Is Fly in/Fly out (FIFO) a viable interim solution to address remote medical workforce shortages?

Abstract

Geographically remote regions of Australia experience a higher degree of socioeconomic inequality and health inequity, amid poor resourcing and extreme climatic conditions, when compared with their more urban counterparts. Doctors with the knowledge, skills and interest in remote work remain a scarce resource, with only 58 practitioners per 100,000 people versus 196/100,000 in metropolitan areas. Pending the arrival of the full complement of long-term remote medical workforce, an alternative solution that has so far received little attention but could provide near equivalence to resident doctors is the 'fly in/fly out' (FIFO) model. Specifically, where one doctor has a continuous relationship with one town or community, albeit spending their rostered time off away from this location, rather than continuity of service with different doctors each time. In this model, doctors spend a fixed number of days at work geographically remote from their home and families, with logistical support (eg housing, transport) provided, followed by a fixed number of days back at home not working. This provides a the doctor with the benefits of remote clinical work plus guaranteed time off at home, a more acceptable roster than in many remote locations at present. This also avoids the complex issue of experienced doctors having to leave remote areas mid-career for the well-documented reasons of spouse employment and children's education, as well as providing easier access to professional development activities. The author followed this path and remains a FIFO doctor after 7 years of continuous service. For FIFO to be effective, there needs to be a commitment from the sponsoring organisation for short, balanced, flexible, family friendly rosters and a positive organizational structure with effective communication between management and front line staff. Evidence shows that families and children with healthy family functioning, who are able to balance separateness and togetherness and are able to readily adjust when circumstances move from stability through change, and have strong communication skills, cope well with FIFO work. The author's employer actively supports his FIFO work arrangements. Although FIFO presents challenges and is not for everyone, it may be time for organisations providing medical care to remote Australia to further consider this option. Allowing mid-career doctors experienced in remote medicine to continue remote clinical practice when they move to the city for family reasons would provide an immediate benefit to remote communities. Notwithstanding the challenges, perhaps it is time to consider the option of FIFO to address ongoing workforce shortages?