It is a goal of this policy that there be sufficient numbers of rural doctors
with the appropriate skills to meet the health needs of people in rural and
remote areas. Retention of the existing rural workforce is essential to
achieve this goal. This will require the removal of disincentives to rural
practice, and the provision of incentives which help to counteract the
additional responsibility of isolated practice.
Rural doctors have identified financial, work practice and professional issues
which can be adapted to enhance the capacity of rural doctors to remain in
rural practice.
These strategies will also assist the recruitment of doctors to rural
practice.
An integrated approach to rural workforce recruitment and retention will
include the following initiatives:
Reasonable working conditions which include a balance between work, on call and
free time are essential if doctors are to spend extended periods in rural
practice. This requires sufficient local back-up and locum relief to allow
doctors to take care of themselves. Adequate financial rewards which recognise
the complexity and degree of clinical responsibility accepted by rural doctors
are an important incentive.
Strategies
Targeted financial support for rural practice such as:
3.1.1 Funding models that provide security and flexibility for the doctor and
recognise the physician as a community resource.
3.1.2 Additional payments to rural practitioners in recognition of higher
level of clinical responsibility, services provided and on call demands.
3.1.3 Specific incentive payments for practising in isolated/underserved
areas.
3.1.4 Financial assistance to maintain the economic viability of at least two
doctors working together in a rural location.
3.1.5 Funding for travel and other costs for the doctor to attend continuing
medical education.
3.1.6 Support and incentives for rural doctors' spouses and families.
The retention of rural doctors is predicated on the satisfaction that they
achieve in both their professional and personal life. The isolation of rural
practice puts strains on both of these. There is a need to provide an adequate
working environment for rural doctors to use the extended range of skills that
they have required. Too often the rural doctor has to work in substandard
facilities. The extended period of on-call, often single handed, is a source of
stress to doctors and their families. Such conditions must be alleviated if
doctors are to remain in rural areas. Rural locum schemes, where provided, have
been eagerly accepted by rural doctors and their families.
Strategies
Creation of a work environment in which the rural doctor can separate work and
personal time and is supported in using her or his skills by:
3.2.1 The establishment of locum relief schemes to permit release of rural
general practitioners to undertake continuing education as well as recreation
and other forms of leave
3.2.2 Sustainable work practices should also address the need for relief from
being on-call and should include, where appropriate, mechanisms such as nurse
backup and triage
3.2.3 The provision of facilities, staff and technology support for service
delivery commensurate with the level of training of health practitioners
International mobility of workers is recognised as important in providing much
needed skills, cross fertilisation and international understanding. It is vital
that such mobility is supported without causing a drain of talented
professionals from less developed countries.
Many rural health teams rely on the recruitment of overseas trained doctors.
This requires careful management to ensure that the doctors are appropriately
trained for their new environment, and that disadvantaged countries do not lose
their doctors to countries with a higher standard of living. Attention must be
paid to the following:
Strategies
3.3.1 Appropriate processes to enable reasonable international mobility of
doctors prepared to undertake rural service positions and exchange programs.
3.3.2 Governments of countries experiencing damaging "brain drain" must be
encouraged to explore the reasons why and to ensure regular and fair provision
of at least a "living wage" and adequate basic support in terms of tools and
equipment to maintain an adequate medical service where they practice
3.3.3 Governments and medical councils that rely on doctors from other
countries to serve their needs should be encouraged to consider the effect that
their policies are having on the other disadvantaged countries, and take
corrective action.
Doctors can be encouraged to stay in rural practice if systems are in place to
ensure they do not become professionally isolated and are able to re-enter
urban practice if they need to.
Strategies
This requires:
3.4.1 Access to ongoing appropriate continuing medical education to enhance
and maintain their skills.
3.4.2 Development of clear and attractive career pathways for rural
practitioners.
3.4.3 Preferential access to specialist training for those rural doctors who
choose to change career pathways.
3.4.4 There should be no financial, career or regulatory barriers to doctors
moving to practice in urban areas.
3.4.5 Academic appointments and support for rural doctors.
Many doctors leave rural areas for family and social reasons rather than
professional ones. Partners often struggle to develop a meaningful role for
themselves outside of the practice situation, and children's educational needs
are often not met. The health service cannot focus narrowly on the doctor
alone if the problems of rural health care are to be addressed.
Careful attention to the needs of the doctor as part of a family unit will
increase the probability that doctors will be attracted to and stay in rural
practice.
Strategies
These include:
3.5.1 The establishment of spouse and family networks such as the Rural
Medical Family Network in Australia.
3.5.2 Education regarding rural doctor/family relationships and professional
boundaries.
3.5.3 Education of communities on the needs of rural doctors and their
families.
3.5.4 Employment opportunities for doctors' spouses.
3.5.5 Suitable local education opportunities for doctors' children or funding
to facilitate education of the doctors' family at distant centres and funding
to visit family members undertaking such secondary or tertiary education.
3.5.6 Funding to permit travel by the doctor and family for recreation and
other forms of leave.
3.5.7 Financial assistance with accommodation for the doctor and family.