analysis: Two comparative case studies from the field. In: Brown, A editors. Proceedings of the 7th European Conference on Research Methodology for Business and Management Studies: ECRM2008, 19–20 June 2008, Regents College, London: Academic Conferences Ltd; p. 293–308.
 Yan W, Li J, Scott A, Sivey P, Cheng T, Leahy A. MABEL user manual: wave 4 release. Melbourne: Melbourne Institute of Applied Economic and Social Research, The University of Melbourne; 2013.
 McGrail MR, Russell DJ, Campbell DG. Vocational training of general practitioners in rural locations is critical for the Australian rural medical workforce. Med J Aust 2016; 205 216–21.
| Vocational training of general practitioners in rural locations is critical for the Australian rural medical workforce.CrossRef |
 Playford D, Larson A, Wheatland B. Going country: rural student placement factors associated with future rural employment in nursing and allied health. Aust J Rural Health 2006; 14 14–9.
| Going country: rural student placement factors associated with future rural employment in nursing and allied health.CrossRef |
 Russell DJ, McGrail M, Humphreys JS, Wakerman J. What factors contribute most to the retention of general practitioners in rural and remote areas? Aust J Primary Health 2012; 18 289–94.
 Australian Government Department of Health. Media Release: Building a workforce for regional Australia. 2015. Available at: https://www.health.gov.au/internet/ministers/publishing.nsf/Content/40FEE0992461C3C9CA257F1C001DB8E5/$File/SL150.pdf [verified 16 March 2016].
 International Medicine Society of Australia & New Zealand. Dual training to begin regional NSW. 2013. Available at: https://www.imsanz.org.au/latest-news/dual-training-program-to-begin-in-regional-nsw [verified 17 March 2016].
 Jones MP, Bushnell JA, Humphreys JS. Are rural placements positively associated with rural intentions in medical graduates? Med Educ 2014; 48 405–16.
| Are rural placements positively associated with rural intentions in medical graduates?CrossRef |
 Costa DL, Kahn ME. Power couples: changes in the locational choice of the college educated 1940–1990. Q J Econ 2000; 115 1287–315.
| Power couples: changes in the locational choice of the college educated 1940–1990.CrossRef |
 Rural Doctors Association of Australia. Regional, rural and remote specialists survey. 2012. Available at: http://www.rdaa.com.au/Uploads/Documents/FInal%20(with%20Updated%20Logo)%20RDAA%20rural%20medical%20specialist%20survey_20121011030002.pdf [verified 15 May 2013].
 McMillan DW, Chavis DM. Sense of community: a definition and theory. J Community Psychol 1986; 14 6–23.
| Sense of community: a definition and theory.CrossRef |
 Sweet M. Rescue operation: rural specialists call for help. Aust Rural Doctor 2009; July 6–10.
 Wiseman H. Clever connections. Aust Doctor 2012; April
 Australian Medical Association. Regional training networks – 2014. 2014. Available at: https://ama.com.au/position-statement/regional-training-networks-2014 [verified 16 March 2016].
 Greenhill J, Walker J, Playford D, Walker JGJ. Outcomes of Australian rural clinical schools: a decade of success building the rural medical workforce through the education and training continuum. Rural Remote Health 2015; 15 2991
 NSW Liberals. Putting patients first: huge boost in frontline staff and hospital activity. [Media Release] 2014. Available at: http://nsw.liberal.org.au/putting-patients-first-huge-boost-in-frontline-staff-and-hospital-activity/ [verified 28 February 2016].