Evidence-based rural workforce policy: an enduring challenge

Abstract

David Wilkinson is Professor of Health Sciences, Pro Vice-Chancellor and Vice-President, Division of Health Sciences, University of South Australia, Australia. He was Foundation Chair in Rural health at University of Adelaide and University of South Australia between 1999 and 2002, and is an Editorial Board Member of Rural and Remote Health. In their article Rural origin and rural medical exposure: their impact on the rural and remote medical workforce in Australia Dunbabin and Levitt provide a useful narrative overview of the literature on this important topic. The authors seek – in their own words – 'to explore the relationship between rural origin and rural exposure during undergraduate and postgraduate training and choice of practice location'. They acknowledge that theirs is a narrative, rather than a systematic review, that their literature review is limited to the years 1977-2003, and that they do not seek to draw quantitative conclusions of associations between exposures (rural background and rural medicine experience at underand postgraduate levels), and the outcome (medical practice location). The authors summarise several of the major reports from the USA, 'other countries' and Australia. They go on to very usefully list the major Australian Commonwealth government initiatives in this field in recent years, and then to explore medical-school level initiatives in Australia (including rural selection, and undergraduate rural-practice exposure) and rural postgraduate opportunities. In the section on evaluation, the authors summarise the few studies that have attempted to quantify the impact of these initiatives on the workforce. In short, have we got more rural doctors as a result? – the answer is not clear. And, in their conclusion, the authors note that the number of rural origin medical students has