Workforce edition, December 2010

Abstract

While it is misleading to think that more staff will solve all issues in rural and remote health, workforce shortage is one of the biggest issues in Australia and elsewhere.1-3 At the face of it, workforce shortage seems a reasonably straightforward problem – the need to recruit more health professionals to rural and remote settings and retain who is there. But the issue is more complex than it initially appears. Adequate staffing is not simply about recruiting anyone with a qualification immediately but developing a sustainable and appropriate workforce who have been trained for the context, are supported in what they do and can cater for the needs of the local population.4 At the population level, this requires a more equitable approach than recruiting health professionals from other rural and remote areas in Australia and overseas. Further, it is important to support the many health practitioners who have provided quality care in rural and remote communities over many years.5 It is also acknowledged that workforce shortages have encouraged many rural and remote services to develop new models that are financially efficient and tailored to community needs.4 The workforce shortage has flow on effects, both for those who are working in rural and remote health and for consumers using these services. For those working in rural and remote health, the shortage adds to their workloads, imposes time pressures and leads to burnout. It can also erode time for non-clinical professional interests or development, reduce their ability to provide responsive and continuous care, and restrict time for training others who may add to the workforce. Hence, the effects of the shortage add to recruitment and retention difficulties.4-6 For consumers, the workforce shortage can reduce access to care, contribute to waiting lists for appointments and result in rushed consultations. For some consumers, this detracts from their satisfaction with services and confidence in the care they receive.7 In these ways, quality of care is threatened.3 But perhaps the bigger question to consider is why: why do health professionals not want to work in or stay in rural and remote settings and what are the barriers to rural and remote practice? For professionals, this relates to the type of work, workloads, career options, management, lifestyles, family, isolation and their general perceptions of rural and remote areas.4, 5 The stereotypes of rural and remote as backward, homogenous, dependent on urban and culturally void play a key role. Rural and remote Australia are diverse and contribute substantially to the national economy, national cultures, and the land and history of many Aboriginal and Torres Strait Islander people.8, 9 Yet, the myths about rural and remote continue, evident in response to the three vocal Independents who were criticised for demanding a ‘fairer share’ for rural and remote Australia. There has been significant investment in training students to inform them about rural and remote practice, to encourage their support of rural and remote practitioners and to promote rural and remote careers. But academics have spent less time proactively and strategically challenging the stereotypes and stigmas of rural and remote health practice and living. This requires social change broader to, but impacting on, rural and remote health. Challenging urban mindsets that dismiss rural Australia, begrudge increased spending in ‘the regions’ and dissuade health professionals and graduates from relocating to non-metropolitan areas are key priorities for long-term change in rural and remote health. This challenge needs to be undertaken in as many arenas as possible, including in urban and rural contexts as well as in political, health and social settings. Given the political clout of regional Australia at present, there has never been a better time.