Lost opportunities with Australia's health workforce?

To the Editor: I applaud Leach and colleagues for their recent article examining lost opportunities with Australia’s health workforce.1 There are many lost opportunities in the area of rural health. National and international studies have documented that a health professional with rural origins is more likely to return to a rural area to work than a colleague who grew up in the city.2,3 My research over the past 4 years looks predominantly at primary school students and their parents, teachers and governesses who reside over 800 000 km2 of outback Australia and study by distance education. My research is mainly into primary school-aged students because it is generally agreed among career development theorists that students start to shape ideas about occupations long before they reach high school.4

The students I studied initially had little knowledge or interest in health careers (relevant educational activities were subsequently provided to the school community in 2008). I identified five main factors inhibiting their knowledge and interest in health careers: the severe chronic shortage of health professionals in rural and remote Australia (and therefore a shortage of positive health professional role models); the limited career pool of their parents (most of whom are involved in the agricultural industry); the isolation in which they live; the limited information about the health professions provided by the school (their window to the outside world, which did not make up for their environmental shortfall); and parental perceptions.

Two factors influencing parental perceptions deserve mention: awareness of the unhealthy workloads and the high degree of burnout among rural medical practitioners (they didn’t want this for their children); and the negative images portrayed in the media (eg, reports about health workers’ pay).

My research focused solely on developing an awareness of the health professions as possible career options for these students.5 However, other factors also prevent students who live in rural and remote Australia becoming health professionals: inequality of primary and secondary educational opportunities;6 falling access, participation, retention and success rates in tertiary education;7 and the financial, emotional, family and social costs of attending tertiary courses a long way from home.8 We are all aware of the hardships of urban-raised health professionals undertaking rural medical placements, but do we understand equally the hardships of rural and remote students studying in the city?

If Australia is genuine about wishing to solve the rural health workforce crisis, students from rural and remote areas must be provided with real opportunities to become rural health professionals, because the evidence suggests that the long-term survival of rural health services may depend on the recruitment of rural students.