Abstract
Medical workforce shortages in rural and remote areas are a global issue. High-income countries (HICs) and low- and middle-income countries (LMICs) seek to implement strategies to address this problem, regardless of local challenges and contexts. This study distilled strategies with positive outcomes and success from international peer-reviewed literature regarding recruitment, retention, and rural and remote medical workforce development in HICs and LMICs. The Arksey and O'Malley scoping review framework was utilised. Articles were retrieved from electronic databases Medline, Embase, Global Health, CINAHL Plus, and PubMed from 2010-2020. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline was used to ensure rigour in reporting the methodology in the interim, and PRISMA extension for scoping review (PRISMA-ScR) was used as a guide to report the findings. The success of strategies was examined against the following outcomes: for recruitment - rural and remote practice location; for development - personal and professional development; and for retention - continuity in rural and remote practice and low turnover rates. Sixty-one studies were included according to the restriction criteria. Most studies (n=53; 87%) were undertaken in HICs, with only eight studies from LMICs. This scoping review found implementation strategies classified as Educational, Financial, and Multidimensional were successful for recruitment, retention, and development of the rural and remote medical workforce. This scoping review shows that effective strategies to recruit and retain rural and remote medical workforce are feasible worldwide despite differences in socio-economic factors. While adjustment and adaptation to match the strategies to the local context are required, the country's commitment to act to improve the rural medical workforce shortage is most critical.
Highlights
Shortages of medical personnel and maldistribution of the workforce remain critical problems for many rural and remote communities and contribute to disparities in the health between rural and urban populations
What are the similarities and differences between approaches implemented in High-income countries (HICs) and low- and middle-income countries (LMICs)?
Eligibility Criteria The research question was developed as a broad framing of the population, the concept and the context to be explored and mapped to the objectives of the review
Summary
Shortages of medical personnel and maldistribution of the workforce remain critical problems for many rural and remote communities and contribute to disparities in the health between rural and urban populations. Many factors contribute to the low number of medical personnel in rural and remote areas. In addition to the rural and remote nature of areas being a disincentive for medical personnel choosing to live and work there,[1,2,3,4] when compared with urban areas, rural areas have less infrastructure, facilities and amenities, difficulties with internet and poorer access to education.[1,2,3,4] the opportunity costs of rural practice include lost income because of limited opportunities for private practice in rural areas and additional housing costs that may occur with maintaining a residence in an urban area for children’s education and a spouse’s job.[5,6] Some studies in several low- and middle-income countries (LMICs) report that doctors prefer employment in a rural area only in specific circumstances that reflect their interests.[7,8,9,10]. The recommendation included educational approaches, regulation, financial inducements, and personal and professional support.[5]
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