Abstract
BackgroundThe capacity for high-income countries to supply enough locally trained doctors to minimise their reliance on overseas-trained doctors (OTDs) is important for equitable global workforce distribution. However, the ability to achieve self-sufficiency of individual countries is poorly evaluated. This review draws on a decade of research evidence and applies additional stratified analyses from a unique longitudinal medical workforce research program (the Medicine in Australia: Balancing Employment and Life survey (MABEL)) to explore Australia’s rural medical workforce self-sufficiency and inform rural workforce planning. Australia is a country with a strong medical education system and extensive rural workforce policies, including a requirement that newly arrived OTDs work up to 10 years in underserved, mostly rural, communities to access reimbursement for clinical services through Australia’s universal health insurance scheme, called Medicare.FindingsDespite increases in the number of Australian-trained doctors, more than doubling since the late 1990s, recent locally trained graduates are less likely to work either as general practitioners (GPs) or in rural communities compared to local graduates of the 1970s–1980s. The proportion of OTDs among rural GPs and other medical specialists increases for each cohort of doctors entering the medical workforce since the 1970, peaking for entrants in 2005–2009.Rural self-sufficiency will be enhanced with policies of selecting rural-origin students, increasing the balance of generalist doctors, enhancing opportunities for remaining in rural areas for training, ensuring sustainable rural working conditions and using innovative service models. However, these policies need to be strongly integrated across the long medical workforce training pathway for successful rural workforce supply and distribution outcomes by locally trained doctors. Meanwhile, OTDs substantially continue to underpin Australia’s rural medical service capacity. The training pathways and social support for OTDs in rural areas is critical given their ongoing contribution to Australia’s rural medical workforce.ConclusionIt is essential for Australia to monitor its ongoing reliance on OTDs in rural areas and be considerate of the potential impact on global workforce distribution.
Highlights
The capacity for high-income countries to supply enough locally trained doctors to minimise their reliance on overseas-trained doctors (OTDs) is important for equitable global workforce distribution
Rural work location patterns by country of basic medical training The MABEL data, applied as a new stratified analyses, shows the geographical distribution and specialty type of the locally trained medical workforce according to the year that they graduated from medical school and entered the medical workforce (Fig. 1) [27]
The same pattern exists for the metropolitan distribution by cohort with a less pronounced effect by cohort than is observed for rural locations. This pattern is relatively consistent across the period in the 1990s when regulatory policies required OTDs to work in districts of workforce shortages and when more rurally oriented rural workforce pipeline policies were introduced into Australia
Summary
It is essential for Australia to monitor its ongoing reliance on OTDs in rural areas and be considerate of the potential impact on global workforce distribution. Remoteness Area (ASGS-RA) classification [63] aTotal indigenous population = 669 900; 3% of the total Australian population bFull time equivalents (of general practitioners (GPs), other specialists) per 100 000 population: based on total hours worked in the past week as collected in the Australian Health Practitioner Regulation Agency annual medical workforce survey This measure poorly accounts for high workforce turnover, use of locums, OTDs and poorer population health status cFull service equivalents of GPs per 100 000 population: approximation of hours worked, based on Medicare Benefits Schedule billing (universal billing system) data of number of days worked, volume of services and schedule fees. This review draws on over 10 years’ evidence and applies additional stratified analyses of the MABEL longitudinal data to inform planning for self-sufficiency of the rural medical workforce in Australia It explores the (1) patterns in rural work location by overseasand locally trained doctors, differentiated by specialty and career stage, and (2) factors associated with rural work outcomes by locally trained doctors, and (3) discusses the implications of this evidence in light of the international literature
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