The future of Queensland's rural medical workforce

An update from the Rural Doctors Association of Queensland

The Rural Doctors Association of Queensland (RDAQ) is optimistic about the future of rural medicine. Our 25th anniversary conference in June was an outstanding celebration of bush camaraderie, the RDAQ's rich history, and the intellectual contribution of the giants of rural medicine on whose shoulders we stand (all 23 past presidents were present). Colleagues from across the state, their families and students attended, and relaxed to covers by the famous Rural Rednecks.

However, the rural workforce faces major challenges. Like the three-legged stool of rural clinical placements — accommodation, clinical activity and clinical teachers — the rural workforce has three pillars that are similarly interdependent. All three pillars — supply, training and the working environment (closely linked to retention) — must be strong to ensure that the structure does not collapse.

Regarding the first pillar, the problems of inadequate supply, insufficient succession planning, and overreliance on international medical graduates (IMGs) and short-term locums are well documented. Recent data demonstrate our dependence on overseas-trained colleagues — just 53% of Queensland's regional, rural and remote medical workforce was trained locally.1 We are a long way from being self-sufficient.

Queensland has a substantial rural and remote population, many mining towns, a large Indigenous population, and a mix of private and public health care funding. Although Queensland Health has reconfirmed commitment to staffing and funding small rural hospitals,2 this support needs to be delivered flexibly, tailored to local needs. State and federal lines of responsibility should not be rigid and bureaucratic; they need to enable creative and innovative solutions that meet community needs and deliver appropriate workforce models. The hospital and health service roll-out3 has the potential to promote local innovation and problem solving, but we must ensure that the needs of rural communities are addressed and that the momentum of statewide reform is maintained.

We are encouraged by the fact that rural health matters are on the agenda; we have the ear of government and we have a strong portfolio of rurally focused data, policies, organisations, events, education and family support. The Queensland Minister for Health, Lawrence Springborg, is committed to reopening maternity services, starting with Beaudesert and then Cooktown, Weipa and Ingham.4 The RDAQ is engaged in this discussion and working closely with the Hospital and Health Services and local clinicians.

It is apparent that much of the growth in numbers of health care students, registrars and education providers in Queensland is occurring in regional and rural areas. We need to create additional generalist-focused training places in non-metropolitan locations to match training to workforce needs and ensure the communities most in need benefit from this workforce supply. Regionally based training models are demonstrating strikingly different outcomes compared with traditional models. For example, two-thirds of James Cook University medical graduates undertake non-metropolitan internships compared with one in six medical graduates from other universities. Across eight postgraduate years, more than two-thirds of James Cook University medical graduates are practising outside metropolitan areas, compared with 20% of all Australian clinicians.5,6

Regarding the second pillar, training, can we train the increasing numbers of rural students and registrars who are interested in rural practice? We are encouraged by students' commitment to social accountability. There is no shortage of altruistic young people committed to making a difference. The National Rural Health Students' Network (http://www.nrhsn.org.au) — the future of rural health — aims to harness good intent by networking with student rural health clubs such as Rural Health in the Northern Outback (Club RHINO). Dhoom Medical Charity, Supporting All Nations Towards Equality (SANTE), Insaka and Run to Better Days are other examples of student organisations committed to social justice.

While innovations abound and Australian training is world class, we need to maintain attractive, properly resourced training pathways. The acclaimed Queensland Rural Generalist Pathway is expanding and attracting international recognition.7 The pathway has attracted more graduates rurally, especially to generalist positions in rural hospitals. We must ensure that strengthening public career pathways does not attract registrars away from private general practice, a cornerstone of rural clinical care and training. We need more rural doctors but must also achieve “An equilibrium balancing public and private medical workforce”.8

Looking at the third pillar, the working environment, raises the question of whether there are good jobs and good places to work in rural areas. The Statewide Rural and Remote Clinical Network, chaired by RDAQ past president Bruce Chater, does ground-breaking work guiding the effective and safe delivery of rural and remote health services. Key resources include Better health for the bush, which describes “safe, applicable healthcare for rural and remote Queensland”, and the Queensland Rural and Remote Health Service Framework, which outlines clinical services that communities can expect locally.2,9 These initiatives provide clarity around the environment in which tomorrow's workforce will train and work. They present a consistent approach to classification and terminology which can, therefore, “provide a general overview of the service mix, service capability and workforce profile for each classification of rural and remote health facility”.2

Each of the three interdependent pillars is vital: if one collapses, the whole structure will fall. And although they are all strong, we must remain vigilant to keep them strong. Finally, we must remember that rural health matters are everyone's business. Where does our food come from? What sustains our economy? As a South African medical officer recently observed about compulsory rural service, “It is the rural experience which gives doctors the humanity our patients yearn for in us”.10